ORTHOPAEDIC OUTCOME ASSESSMENT

Cross-cultural adaptation and validation of the German versionof the Western Ontario shoulder instability index

Jochen G. Hofstaetter • Beatrice Hanslik-Schnabel •

Stefan G. Hofstaetter • Christian Wurnig •

Wolfgang Huber

Received: 11 October 2009 / Published online: 24 December 2009

� Springer-Verlag 2009

Abstract

Background The Western Ontario shoulder instability

index (WOSI) is a disease-specific quality of life measure-

ment tool with 21 items for patients with shoulder instability.

Here, we report on translation and validation of the German

version of the WOSI according to international guidelines.

Patients and methods A total of 86 patients in three

groups were included in this study. In group I, 24 patients

underwent surgical stabilization of the shoulder. Preoper-

atively and at 12 months post-operatively the WOSI, Rowe

score, UCLA, Constant score, and the SF-36 were evalu-

ated. In group II, 25 patients were evaluated 2.6 ±

1.2 years after sustaining a primary traumatic shoulder

dislocation. Group III consisted of 37 healthy men and

women with normal, healthy shoulders. Evaluation of

Pearson’s correlation coefficient between WOSI and Rowe

score, UCLA, SF-36 and Constant score and for test–retest

reliability was made. Moreover, Cronbach’s alpha and

floor, and ceiling effects were analyzed.

Results Internal consistency was high (Cronbach’s alpha

0.92).Test–retest reliability (Pearson correlation coeffi-

cient) was excellent (r = 0.92). The construct validity

showed a significant correlation between the WOSI and the

scores investigated. There were no floor or ceiling effects

for the German WOSI score.

Conclusion The German translation of the WOSI is a

valid and reliable tool, applicable to outcome studies on

patients with shoulder instability.

Keywords Shoulder instability � Quality of life �Score � WOSI � Translation � Validation

Introduction

A patient’s subjective impression of their health status is a

very important factor to determine the success of a treat-

ment [1]. It has been shown that clinical examination

variables, even when performed by experienced clinicians,

have very poor reliability [2] and correlate poorly with

patients’ subjective evaluations of their function [3] mak-

ing them ineffectual as measures of function. It has also

been shown that physicians tend to evaluate their patients

as functioning better than the patients perceive themselves

to be [4] making it important for measurement tools to be

self administered by the patients. Global health-related

quality of life measurement tools such as SF-36 [5], Index

of Well-Being [6], Sickness Impact Profile [7] were

developed, but these scores are generally poor at detecting

small but clinically important changes in the quality of life

of patients with specific medical conditions [8, 9].

Epidemiological studies suggest that between 7 and 25%

of the general population suffers from shoulder problems [10,

11]. Therefore, several shoulder-disease-specific quality-of-

life instruments such as the Western Ontario rotator cuff

index (WORC) [12], Oxford shoulder score (OSS) [13],

rotator cuff quality-of-life measure (RC-QOL) [14] were

J. G. Hofstaetter (&) � B. Hanslik-Schnabel � C. Wurnig �W. Huber

Department of Orthopaedic Surgery, Vienna General Hospital,

Medical University of Vienna, Waehringer Guertel 18-20,

1090 Vienna, Austria

e-mail: jochen.hofstaetter@meduniwien.ac.at

J. G. Hofstaetter

Department of Orthopaedic Surgery, Children’s Hospital,

Harvard Medical School, Boston, MA, USA

S. G. Hofstaetter

Department of Orthopaedics, Klinikum Wels, Wels, Austria

123

Arch Orthop Trauma Surg (2010) 130:787–796

DOI 10.1007/s00402-009-1033-3

recently developed. The responsiveness value of disease-

specific quality-of-life scores is higher than for any of the

conventional scores [15]. The main advantage of a highly

responsive scale is that fewer subjects are required in clinical

trials to show a statistically significant difference between

treatment groups [15]. However, these scores were mostly

developed in English speaking countries, and a simple word-

by-word translation of an instrument does not correspond to

requested and accepted guidelines. There are definitive

guidelines set up by the Medical Outcome Trust (MOT) and

its Scientific Advisory Committee (SAC) how to cross-cul-

turally adapt and validate quality-of-life and health status

instruments [16]. These guidelines should be observed in

order to obtain measuring instruments conducive to compa-

rable scientific values. We recently translated and validated

several scores that were developed for subjective evaluation

of degenerative changes in the shoulder [17–19] and subse-

quently tested their reliability in cross-sectional studies.

