Archives of Orthopaedic and Trauma Surgery

, Volume 130, Issue 6, pp 787–796 | Cite as

Cross-cultural adaptation and validation of the German version of the Western Ontario shoulder instability index

  • Jochen G. HofstaetterEmail author
  • Beatrice Hanslik-Schnabel
  • Stefan G. Hofstaetter
  • Christian Wurnig
  • Wolfgang Huber
Orthopaedic Outcome Assessment



The Western Ontario shoulder instability index (WOSI) is a disease-specific quality of life measurement tool with 21 items for patients with shoulder instability. Here, we report on translation and validation of the German version of the WOSI according to international guidelines.

Patients and methods

A total of 86 patients in three groups were included in this study. In group I, 24 patients underwent surgical stabilization of the shoulder. Preoperatively and at 12 months post-operatively the WOSI, Rowe score, UCLA, Constant score, and the SF-36 were evaluated. In group II, 25 patients were evaluated 2.6 ± 1.2 years after sustaining a primary traumatic shoulder dislocation. Group III consisted of 37 healthy men and women with normal, healthy shoulders. Evaluation of Pearson’s correlation coefficient between WOSI and Rowe score, UCLA, SF-36 and Constant score and for test–retest reliability was made. Moreover, Cronbach’s alpha and floor, and ceiling effects were analyzed.


Internal consistency was high (Cronbach’s alpha 0.92).Test–retest reliability (Pearson correlation coefficient) was excellent (r = 0.92). The construct validity showed a significant correlation between the WOSI and the scores investigated. There were no floor or ceiling effects for the German WOSI score.


The German translation of the WOSI is a valid and reliable tool, applicable to outcome studies on patients with shoulder instability.


Shoulder instability Quality of life Score WOSI Translation Validation 


Conflict of interest statement

The authors have no conflict of interest. We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated.


