Abstract
Background
Although there are many advantages to patient-based assessment for musculoskeletal conditions, one common problem is that many of these assessments are perceived to be subjective. To overcome this limitation for patient-based shoulder evaluation, we developed a modified Constant-Murley score that allows patients to complete subjective and objective sections of the score.
Questions/purposes
The purpose of our study was to assess the reliability of the new patient-based Constant-Murley score questionnaire by comparing composite scores and subscores obtained with those obtained using the standard physician-based Constant-Murley questionnaire in the same group of patients.
Methods
Between August and October 2000, all patients having shoulder surgery in our institute were invited to participate in this study; 58 of 61 (95%) opted to do so and completed the patient-based questionnaire at preoperative and postoperative assessments. The clinician-based Constant-Murley score was performed by a clinician who was blinded to the corresponding patient-based questionnaire. Patients underwent various procedures ranging from manipulation under anesthesia and arthroscopic procedures to reverse shoulder arthroplasty.
Results
The mean patient-based and the clinician-based Constant-Murley scores were 47 (SD = 19.5; range, 4–90; N = 108) and 48 (SD = 19.9; range, 4–90; N = 108) points respectively. The mean difference was −1.3 (SD = 3; range, −11 to 8; N = 108) points. The new patient-based Constant-Murley score questionnaire reproduced the patient-based method and had substantial to almost perfect agreement with it for the composite score and various subgroups.
Conclusions
These results suggest that a patient-based questionnaire can be used interchangeably with or in place of a clinician-based Constant-Murley score. These results apply to subjective and objective items of the Constant-Murley score.
Level of Evidence
Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.
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References
Badley EM, Tennant A. Changing profile of joint disorders with age: findings from a postal survey of the population of Calderdale, West Yorkshire, United Kingdom. Ann Rheum Dis. 1992;51:366–371.
Bankes MJ, Crossman JE, Emery RJ. A standard method of shoulder strength measurement for the Constant score with a spring balance. J Shoulder Elbow Surg. 1998;7:116–121.
Beaton D, Richards RR. Assessing the reliability and responsiveness of 5 shoulder questionnaires. J Shoulder Elbow Surg. 1998;7:565–572.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310.
Boehm D, Wollmerstedt N, Doesch M, Handwerker M, Mehling E, Gohlke F. [Development of a questionnaire based on the Constant-Murley-Score for self-evaluation of shoulder function by patients] [in German]. Unfallchirurg. 2004;107:397–402.
Carter CW, Levine WN, Kleweno CP, Bigliani LU, Ahmad CS. Assessment of shoulder range of motion: introduction of a novel patient self-assessment tool. Arthroscopy. 2008;24:712–717.
Chakravarty KK, Webley M. Disorders of the shoulder: an often unrecognised cause of disability in elderly people. BMJ. 1990;300:848–849.
Chard MD, Hazleman R, Hazleman BL, King RH, Reiss BB. Shoulder disorders in the elderly: a community survey. Arthritis Rheum. 1991;34:766–769.
Conboy VB, Morris RW, Kiss J, Carr AJ. An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg Br. 1996;78:229–232.
Constant CR. An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg Br. 1997;79:695–696.
Constant CR, Gerber C, Emery RJ, Søjbjerg JO, Gohlke F, Boileau P. A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg. 2008;17:355–361.
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.
Dawson J, Fitzpatrick R, Carr A. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br. 1996;78:593–600.
Dawson J, Hill G, Fitzpatrick R, Carr A. Comparison of clinical and patient-based measures to assess medium-term outcomes following shoulder surgery for disorders of the rotator cuff. Arthritis Rheum. 2002;47:513–519.
Harvie P, Pollard TC, Chennagiri RJ, Carr AJ. The use of outcome scores in surgery of the shoulder. J Bone Joint Surg Br. 2005;87:151–154.
Holtby R, Razmjou H. Measurement properties of the Western Ontario rotator cuff outcome measure: a preliminary report. J Shoulder Elbow Surg. 2005;14:506–510.
Johansson KM, Adolfsson LE. Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment. J Shoulder Elbow Surg. 2005;14:273–278.
Kirkley A, Griffin S, Dainty K. Scoring systems for the functional assessment of the shoulder. Arthroscopy. 2003;19:1109–1120.
Kocher MS, Horan MP, Briggs KK, Richardson TR, O’Holleran J, Hawkins RJ. Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. J Bone Joint Surg Am. 2005;87:2006–2011.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.
Olley LM, Carr AJ. The use of a patient-based questionnaire (the Oxford Shoulder Score) to assess outcome after rotator cuff repair. Ann R Coll Surg Engl. 2008;90:326–331.
Peters D, Davies P, Pietroni P. Musculoskeletal clinic in general practice: study of one year’s referrals. Br J Gen Pract. 1994;44:25–29.
Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, Simmons a, Williams G. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis. 1998;57:649–655.
van Schaardenburg D, Van den Brande KJ, Ligthart GJ, Breedveld FC, Hazes JM. Musculoskeletal disorders and disability in persons aged 85 and over: a community survey. Ann Rheum Dis. 1994;53:807–811.
Walton MJ, Walton JC, Honorez LA, Harding VF, Wallace WA. A comparison of methods for shoulder strength assessment and analysis of Constant score change in patients aged over fifty years in the United Kingdom. J Shoulder Elbow Surg. 2007;16:285–289.
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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
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This study was performed at the Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK.
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Levy, O., Haddo, O., Massoud, S. et al. A Patient-derived Constant-Murley Score is Comparable to a Clinician-derived Score. Clin Orthop Relat Res 472, 294–303 (2014). https://doi.org/10.1007/s11999-013-3249-3
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DOI: https://doi.org/10.1007/s11999-013-3249-3