Continuous follow-up of patient after conservative treatment or surgery is an essential step to monitor the effectiveness of a therapy, to ensure quality management and to improve the patient safety. However, interpretation of shoulder assessment still remains controversial in practice and in literature[1–8]. Multiple scoring systems were proposed, such as the SPADI, DASH, ASES, SRQ, WOOS, SSRS and CMS, based on either examination by a physician and/or additional standardized queries within a questionnaire[6, 9–15]. The validity, reliability and responsiveness for most of these instruments were demonstrated in several studies. Hence, these test-systems are widely accepted for outcome measurement in shoulder surgery[1, 7, 16–18]. However, routine measurement of outcome in shoulder surgery is substantially jeopardized by three major disadvantages of these instruments: i) physical presence of the patient is mandatory if the objective function (e.g. range of motion, muscle strength) is to be assessed, ii) patient-reporting instruments provide only one certain score, making it difficult to compare the results with the literature, iii) several questionnaires are therefore used in most studies but can overburden the compliance of patients willing to participate.
As a result, performing clinical studies is time consuming, expensive and a logistical challenge, especially when physical presence of the patient is required[3–5, 16, 19]. In addition, many procedures are performed on outpatients in centers far away from the home of the patients. For this reason, many patients will refuse or are just unable to keep a long-term follow-up, beside other issues, such as accidents during travel, insurance etc. This makes it hard to follow-up patients on a regular base and beside the lack of patient safety, valuable data on the outcome and the quality of treatment gets lost. Furthermore, by this patient dropout, the comparison of different treatment regimens gets biased and makes it hard or impossible to state which form of therapy is superior and provides the highest safety level for the patient.
Standard questionnaire enable to follow patients on a close and regular base with manageable effort for both, the surgeon and the patients. An optimal instrument for outcome measurement of shoulder surgery should meet the following requirements:
the instrument should be a self-assessment patient reporting tool, so travelling of patients is not required
the questions must be easily comprehensible
filling in should not take more than 30 minutes
the results should provide calculation of several well established scoring systems simultaneously.
Therefore, the aim of this study was to create a self-assessment patient reporting tool by condensing queries of three of the widest distributed and accepted instruments for shoulder function measurement into a 30-item questionnaire based on subjective and objective parameters of shoulder function. This new instrument was then validated by collecting data of the newly designed Munich Shoulder Questionnaire (MSQ) as well as of three established scoring systems (CONSTANT, SPADI and DASH) simultaneously.