The online version of this article (doi:10.1186/s12891-015-0481-x) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
AvdW designed the study, performed all recruitment, clinical assessments and data collection activities, conducted all Rasch and other statistical analyses, and drafted the manuscript. MD helped to design the study, helped with statistical analysis and interpretation, and helped to draft the manuscript. NS helped to design the study and helped to draft the manuscript. ME helped with data collection and helped to draft the manuscript. NT supervised the study, helped to design the study, helped with interpretation of results and helped to draft the manuscript. All authors read and approved the final manuscript.
Proximal humeral fractures are amongst the most common fractures. Functional recovery is often slow and many people have ongoing disability during activities of daily life. Unidimensional measurement of activity limitations is required to monitor functional progress during rehabilitation. However, currentshoulder measures are multidimensional incorporating constructs such as activities, range of motion and pain into a single scale. Psychometric information of these measures is scarce in this population, and indicate measurement issues with reliability. Therefore, the aim was to develop the clinician-observed Shoulder Function Index (SFInX), a unidimensional, interval-level measure of ‘shoulder function’ based on actual performance of activities, reflecting activity limitations following a proximal humeral fracture.
An outcome measure development study was performed including item generation (existing shoulder measures, focus groups) and item selection (selection criteria, importance and feasibility ratings, pilot testing, Rasch analysis). Clinicians (n=15) and people with a proximal humeral fracture (n=13) participated in focus groups. Items were pilot tested (n=12 patients) and validated in a Rasch study. The validation study sample (n=92, 86% female) were recruited between 5 and 52 weeks post-fracture and had a mean age of 63.5 years (SD13.9). Measurements at recruitment and 6 and 7 weeks later were taken in three public metropolitan hospitals or during home visits. Raw SFInX data were analysed with WINSTEPS v3.74 using polytomous Rasch models.
From 282 generated items, 42 items were selected to be rated by clinicians and patients; 34 items were pilot tested and 16 items were included for Rasch analysis. The final SFInX, developed with the Partial Credit Model, contains 13 items and has the response categories: ‘unable’, ‘partially able’ and ‘able’. It is unidimensional measuring ‘shoulder function’, and can measure from early functional use (drinking from a cup) to independence around the house (lifting items above head, carrying heavy items).
The SFInX is a promising outcome measure of shoulder function for people with a proximal humeral fracture. It has content relevant to patients and clinicians, is unidimensional and feasible for use in clinical and home settings. In its current form, the SFInX is ready for further psychometric evaluation, and for subsequent use in clinical settings and research.
Additional file 1: SFInX manual – clinical assessment form and instructional manual.12891_2015_481_MOESM1_ESM.pdf
Additional file 2: Table S1. Focus group participant characteristics. Table S2. Pilot-test sample characteristics.12891_2015_481_MOESM2_ESM.pdf
Additional file 3: Shoulder Function Index – clinical assessment form.12891_2015_481_MOESM3_ESM.pdf
Hodgson S, Mawson S, Stanley D. Rehabilitation after two-part fractures of the neck of the humerus. J Bone Joint Surg Br Vol. 2003;85(3):419–22. CrossRef
den Hartog D, De Haan J, Schep NW, Tuinebreijer WE. Primary shoulder arthroplasty versus conservative treatment for comminuted proximal humeral fractures: a systematic literature review. Open Orthop J. 2010;4:87–92.
Vrancken Peeters MJTFD, Kastelein GW, Breslau PJ. Proximal humerus fractures: a prospective study of the functional outcome after conservative treatment. Eur J Trauma. 2001;27(3):133–6.
den Hartog D, Van Lieshout EM, Tuinebreijer WE, Polinder S, Van Beeck EF, Breederveld RS, et al. Primary hemiarthroplasty versus conservative treatment for comminuted fractures of the proximal humerus in the elderly (ProCon): a multicenter randomized controlled trial. BMC Musculoskelet Disord. 2010;11:97. CrossRef
World Health Organization. International classification of functioning, disability and health: ICF. Geneva: WHO; 2001.
