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Development of the Utrecht Score for clavicle fractures: a short and complete clavicle score with patient-reported and objective measures

  • Martijn Hulsmans
  • Steven Ferree
  • Marijn Houwert
  • Marcel Dijkgraaf
  • Egbert Jan Verleisdonk
  • Mark van Heijl
Original Article
  • 35 Downloads

Abstract

Purpose

The purpose of this study was to develop a clavicle-specific questionnaire with patient-reported and objective measures.

Methods

The present study used data of DASH and Constant scores from a previously performed randomized-controlled trial comparing plate and intramedullary pin fixation of clavicle fractures. Exploratory factor analysis was used to identify the most relevant items and the underlying structure of the questionnaires. To optimize the applicability to patients with a clavicle fracture, the selected items were reformulated. If relevant themes were underexposed, an additional question was added.

Results

Based on the scree plot of eigenvalues and the parallel analysis, a seven-factor model with good factorability was constructed. Using exploratory factor analysis, 13 patient-reported and 2 objective measurements were identified. The internal consistency of the selected questions was excellent. An additional question was added to cover complaints relating to direct pressure on the clavicle and implants.

Conclusion

The Utrecht Score for clavicle fractures is a compact yet complete tool that was developed to assess functional outcome specifically in patients with a clavicle fracture, consisting of patient-reported and objective measures. After external validation, the USC can be used for research purposes or clinical follow-up during rehabilitation in patients with a clavicle fracture.