Instability of the glenohumeral joint is a common

shoulder problem affecting patients most often in their

second and third decades of life [20]. The risk of sustaining

a traumatic anterior dislocation of the shoulder is between 1

and 2% over one’s lifetime [20]. In addition to traumatic

anterior dislocations of the shoulder, there are many other

categories of symptomatic shoulder instabilities that sig-

nificantly increase the overall prevalence of shoulder

instability in the general population. A wide range of con-

servative and surgical treatment modalities is available,

which are all designed to improve a patient’s quality of life

[21]. Shoulder instability is not easy to objectify and score

since it is often just the ‘‘feeling’’ of slipping and the

‘‘feeling’’ of being unable to ‘‘trust’’ the shoulder that leads

to a shoulder-related decrease in quality-of-life. Kirkley

et al. [22] developed the Western Ontario shoulder insta-

bility index (WOSI), which is a valid, reliable, and

responsive disease-specific quality of life measurement tool

for patients with shoulder instability. The WOSI has 21

items representing the domains (1) physical symptoms, (2)

sports/recreation and work, (3) lifestyle, and (4) emotions.

The WOSI is a highly recommended score for the evalua-

tion of shoulder instability with high reliability and

responsiveness [23, 24]. The presence of translated and

validated scores would allow direct international compari-

son of national studies and would simplify the problems of

meta-analysis for clinical research [9, 25]. Moreover,

translated and validated scores are essential for multi-cen-

tric multinational studies which will be more common in the

future [26]. Recently, Salomonsson et al. [27] published the

translation and validation of the Swedish version of the

WOSI. To date, no German version of the WOSI exists.

The purpose of this study was to describe the process

used to translate and to test the adequacy of the German

version of the Western Ontario shoulder instability index

(WOSI) in terms of reliability and validity. The final ver-

sion for use in clinical trials in German-speaking popula-

tions is presented.

Materials and methods

Western Ontario shoulder instability index (WOSI)

The development of the shoulder-instability-specific qual-

ity-of-life measurement (WOSI) by Kirkley et al. [22]

included the generation of issues specific to the ‘‘disease’’

and subsequent item reduction using patient-generated fre-

quency-importance products and correlation matrices [22].

The final instrument has 21 items representing four domains.

The first domain, which is physical symptoms, contains ten

items. The remaining domains are sports, recreation, and

work (four items); lifestyle (four items); and emotions (three

items). The response format selected for the instrument was

the 10-cm VAS anchored verbally at each end. The best score

possible is 0, which signifies that the patient has no decrease

in shoulder-related quality of life. The worst score possible is

2,100. This signifies that the patient has an extreme decrease

in shoulder-related quality of life. The score can also be

presented as percentage with 100% (0 points) being the best

score and 0% (2,100 points) being the lowest score [27].

Translation

Translation of the WOSI was done according to the guide-

lines in the literature [16, 28] by three bilingual people with

German mother tongue and clinical experience. Standard

German as preferred in most of the German-speaking parts

of Europe—such as Germany, Switzerland, and Austria and

the German-language media—was used. The choice of

simple and precise wording was requested, to enable the use

of this questionnaire in all German-speaking areas [29].

Equality of sense and not equality of the vocabulary was

given priority [30]. During a conference, consensus was

achieved on a first preliminary German version based on the

three translations. Subsequently, two professional transla-

tors, with English mother tongue, retranslated this version.

Neither of these two translators was familiar with the ori-

ginal score. Neither was involved in the process of valida-

tion, either prior to the translation or afterward, and each

edited an independent version. Only one of the English

native speakers was experienced in medical literature.

Finally, five people—three orthopedic surgeons, one psy-

chologist, and one medical student—examined all versions.

