The Western Ontario Rotator Cuff Index in Rotator Cuff Disease Patients A Comprehensive Reliability and Responsiveness Validation Study
The Western Ontario Rotator Cuff Index in Rotator Cuff Disease Patients A Comprehensive Reliability and Responsiveness Validation Study
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DOI：
10.1177/0363546512446591
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发表时间：
2012-07-01
影响因子：
4.8
通讯作者：
Nelissen, Rob G. H. H.
中科院分区：
文献类型：
--
作者：
de Witte, Pieter Bas;Henseler, Jan Ferdinand;Nelissen, Rob G. H. H.
背景资料：西安大略肩袖指数（WORC）是越来越多地应用于肩袖（RC）状况的特定状况结局指标。然而，在大多数WORC验证研究中，只有有限数量的心理测量学特性在不明确的患者组中进行了研究。目的：根据科学咨询委员会健康问卷的质量标准，在3个具有不同RC条件的患者组中评估WORC的心理测量学特性。研究设计：队列研究方法：对92例患者（RC撕裂35例，钙化性肌腱炎35例，撞击伤22例）进行两次（T1，T2）WORC评分（范围0-100，21项，5个领域）。此外，还记录了Constant评分（CS）和臂、肩和手残疾评分（DASH）。钙化性肌腱炎患者在针刺和灌洗或肩峰下注射皮质类固醇（T3）治疗6周后重新评估。我们评估了下限和上限的影响，内部一致性，重测信度，精度，结构效度，最低限度的检测变化，并在诊断亚组和总group.Results的反应：平均年龄为55.0 +/- 8.7岁，和49的92（53%）患者是女性。平均基线WORC为46.8 ± 20.4，CS为63.9 ± 15.4，DASH为40.9 ± 18.6。RC撕裂患者（严重症状）和其他患者之间的CS和DASH存在显著差异，但WORC无显著差异。没有天花板和地板效应。内部一致性很高：克朗巴赫α系数为0.95。组内相关系数为0.89，测量标准误差为6.9，表明重复性高。WORC与CS和DASH的Pearson相关性分别为0.56和-0.65（均P <0.001）。T3时，总WORC显著改善（平均变化，18.8; 95%置信区间，11.3-26.2）。WORC变化评分与CS和DASH变化的相关性分别为0.61和-0.84（均P <0.001）。效应大小为0.96，与标准化的反应平均值为0.91，表明良好的responsibility.Conclusion：应用到各种RC患者，WORC具有较高的内部一致性，中度到良好的结构效度，高重测信度，良好的反应。这些研究结果支持使用WORC作为RC患者的条件特异性自我报告的结果测量，但其在严重症状患者中的有效性需要进一步调查。
Background: The Western Ontario Rotator Cuff Index (WORC) is an increasingly applied condition-specific outcome measure for rotator cuff (RC) conditions. However, in most WORC validation studies, only a limited number of psychometric properties are studied in indistinct patient groups.Purpose: To assess psychometric properties of the WORC according to the Scientific Advisory Committee quality criteria for health questionnaires in 3 patient groups with distinct RC conditions.Study Design: Cohort study (diagnosis); Level of evidence, 2.Methods: The WORC (range, 0-100; 21 items, 5 domains) was administered twice (T1, T2) in 92 patients (35 RC tears, 35 calcific tendinitis, 22 impingement). Additionally, the Constant score (CS) and the Disabilities of the Arm, Shoulder and Hand score (DASH) were recorded. Calcific tendinitis patients were reassessed 6 weeks after treatment with needling and lavage or a subacromial injection with corticosteroids (T3). We assessed floor and ceiling effects, internal consistency, test-retest reliability, precision, construct validity, minimally detectable change, and responsiveness in the diagnostic sub-groups and the total group.Results: Mean age was 55.0 +/- 8.7 years, and 49 of 92 (53%) patients were female. Mean baseline WORC was 46.8 +/- 20.4, CS was 63.9 +/- 15.4, and DASH was 40.9 +/- 18.6. Significant differences were found for the CS and DASH between RC tear patients (severe symptoms) and the other patients, but not for the WORC. There were no floor and ceiling effects. Internal consistency was high: the Cronbach alpha coefficient was .95. The intraclass correlation coefficient of .89 and standard error of measurement of 6.9 indicated high reproducibility. Pearson correlations of the WORC with the CS and DASH were .56 and -.65, respectively (both P < .001). At T3, total WORC improved significantly (mean change, 18.8; 95% confidence interval, 11.3-26.2). Correlations of the WORC change scores with CS and DASH changes were .61 and -.84, respectively (both P < .001). Effect size was 0.96, with a standardized response mean of 0.91, indicating good responsiveness.Conclusion: Applied to a variety of RC patients, the WORC had high internal consistency, moderate to good construct validity, high test-retest reliability, and good responsiveness. These findings support the use of the WORC as a condition-specific self-reported outcome measure in RC patients, but its validity in patients with severe symptoms needs further investigation.