Keywords

Clavicle Questionnaire Patient-reported Functional outcome 

Notes

Compliance with ethical standards

Conflict of interest

M. Hulsmans, S. Ferree, R Houwert, M Dijkgraaf, E.J. Verleisdonk, and M. van Heijl declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Lenza M, Buchbinder R, Johnston RV, Belloti JC, Faloppa F. Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Cochrane Database Syst Rev. 2013;6:CD009363.  https://doi.org/10.1002/14651858.CrossRefGoogle Scholar
  2. 2.
    Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987;160-4.Google Scholar
  4. 4.
    Edwards PJ, Roberts I, Clarke MJ, Diguiseppi C, Wentz R, Kwan I, et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2009;(3):MR000008.  https://doi.org/10.1002/14651858.
  5. 5.
    Roddey TS, Olson SL, Cook KF, Gartsman GM, Hanten W. Comparison of the University of California-Los Angeles Shoulder Scale and the Simple Shoulder Test with the shoulder pain and disability index: single-administration reliability and validity. Phys Ther. 2000;80(8):759–68.PubMedGoogle Scholar
  6. 6.
    Gerber C. Integrated scoring systems for the functional assessment of the shoulder. In: Masten FA, Hawkins RJ, editors. The Shoulder: A Balance of Mobility and Stability. Rosemont: American Academy of Orthopaedic Surgeons; 1993.Google Scholar
  7. 7.
    van der Meijden OA, Houwert RM, Hulsmans M, Wijdicks FJ, Dijkgraaf MG, Meylaerts SA, et al. Operative treatment of dislocated midshaft clavicular fractures: plate or intramedullary nail fixation? A randomized controlled trial. J Bone Joint Surg Am 2015;97(8):613–9.  https://doi.org/10.2106/JBJS.N.00449.CrossRefPubMedGoogle Scholar
  8. 8.
    Schemitsch LA, Schemitsch EH, Veillette C, Zdero R, McKee MD. Function plateaus by one year in patients with surgically treated displaced midshaft clavicle fractures. Clin Orthop Relat Res. 2011;469(12):3351–5.  https://doi.org/10.1007/s11999-011-1915-x.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. Seventh ed. Upper Saddle River: Prentice Hall; 2010.Google Scholar
  10. 10.
    Tabachnick BG, Fidell LS. Principal components and factor analysis. In: Tabachnick BG, Fidell LS, editors. Using multivariate statistics. 7th edn. Upper Saddle River: Pearson Education, Inc; 2013. pp. 612–5.Google Scholar
  11. 11.
    Henson RK, Roberts JK. Use of exploratory factor analysis in published research: common errors and some comment on improved practice. Educ Psychol Measur 2006;66(3).  https://doi.org/10.1177/0013164405282485.
  12. 12.
    Thompson B. Exploratory and confirmatory factor analysis: understanding concepts and applications. Washington, DC: American Psychological Association; 2004.CrossRefGoogle Scholar
  13. 13.
    Thompson B, Daniel LG. Factor analytic evidence for the construct validity of scores: A historical overview and some guidelines. Educ Psychol Measure. 1996;56(2):197–208.CrossRefGoogle Scholar
  14. 14.
    Sijtsma K. On the use, the misuse, and the very limited usefulness of Cronbach’s alpha. Psychometrika. 2009;74(1):107–20.CrossRefPubMedGoogle Scholar
  15. 15.
    Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, Decoster TA, et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):1–133.CrossRefGoogle Scholar
  16. 16.
    Ludewig PM, Cook TM, Nawoczenski DA. Three-dimensional scapular orientation and muscle activity at selected positions of humeral elevation. J Orthop Sports Phys Ther. 1996;24(2):57–65.CrossRefPubMedGoogle Scholar
  17. 17.
    van DS, van der Woude, Veeger LH. HE. Load on the shoulder complex during wheelchair propulsion and weight relief lifting. Clin Biomech (Bristol Avon). 2011;26(5):452–7.  https://doi.org/10.1016/j.clinbiomech.2011.01.006.CrossRefGoogle Scholar
  18. 18.
    Iannolo M, Werner FW, Sutton LG, Serell SM, VanValkenburg SM. Forces across the middle of the intact clavicle during shoulder motion. J Shoulder Elbow Surg. 2010;19(7):1013–7.  https://doi.org/10.1016/j.jse.2010.03.016.CrossRefPubMedGoogle Scholar
  19. 19.
    Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587–94.  https://doi.org/10.1067/mse.2002.127096.CrossRefPubMedGoogle Scholar
  20. 20.
    Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg. 1994;3(6):347–52.CrossRefPubMedGoogle Scholar
  21. 21.
    Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991;4(4):143–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Beaton DE, Richards RR. Measuring function of the shoulder. A cross-sectional comparison of five questionnaires. J Bone Joint Surg Am. 1996;78(6):882–90.CrossRefPubMedGoogle Scholar
  23. 23.
    MacDermid JC, Richards RS, Donner A, Bellamy N, Roth JH. Responsiveness of the short form-36, disability of the arm, shoulder, and hand questionnaire, patient-rated wrist evaluation, and physical impairment measurements in evaluating recovery after a distal radius fracture. J Hand Surg Am. 2000;25(2):330–40.CrossRefPubMedGoogle Scholar
  24. 24.
    Johansson KM, Adolfsson LE. Intraobserver and interobserver reliability for the strength test in the Constant–Murley shoulder assessment. J Shoulder Elbow Surg. 2005;14(3):273–8.  https://doi.org/10.1016/j.jse.2004.08.001.CrossRefPubMedGoogle Scholar
  25. 25.
    Yian EH, Ramappa AJ, Arneberg O, Gerber C. The Constant score in normal shoulders. J Shoulder Elbow Surg. 2005;14(2):128–33.  https://doi.org/10.1016/j.jse.2004.07.003.CrossRefPubMedGoogle Scholar
  26. 26.
    Leggin BG, Michener LA, Shaffer MA, Brenneman SK, Iannotti JP, Williams GR, Jr. The Penn shoulder score: reliability and validity. J Orthop Sports Phys Ther. 2006;36(3):138–51.  https://doi.org/10.2519/jospt.2006.36.3.138.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Martijn Hulsmans
    • 1
  • Steven Ferree
    • 1
  • Marijn Houwert
    • 2
  • Marcel Dijkgraaf
    • 3
  • Egbert Jan Verleisdonk
    • 1
  • Mark van Heijl
    • 1
  1. 1.Department of SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
  2. 2.Utrecht Traumacenter, UtrechtUtrechtThe Netherlands
  3. 3.Clinical Research UnitAcademic Medical Center AmsterdamAmsterdamThe Netherlands

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