Afterward, consensus was achieved on the final German

translation (see Appendix). Within a preliminary test, the

final version was presented to 12 people without and to ten

people with shoulder problems to test for comprehensibility.

788 Arch Orthop Trauma Surg (2010) 130:787–796

123

No further changes were required. This study was conducted

in accordance with the guidelines of the local ethics com-

mittee as well as the Helsinki Declaration.

Psychometric testing

Reliability

Reliability is a measure of consistency or degree of

dependability. It can be divided into two major classes: (1)

internal consistency and (2) reproducibility or test–retest

reliability [31]. Internal consistency, which is a measure of

equivalence, is the ability of a scale to measure a single

coherent concept [31, 32]. It was assessed by calculating the

Cronbach’s coefficient alpha [33]. The range of a coefficient

varies between 0 and 1. A higher Cronbach’s coefficient

alpha points to a higher correlation between the questions,

which in turn points to a more exact evaluation of a defined

parameter (e.g., body function) by the questions. A value of

0.65 is regarded as the lower limit. A Cronbach’s alpha of

0.8 represents a good value, and results ranging 0.8–0.95 are

regarded as excellent. A value above 0.95 must be regarded

as an indication that several questions deal with the same

parameter and that therefore, some of them should be

regarded as unnecessary. The test–retest reliability, which is

a measure of stability, is the ability of a scale to give the

same results when administered on separate occasions. It

was evaluated in a group of stable patients, who repeated the

questionnaire after 24–72 h. Correlation between the total

results of both tests was determined by the Pearson corre-

lation coefficient, and the result was regarded as the measure

of reproducibility. A correlation coefficient (r) of 0 means

no reproducibility, whereas a value of 1 shows perfect

correlation. Furthermore, the difference between the two

tests was calculated. To detect systematic trends, the con-

fidence intervals for the mean difference were calculated

and paired Student’s t tests were performed. Confidence

intervals close to zero indicate no relevant systematic trends.

Validity

Validity is an index of how well a test measures what it is

supposed to measure. In this case that meant assessing the

validity of the German version of the WOSI. The Pearson cor-

relation coefficient was calculated between the WOSI and the

Rowe scores [34], The Constant score [35], the UCLA shoulder

rating scale [36] and the short-form of the SF-36 [5, 37, 38].

The Rowe score [34] assesses patients based on three

separate areas—stability, motion, and function—with one

item for each of these areas. The weighting is such that sta-

bility accounts for 50 points, motion for 20 points and function

for 30 points, giving a total possible score of 100 points. The

Constant score has become the most widely used shoulder

evaluation instrument in Europe. This scoring system com-

bines physical examination tests with subjective evaluations

by the patients. The subjective assessment consists of 35

points and the remaining 65 points are assigned for the

physical examination assessment. The subjective assessment

includes a single item for pain (15 points) and four items for

activities of daily living (work 4, sport 4, sleep 2, and posi-

tioning the hand in space 10 points). The objective assessment

includes: range of motion (forward elevation, 10 points; lat-

eral elevation, 10 points; internal rotation, 10 points; external

rotation, 10 points) and power (scoring based on the number

of pounds of pull the patient can resist in abduction to a

maximum of 25 points). The total possible score is therefore

100 points. The publication by Constant [35] in which he

describes the instrument does not include methodology for

how it was developed and more specifically, the rationale for

item selection and relative weighting of the items.

The UCLA shoulder rating scale [36] was intended to be

used in studies of patients undergoing total shoulder arthro-

plasty for arthritis of the shoulder. Since then, however, it has

been used for patients with other shoulder conditions,

including rotator cuff disease [39] and shoulder instability

[40]. The medical outcome study short form 36 (MOS SF-36)

[5, 37, 38] is a 36-item questionnaire, widely used to assess

general health. It provides scores on eight dimensions: phys-

ical function, social function, limitations caused by physical

symptoms, limitations caused by emotional problems, general

mental health, vitality, pain, and perception of general health.

