Pichonnaz C1,2, Balthazard P1, Ancey C1, Gleeson N3
1School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Physiotherapy, Lausanne, Switzerland, 2University Hospital of Lausanne, Department of Musculoskeletal Medicine, Lausanne, Switzerland, 3Queen Margaret University, School of Health Sciences, Edinburgh, United Kingdom
Background: Physiotherapist have to rely on efficient outcome measures to assess adequately their patients' status and to draw appropriate conclusions from their research, based on the measured results. Both PROMs (patient-reported outcome measures) and computerised movement' analysis-based methods (CMABMs) allow the evaluation of shoulder function performance.
Ongoing debates on the validity of shoulder function PROMs and the improved accessibility of CMABMs afforded by technological progress, provoke an imperative to investigate whether CMABMs could represent a suitable alternative to traditional questionnaire-based approaches.
Purpose: This review aims to compare the measurement properties of currently used PROMs and CMABMs for shoulder function evaluation. It will contribute to determining if an approach has advantages over competitors and help identify paths for future research.
Methods: Six valid PROMs (Constant, DASH and QuickDASH, SST, ASES, WOSI) of shoulder function were selected according to their frequency of occurrence in the literature. A bibliographic search was conducted on Medline, Embase, CINAHL, Web of Science and Pedro to retrieve the articles investigating measurement properties in English or French before May 2017, for selected PROMs and CMABMs. Measurement properties were extracted and then interpreted based on recognised standards of adequacy (e.g. intraclass correlation coefficient ≥0.90, area under the receiving operator curve ≥0.70) and benchmarking of PROMs and CMABMs, with double-checking occurring at each step. No literature rating or meta-analysis was conducted due to the lack of adequate methods for these purposes in the domain of measurement properties.
Results: The number of retrieved articles was roughly comparable for PROMs (1800) and CMABM (1642) but a lower number dealt with measurement properties of CMABMs (8 articles on 6 outcomes measures vs. 82 articles addressing 6 selected PROMs). Comparisons amongst outcome measures were limited by the heterogeneity of methodological approaches and the scarcity of direct comparison in similar conditions.
More consistent information was found on the PROMs properties for rotator cuff condition, proximal humerus fracture and glenohumeral osteoarthritis, than for capsulitis and fracture evaluation. The Constant and DASH/QuickDASH offered the most consistent body of clinimetric knowledge. However, no PROM was globally superior to the others, except for the WOSI for shoulder instability evaluation.
The CMABMs outcome measures generally complied with standards for adequate reliability and responsiveness, with the B-B Score the most extensively investigated. They matched and sometimes exceeded PROMs' capabilities in direct comparisons for all pathologies except shoulder instability.
Conclusion(s): No retrieved PROM or CMABM outcome measure was revealed as being superior to any other except for the WOSI for shoulder instability. Outcome measures merely displayed condition-specific clinimetric advantages. The results are presently too limited to be conclusive on the potential of CMABM for shoulder function evaluation. Nevertheless, they constitute a suitable alternative or complement to PROMs.
Implications: The choice of a shoulder function outcome measure should be oriented by its specific measurement properties for the target population and not based on general considerations.
Evaluation of shoulder function by CMABMs is still an emerging field. Future research is needed to exhaustively investigate the measurement properties of existing CMABM outcome measures and develop ones that are more efficient.
Keywords: Shoulder, Patient Outcome Assessment, Litterature review
Funding acknowledgements: School of Health Sciences (HESAV), University of Applied Sciences of Western Switzerland (HES-SO)
Ongoing debates on the validity of shoulder function PROMs and the improved accessibility of CMABMs afforded by technological progress, provoke an imperative to investigate whether CMABMs could represent a suitable alternative to traditional questionnaire-based approaches.
Purpose: This review aims to compare the measurement properties of currently used PROMs and CMABMs for shoulder function evaluation. It will contribute to determining if an approach has advantages over competitors and help identify paths for future research.
Methods: Six valid PROMs (Constant, DASH and QuickDASH, SST, ASES, WOSI) of shoulder function were selected according to their frequency of occurrence in the literature. A bibliographic search was conducted on Medline, Embase, CINAHL, Web of Science and Pedro to retrieve the articles investigating measurement properties in English or French before May 2017, for selected PROMs and CMABMs. Measurement properties were extracted and then interpreted based on recognised standards of adequacy (e.g. intraclass correlation coefficient ≥0.90, area under the receiving operator curve ≥0.70) and benchmarking of PROMs and CMABMs, with double-checking occurring at each step. No literature rating or meta-analysis was conducted due to the lack of adequate methods for these purposes in the domain of measurement properties.
Results: The number of retrieved articles was roughly comparable for PROMs (1800) and CMABM (1642) but a lower number dealt with measurement properties of CMABMs (8 articles on 6 outcomes measures vs. 82 articles addressing 6 selected PROMs). Comparisons amongst outcome measures were limited by the heterogeneity of methodological approaches and the scarcity of direct comparison in similar conditions.
More consistent information was found on the PROMs properties for rotator cuff condition, proximal humerus fracture and glenohumeral osteoarthritis, than for capsulitis and fracture evaluation. The Constant and DASH/QuickDASH offered the most consistent body of clinimetric knowledge. However, no PROM was globally superior to the others, except for the WOSI for shoulder instability evaluation.
The CMABMs outcome measures generally complied with standards for adequate reliability and responsiveness, with the B-B Score the most extensively investigated. They matched and sometimes exceeded PROMs' capabilities in direct comparisons for all pathologies except shoulder instability.
Conclusion(s): No retrieved PROM or CMABM outcome measure was revealed as being superior to any other except for the WOSI for shoulder instability. Outcome measures merely displayed condition-specific clinimetric advantages. The results are presently too limited to be conclusive on the potential of CMABM for shoulder function evaluation. Nevertheless, they constitute a suitable alternative or complement to PROMs.
Implications: The choice of a shoulder function outcome measure should be oriented by its specific measurement properties for the target population and not based on general considerations.
Evaluation of shoulder function by CMABMs is still an emerging field. Future research is needed to exhaustively investigate the measurement properties of existing CMABM outcome measures and develop ones that are more efficient.
Keywords: Shoulder, Patient Outcome Assessment, Litterature review
Funding acknowledgements: School of Health Sciences (HESAV), University of Applied Sciences of Western Switzerland (HES-SO)
Topic: Musculoskeletal: upper limb; Outcome measurement; Orthopaedics
Ethics approval required: No
Institution: None
Ethics committee: None
Reason not required: Litterature review
All authors, affiliations and abstracts have been published as submitted.
