COSMIN database

Elbow-specific clinical rating systems: extent of established validity, reliability, and responsiveness

The, B., Reininga, I. H., El Moumni, M., and Eygendaal, D.
BACKGROUND: The modern standard of evaluating treatment results includes the use of rating systems. Elbow-specific rating systems are frequently used in studies aiming at elbow-specific pathology. However, proper validation studies seem to be relatively sparse. In addition, these scoring systems might not always be used for appropriate populations of interest. Both of these issues might give rise to invalid conclusions being reported in the literature. Our aim was to investigate the extent to which the available elbow-specific outcome measurement tools have been validated and the quality of the validation itself. We also aimed to provide characteristics of the populations used for validation of these scales to enable clinicians to use them appropriately.

METHODS: A literature search identified 17 studies of 12 different elbow-specific scoring systems. These were assessed for validity, reliability, and responsiveness characteristics. The quality of these assessments was rated according to the Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist criteria, a standardized and validated tool developed specifically for this purpose.

RESULTS: Currently, the only elbow-specific rating system that is validated using high-quality methodology is the Oxford Elbow Score, a patient-administered outcome measure tool that has been validated on heterogeneous study populations.

CONCLUSION: Other rating systems still have to be proven in the future to be as good as the Oxford Elbow Score for clinical or research purposes. Additional validation studies are needed.
J Shoulder Elbow Surg
1532-6500 (Electronic)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Physical state
Functional status:
Physical functioning
Adults (18-65)
Children (0-18)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
4 - Performance-based tests
6 - Clinical rating scales
ASES-elbow - American Shoulder and Elbow Surgeons-elbow
Broberg and Morrey score
EFA - Elbow Function Assessment   
Ewald score
HSS2 - Hospital for Special Surgery score-short version
HSS - Hospital for Special Surgery
LES - Liverpool Elbow Score
MEPS - Mayo Elbow Performance Score
OES - Oxford Elbow Score
PREE - Patient rated elbow evaluation
Pritchard score
PRTEE - Patient-Rated Tennis Elbow Evaluation