Time needed, comprehensibility, and acceptance

All patients were asked to note the time they required to

answer the questions. Comprehensibility and acceptance of

the questionnaire were evaluated based on compliance, i.e.,

how many questions were answered and how many skip-

ped. Additionally, the time needed for evaluation of the

questionnaires was recorded.

Statistical evaluation

Unpaired t test was used to calculate statistical significance

between WOSI score of Groups II and III. Paired t test was

used to calculate statistical significance between the pre-

and post-op WOSI in Group I.

Statistical analyses were performed using the SAS/

STAT system, Version 8 (1999), SAS Institute, Cary, NC,

USA and Graph Pad Prism 4.0 (San Diego, CA, USA).

Patients

A total of 86 patients were included in this study. They

were divided into three groups. Patient demographics of

each group are summarized in Table 1.

Arch Orthop Trauma Surg (2010) 130:787–796 789

123

Group I (n = 24)

Between 2003 and 2007, 24 patients (16 females, 8 males)

with an average age of 34 ± 4.7 years underwent surgical

stabilization of the shoulder (Table 1). Preoperatively and at

12 months post-operatively the WOSI, Rowe score, UCLA,

Constant score, and the SF-36 were evaluated. This group

was used for the evaluation of Pearson’s correlation coef-

ficient between WOSI and Rowe, UCLA, Constant score

and SF-36. Moreover, evaluation of internal consistency by

Cronbach’s alpha and floor and ceiling effects were done.

Pre- and postoperative data were pooled for analysis.

Group II (n = 25)

During the period 2004–2008, 25 patients (13 females, 12

males) with an average age of 44 ± 11.7 with primary

traumatic shoulder dislocation were treated by closed

reduction. After an average of 2.6 ± 1.2 years patients

underwent a clinical examination of their shoulder and

WOSI, Rowe score, UCLA, Constant score, and the SF-36

were evaluated. Four out of the 25 patients underwent

arthroscopic stabilization of the shoulder at another hos-

pital since the initial traumatic shoulder dislocation

(Table 1).

This group of 25 patients was used for evaluation of the

criterion validity, expressed as Pearson’s correlation coef-

ficient between WOSI and Rowe score, and test–retest

reliability.

Group III (n = 37)

As a reference group of how a population without shoulder

problems would score in the WOSI, we asked 37 healthy men

and women (medical students and residents) with normal,

healthy shoulders to answer the questionnaire (Table 1).

Results

The questionnaires were evaluated for a total of 86

patients, and all patients were investigated clinically. The

mean time required for completing the questionnaire was

5 min 55 s (range 2–11 min). No question was unanswered

or skipped. The mean time required for evaluation of the

questionnaire was 3 min 35 s (range 2 min–5 min).

Internal consistency

Internal consistency was high (Cronbach’s alpha 0.92).

Elimination of one item in all 21 cases did not result in a

value\0.90. Among the domains, the lifestyle domain had

the lowest value of Cronbach’s alpha (0.68) (Table 2).

Reproducibility

Twenty-five patients (Group II) filled out the questionnaire

twice for testing of test–retest reliability. The Pearson

correlation coefficient was r = 0.92. The mean difference

between both tests was 8.1 points (standard deviation 109.1

points; 95% confidence interval -37.3 to 53.2) and did not

show a significant difference (Table 3).

Construct validity

The construct validity was tested by the Pearson correlation

coefficient (Table 4). As assumed there was a significant

correlation between WOSI and the investigated individual

scores. Physical subscales of the MOS SF-36 exhibited

higher values than emotional/mental components. There

were no floor and no ceiling effects for the WOSI score.

In group I, the mean pre-op WOSI score was

50.83 ± 7.5% and was significantly higher at the 1-year

post-op follow-up (68.2 ± 7.6%, P \ 0.0001). This

Table 1 Patient demographics of Groups I, II, and III included in this

study

Group I (n = 24)

Age (years) 34 ± 4.7

Sex (F/M) 16/8

Diagnosis

Recurrent traumatic anterior instability 22

Recurrent traumatic anterior and inferior instability 2

Surgical stabilization (arthroscopic/open) 11/13

Average time after surgery (months) 12 ± 1.1

Group II (n = 25)

