Abstract
PurposeThe Patient-Specific Functional Scale (PSFS), Disability of the Arm, Shoulder and Hand (DASH), Quick-DASH, and Shoulder Pain and Disability Index (SPADI) are frequently used instruments in shoulder functional assessment. They are available in Nepali and all but the PSFS has been validated for shoulder assessment. Therefore, the aim of this study was to validate the Nepali PSFS in shoulder pain patients and to compare validity, reliability, and responsiveness of all four instruments to provide a recommendation for their use.MethodPatients attending physiotherapy completed the Nepali PSFS at baseline and follow-up (1–3 weeks). It was tested for reliability using internal consistency (Cronbach’s α), intraclass correlation coefficient (ICC), construct validity by hypothesis testing and responsiveness by anchor-based method using Area Under the Curve (AUC). The instruments were compared based on reported measurement properties and patients’ preference.Results156 patients enrolled at baseline and 121 at follow-up. The PSFS showed sufficient reliability (α = 0.70, ICC = 0.82), construct validity (all three hypotheses met) and responsiveness (AUC = 0.83). Measurement property comparison demonstrated adequate reliability and validity, while PSFS was the most responsive instrument. Patients favoured the verbal rating scale of the DASH/Quick-DASH. The DASH had a lower completion rate for ‘culturally sensitive’ and ‘uncommon’ activities.ConclusionThe Nepali PSFS is a reliable, valid, and responsive instrument in shoulder functional assessment. The combined use of the Quick-DASH or SPADI with the PSFS is recommended for a comprehensive assessment of Nepali shoulder pain patients in clinical and research settings. They are shorter, more appropriate to the Nepali context and provide balanced self-evaluation.
Highlights
Patient-reported outcome measures (PROMs) are increasingly used in the assessment and management of musculoskeletal disorders [1]
While participant feedback suggested there were no issues of understanding with the instructions, items and the response scales used in the three shoulder-specific PROMs (DASHNP, QuickDASH-NP, Shoulder Pain and Disability Index (SPADI)-NP) investigated, some items were flagged as difficult to answer for cultural reasons, in the DASH-NP and the QuickDASH-NP
There is strong measurement testing evidence to support the use of all four available Nepali instruments (PSFS-NP, SPADI-NP, DASH-NP, QuickDASH-NP) for shoulder pain patients in Nepal and there is no need to continue developing new PROMs or translating other shoulder-related PROMs into Nepali
Summary
Patient-reported outcome measures (PROMs) are increasingly used in the assessment and management of musculoskeletal disorders [1]. Many region-specific PROMs are available, including more than 30 for the shoulder region These PROMs should be developed according to recommended guidelines and be tested for their measurement properties before they can be endorsed and used clinically and in research [2, 3]. Previous studies have suggested that using two PROMs provides a more balanced measure of shoulder function [6, 7]. These three PROMs are available in multiple languages [3, 8] including recently published Nepali versions [9,10,11]. They are the only available shoulder or upper limb specific tools in Nepali, the national language of Nepal
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