Constant-Murley Score: Systematic Review and Standardized Evaluation in Different Shoulder Pathologies

Overview

Journal Qual Life Res

Specialties Pharmacology
Rehabilitation Medicine

Date 2018 May 12

PMID 29748823

Citations 64

Authors

Kalliopi Vrotsou

Monica Avila

Monica Machon

Maider Mateo-Abad

Yolanda Pardo

Olatz Garin

Carlos Zaror

Nerea Gonzalez

Antonio Escobar

Ricardo Cuellar

Affiliations

Soon will be listed here.

Abstract

Purpose: The objective of this study was to evaluate the psychometric properties of the Constant-Murley Score (CMS) in various shoulder pathologies, based on a systematic review and expert standardized evaluations.

Methods: A systematic review was performed in MEDLINE and EMBASE databases. Titles and abstracts were reviewed and finally the included articles were grouped according to patients' pathologies. Two expert evaluators independently assessed the CMS properties of reliability, validity, responsiveness to change, interpretability and burden score in each group, using the EMPRO (Evaluating Measures of Patient Reported Outcomes) tool. The CMS properties were assessed per attribute and overall for each considered group. Only the concept and measurement model was assessed globally.

Results: Five individual pathologies (i.e. subacromial, fractures, arthritis, instability and frozen shoulder) and two additional groups (i.e. various pathologies and healthy subjects) were considered. Overall EMPRO scores ranged from 58.6 for subacromial to 30.6 points for instability. Responsiveness to change was the only quality to obtain at least 50 points across all groups, but for frozen shoulder. Insufficient information was obtained in relation to the concept and measurement model and great variability was seen in the other evaluated attributes.

Conclusions: The current evidence does not support the CMS as a gold standard in shoulder evaluation. Its use is advisable for subacromial pathology; but data are inconclusive for other shoulder conditions. Prospective studies exploring the psychometric properties of the scale, particularly for fractures, arthritis, instability and frozen shoulder are needed.

Level Of Evidence: Systematic review.

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References

Walton M, Walton J, Honorez L, Harding V, Wallace W . 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(3):285-9. DOI: 10.1016/j.jse.2006.08.002. View

van den Ende C, Rozing P, Dijkmans B, Verhoef J, Voogt-van der Harst E, Hazes J . Assessment of shoulder function in rheumatoid arthritis. J Rheumatol. 1996; 23(12):2043-8. View

Valderas J, Ferrer M, Mendivil J, Garin O, Rajmil L, Herdman M . Development of EMPRO: a tool for the standardized assessment of patient-reported outcome measures. Value Health. 2008; 11(4):700-8. DOI: 10.1111/j.1524-4733.2007.00309.x. View

Othman A, Taylor G . Is the constant score reliable in assessing patients with frozen shoulder? 60 shoulders scored 3 years after manipulation under anaesthesia. Acta Orthop Scand. 2004; 75(1):114-6. DOI: 10.1080/00016470410001708230. View

Huang H, Grant J, Miller B, Mirza F, Gagnier J . A Systematic Review of the Psychometric Properties of Patient-Reported Outcome Instruments for Use in Patients With Rotator Cuff Disease. Am J Sports Med. 2015; 43(10):2572-82. DOI: 10.1177/0363546514565096. View

Mahabier K, Den Hartog D, Theyskens N, Verhofstad M, Van Lieshout E . Reliability, validity, responsiveness, and minimal important change of the Disabilities of the Arm, Shoulder and Hand and Constant-Murley scores in patients with a humeral shaft fracture. J Shoulder Elbow Surg. 2016; 26(1):e1-e12. DOI: 10.1016/j.jse.2016.07.072. View

Bankes M, Crossman J, Emery R . A standard method of shoulder strength measurement for the Constant score with a spring balance. J Shoulder Elbow Surg. 1998; 7(2):116-21. DOI: 10.1016/s1058-2746(98)90220-8. View

Schmidt S, Ferrer M, Gonzalez M, Gonzalez N, Valderas J, Alonso J . Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence. J Shoulder Elbow Surg. 2014; 23(3):434-44. DOI: 10.1016/j.jse.2013.09.029. View

Angst F, Schwyzer H, Aeschlimann A, Simmen B, Goldhahn J . Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized.... Arthritis Care Res (Hoboken). 2012; 63 Suppl 11:S174-88. DOI: 10.1002/acr.20630. View

10.

Plancher K, Lipnick S . Analysis of evidence-based medicine for shoulder instability. Arthroscopy. 2009; 25(8):897-908. DOI: 10.1016/j.arthro.2009.03.017. View

11.

Rocourt M, Radlinger L, Kalberer F, Sanavi S, Schmid N, Leunig M . Evaluation of intratester and intertester reliability of the Constant-Murley shoulder assessment. J Shoulder Elbow Surg. 2008; 17(2):364-9. DOI: 10.1016/j.jse.2007.06.024. View

12.

Lillkrona U . How should we use the Constant Score?--A commentary. J Shoulder Elbow Surg. 2007; 17(2):362-3. DOI: 10.1016/j.jse.2007.06.013. View

13.

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

14.

Christie A, Hagen K, Mowinckel P, Dagfinrud H . Methodological properties of six shoulder disability measures in patients with rheumatic diseases referred for shoulder surgery. J Shoulder Elbow Surg. 2008; 18(1):89-95. DOI: 10.1016/j.jse.2008.07.008. View

15.

Aaronson N, Alonso J, Burnam A, Lohr K, Patrick D, Perrin E . Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res. 2002; 11(3):193-205. DOI: 10.1023/a:1015291021312. View

16.

Dawson J, Fitzpatrick R, Carr A . The assessment of shoulder instability. The development and validation of a questionnaire. J Bone Joint Surg Br. 2000; 81(3):420-6. DOI: 10.1302/0301-620x.81b3.9044. View

17.

Roy J, MacDermid J, Woodhouse L . A systematic review of the psychometric properties of the Constant-Murley score. J Shoulder Elbow Surg. 2009; 19(1):157-64. DOI: 10.1016/j.jse.2009.04.008. View

18.

Schmidt S, Garin O, Pardo Y, Valderas J, Alonso J, Rebollo P . Assessing quality of life in patients with prostate cancer: a systematic and standardized comparison of available instruments. Qual Life Res. 2014; 23(8):2169-81. PMC: 4155169. DOI: 10.1007/s11136-014-0678-8. View

19.

Garin O, Herdman M, Vilagut G, Ferrer M, Ribera A, Rajmil L . Assessing health-related quality of life in patients with heart failure: a systematic, standardized comparison of available measures. Heart Fail Rev. 2013; 19(3):359-67. DOI: 10.1007/s10741-013-9394-7. View

20.

Levy O, Haddo O, Massoud S, Mullett H, Atoun E . A patient-derived Constant-Murley score is comparable to a clinician-derived score. Clin Orthop Relat Res. 2013; 472(1):294-303. PMC: 3889436. DOI: 10.1007/s11999-013-3249-3. View