Age (years) 44 ± 11.7

Sex (F/M) 13/12

Diagnosis

Traumatic anterior dislocation 25

Surgical stabilization (arthroscopic) 4

Average time after surgery (years) 2.6 ± 1.2

Group III (n = 37)

Age (years) 24.1 ± 2.7

Sex (F/M) 22/15

Data are presented as mean ± SD

Table 2 Internal consistency

Domain Items Mean SD Range Cronbach’s alpha

Physical 10 68 25 18–99 0.90

Sport 4 61 33 5–99 0.87

Lifestyle 4 58 27 17–99 0.68

Emotion 3 45 26 12–100 0.85

WOSI total score 21 67 25 47–99 0.92

790 Arch Orthop Trauma Surg (2010) 130:787–796

123

corresponds to an average 32.5% improvement (ranging

from a 54.9% improvement to a 1.7% worsening in one

patient) (Fig. 1a). The mean WOSI score in Group II was

71.3 ± 8.7%, and was significantly different from Group

III (96.1 ± 2.6%; P \ 0.0001) (Fig. 1b). In the reference

group III with normal, healthy shoulders no floor effects

and high ceiling effects in all items were observed

(Table 5).

Discussion

Most therapies in orthopedics are designed to improve

quality of life rather than to extend the duration of a

patient’s life. A patient’s subjective impression of their

health status is therefore a very important factor to deter-

mine the success of a treatment, and a measure of quality of

life is required to assess the benefit of such interventions.

Many treatments have been advocated for these various

forms of instability. Brophy et al. [21] recently performed a

systematic review analyzing the literature for the latest

evidence comparing outcomes of treatment for traumatic

anterior instability of the shoulder. They found that rates of

recurrent instability after a first-time anterior shoulder dis-

location, particularly in young active male patients, are

reduced by surgical intervention compared with nonopera-

tive treatment [21]. If surgical treatment is indicated, an

arthroscopic approach using suture anchors appears to have

similar results in terms of recurrent instability to an open

approach using suture anchors [21]. Shoulder instability is

more complex to evaluate and to score than other shoulder

diseases such as rotator-cuff tears, etc. Since in mild forms,

it is often just the ‘‘feeling’’ of slipping and just the ‘‘feel-

ing’’ of being unable to ‘‘trust’’ the shoulder that leads to a

shoulder-related decrease in quality-of-life. There are a

number of measurement tools for patients with shoulder

problems. The most commonly used in orthopedic publi-

cations are the Rowe rating system [34], the UCLA shoul-

der rating scale [36], the ASES [41], and the Constant score

[35]. However, these older instruments have been devel-

oped at a time when little information was available on the

appropriate methodology for instrument development [15].

The Western Ontario shoulder instability index (WOSI) is

more responsive (sensitive to change) than other shoulder

measurement tools (the Disabilities of the Arm, Shoulder

and Hand scale; The American Shoulder and Elbow Sur-

geons Standardized Shoulder Assessment Form; the UCLA

shoulder rating scale; the Constant score; and the Rowe

rating scale), a global health instrument (the SF12), and

range of motion [22]. Out of ten different scoring systems

that are available for the assessment of shoulder instability,

the WOSI was the most recommended score [23]. More-

over, a comparative evaluation of the measurement prop-

erties of various shoulder outcome instruments also showed

that the WOSI has the best reliability and responsiveness in

shoulder instability [24]. Appropriate international use of

these disease-specific quality-of-life tools depends on

adapting them to different languages and cultures while

maintaining cultural equivalence [28]. The presence of

culturally equivalent outcome measures would allow direct

Table 3 Test–retest reliability after 24–72 h

Domain Intraclass correlation

coefficient (r)

WOSI total score 0.98

Physical symptoms 0.92

Sport/recreation/work 0.87

Lifestyle 0.92

Emotions 0.93

Table 4 Correlation between WOSI and Rowe rating scale, UCLA

shoulder rating scale, Constant score, and MOS SF-36

Correlation with WOSI

Rowe rating scale 0.627

UCLA shoulder rating scale 0.609

Constant score 0.590

MOS SF-36

Physical functioning 0.44

Pain 0.56

Vitality 0.33

Role emotional 0.32

Role physical 0.39

Social functioning 0.32

Mental health 0.38

General health 0.34

All correlations P \ 0.0001

Fig. 1 a Pre- and postoperative WOSI Score at 1-year follow-up

of 24 patients who underwent surgical stabilization of the shoulder.