  1. 1.
    Simmen BR, Angst F, Schwyzer HK, Herren DB, Pap G, Aeschlimann A et al (2009) A concept for comprehensively measuring health, function and quality of life following orthopaedic interventions of the upper extremity. Arch Orthop Trauma Surg 129(1):113–118CrossRefPubMedGoogle Scholar
  2. 2.
    Koran LM (1975) The reliability of clinical methods, data and judgments (first of two parts). N Engl J Med 293(13):642–646PubMedGoogle Scholar
  3. 3.
    Guyatt GH, Bombardier C, Tugwell PX (1986) Measuring disease-specific quality of life in clinical trials. CMAJ 134(8):889–895PubMedGoogle Scholar
  4. 4.
    Lieberman JR, Dorey F, Shekelle P, Schumacher L, Thomas BJ, Kilgus DJ et al (1996) Differences between patients’ and physicians’ evaluations of outcome after total hip arthroplasty. J Bone Joint Surg Am 78(6):835–838PubMedGoogle Scholar
  5. 5.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483CrossRefPubMedGoogle Scholar
  6. 6.
    Kaplan RM, Bush JW, Berry CC (1976) Health status: types of validity and the index of well-being. Health Serv Res 11(4):478–507PubMedGoogle Scholar
  7. 7.
    Bergner M, Bobbitt RA, Carter WB, Gilson BS (1981) The Sickness Impact Profile: development and final revision of a health status measure. Med Care 19(8):787–805CrossRefPubMedGoogle Scholar
  8. 8.
    MacKenzie CR, Charlson ME, DiGioia D, Kelley K (1986) Can the Sickness Impact Profile measure change? An example of scale assessment. J Chronic Dis 39(6):429–438CrossRefPubMedGoogle Scholar
  9. 9.
    Pynsent PB (2001) Choosing an outcome measure. J Bone Joint Surg Br 83(6):792–794CrossRefPubMedGoogle Scholar
  10. 10.
    Bjelle A (1989) Epidemiology of shoulder problems. Baillieres Clin Rheumatol 3(3):437–451CrossRefPubMedGoogle Scholar
  11. 11.
    Chakravarty KK, Webley M (1990) Disorders of the shoulder: an often unrecognised cause of disability in elderly people. BMJ 300(6728):848–849CrossRefPubMedGoogle Scholar
  12. 12.
    Kirkley A, Alvarez C, Griffin S (2003) The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: The Western Ontario Rotator Cuff Index. Clin J Sport Med 13(2):84–92CrossRefPubMedGoogle Scholar
  13. 13.
    Dawson J, Fitzpatrick R, Carr A (1996) Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br 78(4):593–600PubMedGoogle Scholar
  14. 14.
    Hollinshead RM, Mohtadi NG, Vande Guchte RA, Wadey VM (2000) Two 6-year follow-up studies of large and massive rotator cuff tears: comparison of outcome measures. J Shoulder Elbow Surg 9(5):373–381CrossRefPubMedGoogle Scholar
  15. 15.
    Kirkley A, Griffin S, Dainty K (2003) Scoring systems for the functional assessment of the shoulder. Arthroscopy 19(10):1109–1120PubMedGoogle Scholar
  16. 16.
    Lohr KN, Aaronson NK, Alonso J, Burnam MA, Patrick DL, Perrin EB et al (1996) Evaluating quality-of-life and health status instruments: development of scientific review criteria. Clin Ther 18(5):979–992CrossRefPubMedGoogle Scholar
  17. 17.
    Huber W, Hofstaetter JG, Hanslik-Schnabel B, Posch M, Wurnig C (2005) Translation and psychometric testing of the Western Ontario rotator cuff index (WORC) for use in Germany. Z Orthop Ihre Grenzgeb 143(4):453–460CrossRefPubMedGoogle Scholar
  18. 18.
    Huber W, Hofstaetter JG, Hanslik-Schnabel B, Posch M, Wurnig C (2005) Translation and psychometric testing of the rotator cuff quality-of-life measure (RC-QOL) for use in German-speaking regions. Z Rheumatol 64(3):188–197CrossRefPubMedGoogle Scholar
  19. 19.
    Huber W, Hofstaetter JG, Hanslik-Schnabel B, Posch M, Wurnig C (2004) The German version of the Oxford shoulder score—cross-cultural adaptation and validation. Arch Orthop Trauma Surg 124(8):531–536CrossRefPubMedGoogle Scholar
  20. 20.
    van der Heijden GJ (1999) Shoulder disorders: a state-of-the-art review. Baillieres Best Pract Res Clin Rheumatol 13(2):287–309CrossRefPubMedGoogle Scholar
  21. 21.
    Brophy RH, Marx RG (2009) The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy 25(3):298–304PubMedCrossRefGoogle Scholar
  22. 22.
    Kirkley A, Griffin S, McLintock H, Ng L (1998) The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario shoulder instability index (WOSI). Am J Sports Med 26(6):764–772PubMedGoogle Scholar
  23. 23.
    Plancher KD, Lipnick SL (2009) Analysis of evidence-based medicine for shoulder instability. Arthroscopy 25(8):897–908PubMedCrossRefGoogle Scholar
  24. 24.
    Oh JH, Jo KH, Kim WS, Gong HS, Han SG, Kim YH (2009) Comparative evaluation of the measurement properties of various shoulder outcome instruments. Am J Sports Med 37(6):1161–1168CrossRefPubMedGoogle Scholar
  25. 25.
    Amadio PC (1993) Outcomes measurements. J Bone Joint Surg Am 75(11):1583–1584PubMedGoogle Scholar
  26. 26.
    Freedman KB, Back S, Bernstein J (2001) Sample size and statistical power of randomised, controlled trials in orthopaedics. J Bone Joint Surg Br 83(3):397–402CrossRefPubMedGoogle Scholar
  27. 27.
    Salomonsson B, Ahlstrom S, Dalen N, Lillkrona U (2009) The Western Ontario Shoulder Instability Index (WOSI): validity, reliability, and responsiveness retested with a Swedish translation. Acta Orthop 80(2):233–238CrossRefPubMedGoogle Scholar
  28. 28.
    Guillemin F, Bombardier C, Beaton D (1993) Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 46(12):1417–1432CrossRefPubMedGoogle Scholar
  29. 29.
    Wiesinger GF, Nuhr M, Quittan M, Ebenbichler G, Wolfl G, Fialka-Moser V (1999) Cross-cultural adaptation of the Roland-Morris questionnaire for German-speaking patients with low back pain. Spine 24(11):1099–1103CrossRefPubMedGoogle Scholar
  30. 30.
    Secherst L, Fay TL, Zaidi SM (1972) Problems of translation in cross-cultural research. J Cross Cult Psychol 3:41–56Google Scholar
  31. 31.
    Portney LG, Watkins MP (2000) Foundations of clinical research: applications to practice, 2nd edn. Prentice Hall, Upper Saddle RiverGoogle Scholar
  32. 32.
    Nunnally JC, Bernstein ICH (1994) Psychometric theory. McGraw-Hill, New York CityGoogle Scholar
  33. 33.
    Cronbach LJ (1951) Coefficient alpha and internal structure of tests. Psychometrika 16:297–334CrossRefGoogle Scholar
  34. 34.
    Rowe CR, Patel D, Southmayd WW (1978) The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am 60(1):1–16PubMedGoogle Scholar
  35. 35.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res (214):160–164Google Scholar
  36. 36.
    Amstutz HC, Sew Hoy AL, Clarke IC (1981) UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res (155):7–20Google Scholar
  37. 37.
    Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T et al (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305(6846):160–164CrossRefPubMedGoogle Scholar
  38. 38.
    Bullinger M (1995) German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med 41(10):1359–1366CrossRefPubMedGoogle Scholar
  39. 39.
    Ellman H, Hanker G, Bayer M (1986) Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am 68(8):1136–1144PubMedGoogle Scholar
  40. 40.
    Romeo AA, Bach BR Jr, O’Halloran KL (1996) Scoring systems for shoulder conditions. Am J Sports Med 24(4):472–476CrossRefPubMedGoogle Scholar
  41. 41.
    Richards RR, An KE, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3:347–352Google Scholar
  42. 42.
    Mousavi SJ, Parnianpour M, Abedi M, Askary-Ashtiani A, Karimi A, Khorsandi A et al (2008) Cultural adaptation and validation of the Persian version of the disabilities of the arm, shoulder and hand (DASH) outcome measure. Clin Rehabil 22(8):749–757CrossRefPubMedGoogle Scholar
  43. 43.
    Vermeulen HM, Boonman DC, Schuller HM, Obermann WR, van Houwelingen HC, Rozing PM et al (2005) Translation, adaptation and validation of the shoulder rating questionnaire (SRQ) into the Dutch language. Clin Rehabil 19(3):300–311CrossRefPubMedGoogle Scholar
  44. 44.
    Michener LA, Leggin BG (2001) A review of self-report scales for the assessment of functional limitation and disability of the shoulder. J Hand Ther 14(2):68–76PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jochen G. Hofstaetter
    • 1
    • 2
    Email author
  • Beatrice Hanslik-Schnabel
    • 1
  • Stefan G. Hofstaetter
    • 3
  • Christian Wurnig
    • 1
  • Wolfgang Huber
    • 1
  1. 1.Department of Orthopaedic Surgery, Vienna General HospitalMedical University of ViennaViennaAustria
  2. 2.Department of Orthopaedic SurgeryChildren’s Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Department of OrthopaedicsKlinikum WelsWelsAustria

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