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The Scientific World Journal
Volume 2012 (2012), Article ID 410125, 7 pages
http://dx.doi.org/10.1100/2012/410125
Clinical Study

An Evaluation of the Responsiveness and Discriminant Validity of Shoulder Questionnaires among Patients Receiving Surgical Correction of Shoulder Instability

1Orthopaedic Research, Alberta Health Services, Capital Health Region, 1F1.52 WMC, 8440-112 Street, Edmonton, AB, Canada T6G 2B7
2Department of Surgery, University of Alberta, 1F1.52 WMC, 8440–112 Street, Edmonton, AB, Canada T6G 2B7
3Department of Physical Therapy, University of Alberta, 3-71 Corbett Hall, Edmonton, AB, Canada T6G 2G4
4Department of Rehabilitation Medicine, Covenant Health-Grey Nuns Hospital, 110 Youville Drive West, Room 1107, Edmonton, AB, Canada T6L 5X8

Received 20 October 2011; Accepted 8 December 2011

Academic Editor: Kiyohisa Ogawa

Copyright Β© 2012 Kyle A. R. Kemp et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Health-related quality-of-life (HRQL) measures must detect clinically important changes over time and between different patient subgroups. Forty-three patients (32 M, 13 F; mean age  =  26.00  ±  8.19 years) undergoing arthroscopic Bankart repair completed three validated shoulder questionnaires (Western Ontario Shoulder Instability index (WOSI), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment form (ASES), Constant score) preoperatively, and at 6, 12, and 24 months postoperatively. Responsiveness and discriminant validity was assessed between those with a satisfactory outcome and those with (1) a major recurrence of instability, (2) a single episode of subluxation, (3) any postoperative episode of instability. Eight (20%) patients reported recurrent instability. Compared to baseline, the WOSI detected improvement at the 6- ( 𝑃 < 0 . 0 0 1 ) and 12-month ( 𝑃 = 0 . 0 1 1 ) evaluations. The ASES showed improvement at 6 months ( 𝑃 = 0 . 0 0 3 ), while the Constant score did not report significant improvement until 12 months postoperatively ( 𝑃 = 0 . 0 0 1 ). Only the WOSI detected differential shoulder function related to shoulder instability. Those experiencing even a single episode of subluxation reported a 10% drop in their WOSI score, attaining the previously established minimal clinically important difference (MCID). Those experiencing a frank dislocation or multiple episodes of subluxation reported a 20% decline. The WOSI allows better discrimination of the severity of postoperative instability symptoms following arthroscopic Bankart repair.