b Individual WOSI scores of Groups II and III (control group). Blackboxes in Group II indicate the four patients who underwent surgical

stabilization of the shoulder

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123

international comparison of national studies and would

simplify the problems of meta-analysis for clinical research

[9, 25, 42, 43]. Moreover, in order to provide more statis-

tical power of randomized controlled trials in orthopedics

more multi-centric and multinational studies may be needed

in the future [26]. Therefore, there is a need for a validated

scoring instrument enabling comparison of treatment results

and, thereby, international studies.

Recently, a translation of the WOSI was made into

Swedish and retested by analyzing the psychometric

properties validity, reliability, and responsiveness [27]. To

date, no German version of the WOSI exists; hence, there

is a necessity for a measuring instrument for German-

speaking regions to allow subjective evaluation of a

patient’s condition.

Here, we present the translation, cross-cultural adaption,

and validation of the German version of the Western

Ontario shoulder instability index (WOSI) for patients

suffering from shoulder instability. Examination of reli-

ability resulted in a Cronbach’s coefficient alpha of

r = 0.92, an excellent value. Testing of reproducibility was

done within a short time in order to minimize changes in

the clinical status of patients. Both statistical methods

exhibited a good reproducibility. The test–retest reliability

was slightly higher in our study (r = 0.98) than in the

Swedish study (r = 0.94) [27], which can be explained that

our re-test was done within 72 h and the one done by

Salomonsson et al. [27] was done within 2 months. The

correlation coefficient between the absolute values of

WOSI, Rowe, Constant–Murley score, UCLA score was

generally modest. It is noteworthy that the Pearson’s cor-

relation coefficient with Rowe score 0.627 is very close to

the value of 0.61 presented by Kirkley et al. [22] for the

original English version of the score [22] and 0.59 for the

Swedish version [27]. As expected, the SF-36, which is a

global measure of health, was found to have a low corre-

lation to the disease-specific WOSI, but the subscales for

pain and body function of the SF-36 exhibited the highest

values. In comparison to other shoulder scores that have

been investigated, the WOSI score does well regarding

sensitivity to change for instability disorders of the

shoulder [15]. A high responsiveness also indicates that a

score is valid, which is supported by the high content

validity shown by minimal floor and ceiling effects. As

pointed out by Salomonsson et al. [27], some questions can

be raised about the suboptimal score value in their control

group of students with no shoulder problems. We also

found that most individuals of our control group III did not

reach the maximum score. Several items in the WOSI

relate to symptoms that not are entirely shoulder-associ-

ated—but that could in any case be relevant and sensitive

for a patient with a history of shoulder instability. For

example, questions 5, 6, and 7 relate to clicking, stiffness,

and symptoms from neck muscles; these are not necessarily

related to shoulder disorders or impaired function. Another

possible explanation why the score is not 100% for all

individuals with healthy shoulders may support the idea

that the score is highly sensitive for patients with even

minor symptoms [27].

The demanded criteria for a measuring instrument are

comprehensive questioning, quick filling-in by the patient,

and time-saving evaluation by the examiner, as well as easy

administration and suitability of the questionnaire [44]. The

structure of the questions of the WOSI is simple, and they

are easily understood, resulting in a high percentage of

answers and an excellent acceptance by patients. For the

patient, detailed supplementary instructions and explana-

tions are not necessary for independent answering of the

questions. Wiesinger et al. [29] showed that the use of

standard German does not create problems of understanding

in German-speaking patients of different nations (Germany,

Austria, Switzerland). Therefore, no regional restriction in

the use of the German version of the WOSI is necessary. In

conclusion, the German version of the WOSI is an adapted

and validated measuring instrument for clinical use, trans-

lated according to international standardized guidelines for

patients suffering from shoulder instability.

