COSMIN database

Clinimetric evaluation of shoulder disability questionnaires: a systematic review of the literature

Bot, S. D., Terwee, C. B., van der Windt, D. A., Bouter, L. M., Dekker, J., and de Vet, H. C.
OBJECTIVE: To identify all available shoulder disability questionnaires designed to measure physical functioning and to evaluate evidence for the clinimetric quality of these instruments.

METHODS: Systematic literature searches were performed to identify self administered shoulder disability questionnaires. A checklist was developed to evaluate and compare the clinimetric quality of the instruments.

RESULTS: Two reviewers identified and evaluated 16 questionnaires by our checklist. Most studies were found for the Disability of the Arm, Shoulder, and Hand scale (DASH), the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons Standardised Shoulder Assessment Form (ASES). None of the questionnaires demonstrated satisfactory results for all properties. Most questionnaires claim to measure several domains (for example, pain, physical, emotional, and social functioning), yet dimensionality was studied in only three instruments. The internal consistency was calculated for seven questionnaires and only one received an adequate rating. Twelve questionnaires received positive ratings for construct validity, although depending on the population studied, four of these questionnaires received poor ratings too. Seven questionnaires were shown to have adequate test-retest reliability (ICC >0.70), but five questionnaires were tested inadequately. In most clinimetric studies only small sample sizes (n<43) were used. Nearly all publications lacked information on the interpretation of scores.

CONCLUSION: The DASH, SPADI, and ASES have been studied most extensively, and yet even published validation studies of these instruments have limitations in study design, sample sizes, or evidence for dimensionality. Overall, the DASH received the best ratings for its clinimetric properties.
Ann Rheum Dis
0003-4967 (Print)
Publication year:
Symptom status:
Physical state
Functional status:
Physical functioning
Role functioning
Social functioning
General health perceptions / HRQoL:
Self-rated health
Adults (18-65)
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
6 - Clinical rating scales
ASES - American Shoulder and Elbow Surgeons
DASH - Disabilities of the Arm, Shoulder and Hand (versions: DASH Modified)   
OSQ - (Oxford) Shoulder Questionnaire
RC-QOL - Rotator Cuff Quality of Life Measure
SDQ - Shoulder Disability Questionnaire [alias: SDQ-NL or SDQ-UK]   
SIQ - Shoulder Instability Questionnaire
SPADI - Shoulder Pain and Disability Index   
SRQ - Shoulder Rating Questionnaire [alias: L'Insalata]   
SSI - Shoulder Severity Index
SSRS - Subjective Shoulder Rating Scale
SST - Simple Shoulder Test [alias; Patte score]   
UEFL - Upper Extremity Functional Limitation Scale
UEFS - Upper Extremity Functional Scale
WOOS - Western Ontario Osteoarthritis of the Shoulder index
WOSI - Western Ontario Shoulder Instability Index