Van de Water ATM, Shields N, Taylor NF. Outcome measures in the management of proximal humeral fractures: a systematic review of their use and psychometric properties. J Shoulder Elb Surg. 2011;20(2):333–43. CrossRef
Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, et al. A standardized method for the assessment of shoulder function. J Shoulder Elb Surg. 1994;3(6):347–52. CrossRef
Dawson J, Fitzpatrick R, Carr A. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br Vol. 1996;78(4):593–600.
Slobogean GP, Noonan VK, O'Brien PJ. The reliability and validity of the disabilities of arm, shoulder, and hand, EuroQol-5D, health utilities index, and short form-6D outcome instruments in patients with proximal humeral fractures. J Shoulder Elb Surg. 2010;19(3):342–8. CrossRef
Baker P, Nanda R, Goodchild L, Finn P, Rangan A. A comparison of the constant and Oxford shoulder scores in patients with conservatively treated proximal humeral fractures. J Shoulder Elb Surg. 2008;17(1):37–41. CrossRef
Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? Br Med J. 2001;322(7294):1115–7. CrossRef
Fix AJ, Daughton DM. Human Activity Profile professional manual. 1st ed. Odessa (Florida, USA): Psychological Assessment Resources Inc; 1988.
Neer II CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg (Am Vol). 1970;52(6):1077–89.
Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Berlin: Springer; 1990. http://www.aofoundation.org/resource/publication/mueller-classification/Pages/mueller-cassification.aspx. CrossRef
Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elb Surg. 2004;13(4):427–33. CrossRef
Linacre JM. Sample size and item calibration stability. Rasch Meas Trans. 1994;7(4):328.
Linacre JM. PROX with missing data, or known item or person measures. Rasch Meas Trans. 1994;8(3):378.
Cohen L. Approximate expressions for parameter estimates in the Rasch Model. Br J Math Stat Psychol. 1979;32:113–20. CrossRef
Wright BD, Panchapakesan N. A procedure for sample-free item analysis. Educ Psychol Meas. 1969;29:23–48. CrossRef
Nilsson AL, Tennant A. Past and present issues in Rasch analysis: the Functional Independence Measure (FIM TM) revisited. J Rehabil Med. 2011;43:884–91. CrossRef
Linacre JM, Smith EV. Practical Rasch measurement - core topics handbook, Oct 2012 edn: Course through www.statistics.com; 2012.
Andrich D. A rating formulation for ordered response categories. Psychometrika. 1978;43:357–74. CrossRef
Masters GN. A Rasch model for partial credit scoring. Psychometrika. 1982;47:149–74. CrossRef
Wright BD, Linacre JM. Reasonable mean-square fit values. Rasch Meas Trans. 1994;8(3):370.
Linacre JM, Tennant A. More about critical Eigenvalue sizes in standardized-residual Principal Components Analysis (PCA). Rasch Meas Trans. 2009;23(3):1228.
Wright BD. Reliability and separation. Rasch Meas Trans. 1996;9(4):472.
Streiner DL, Norman GR. Health Measurement Scales - a practical guide to their development and use. 4th ed. Oxford: Oxford University Press; 2008. CrossRef
Suk M, Hanson BP, Norvell DC, Helfet DL. AO handbook - musculoskeletal outcomes measures and instruments - volume 1 selection and assessment upper extremity, vol. 2nd. 1st ed. Davos, Switserland: AO Foundation Publishing; 2009.
Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, 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 shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care Res. 2011;63 Suppl 11:S174–88. CrossRef
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop. 1987;214:160–4. PubMed
Hughes R, Johnson M, Skow A, An K, O'Driscoll S. Reliability of a simple shoulder endurance test. J Musculoskelet Res. 1999;3(3):195–200. CrossRef
Matsen III FA, Ziegler DW, DeBartolo SE. Patient self-assessment of health status and function in glenohumeral degenerative joint disease. J Shoulder Elb Surg. 1995;4(5):345–51. CrossRef
- The Shoulder Function Index (SFInX): a clinician-observed outcome measure for people with a proximal humeral fracture
Alexander TM van de Water
Matthew C Evans
Nicholas F Taylor
- BioMed Central
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