Conflict of interest statement The authors have no conflict of

interest. We certify that no party having a direct interest in the results

of the research supporting this article has or will confer a benefit on us

or on any organization with which we are associated.

Table 5 WOSI score and domains of reference group III (n = 37) with normal healthy shoulders

Domain Items Mean (%) Range Number

at floor

Percentage

at floor

Number

at ceiling

Percentage

at ceiling

Physical 10 93 70–100 0 0 9 24.3

Sport 4 97 92–100 0 0 26 70.3

Lifestyle 4 98 93–100 0 0 22 59.8

Emotion 3 97 68–100 0 0 24 64.9

WOSI Total Score 21 97 84–100 0 0 11 29.8

Presented and percentage of a healthy shoulder (maximum 100%) for domains and the WOSI score. Floor and ceiling considered as being 0–1

and 99–100%, respectively

792 Arch Orthop Trauma Surg (2010) 130:787–796

123

Appendix

German version of Western Ontario Shoulder-Instability

Index (WOSI-G)

1. Wie stark ist der Schulterschmerz in Ihrer betroffenen Schulter bei Aktivitäten über

dem Kopf ?

2. Wieviel stechende und/oder pochende Schmerzen verspüren Sie in der betroffenen

Schulter ?

Keine Schmerzen

Extreme Schmerzen

KeinStechen/Pochen

Extremes Stechen/Pochen

3. Wie groß empfinden Sie die Schwäche oder den Mangel an Kraft in Ihrer betroffenen

Schulter ?

4. Wie stark empfinden Sie die Ermüdung oder den Mangel an Ausdauer in Ihrer betroffenen Schulter ?

5. Wie stark klickt, schnappt oder knackt es in ihrer betroffenen Schulter?

6.Wie steif empfinden Sie Ihre Schulter ?

7.Wie stark sind die Beschwerden im Bereich der Nackenmuskulatur aufgrund Ihrer

Schulterproblematik ?

Keine Schwäche

Extreme Schwäche

Keine Ermüdung

Extreme Ermüdung

Gar Nicht

Extrem

NichtSteif

ExtremSteif

Keine Beschwerden

Extreme Beschwerden

I.Teil: Körperliche Beschwerden:

Die folgenden Fragen betreffen die Beschwerden die Sie aufgrund Ihrer

Schulterproblematik haben. Bitte tragen Sie bei jeder Frage jenen Schweregrad Ihrer

Beschwerden ein, den Sie in der letzten Woche verspürt haben, indem Sie auf der

horizontalen Linie ein "X" eintragen.

8.Wie stark ist das Instabilitätsgefühl in Ihrer Schulter ?

9.Wie stark müssen Sie andere Muskeln benützen um Ihre eingeschränkte Schulterfunktion auszugleichen ?

10.Wie groß ist der Verlust des Bewegungsumfanges in Ihrer Schulter ?

KeinInstabilitätsgefühl

Extremes Instabilitätsgefühl

Gar Nicht

Extrem

Kein Verlust Extremer Verlust

Arch Orthop Trauma Surg (2010) 130:787–796 793

123

II.Teil: Sport / Freizeit / Arbeit:

In den folgenden Fragen geht es darum wie stark Ihre Schulterproblematik Ihre Arbeit,

Sport- und Freizeitgewohnheiten in der letzten Woche beeinflußt hat. Bitte tragen Sie

wiederum den Schweregrad mittels eines "X" auf der horizontalen Linie ein.

11. Wie stark hat Sie ihre Schulter behindert Sport oder andere Freizeitaktivitäten zu

betreiben?Keine Behinderung

Extreme Behinderung

12. Wie stark hat Ihre Schulterproblematik spezielle Tätigkeiten in Ihrem Sport und/oder

Ihrer Arbeit beeinflußt ? (Falls beide Gebiete betroffen sind, bewerten Sie das stärker

betroffene )

13. Wie groß ist der Drang ihren Arm währ end einer Aktivität zu schützen ?

14. Wie schwer fällt es Ihnen, auf Grund Ihrer Schulterproblematik schwere

Gegenstände bis auf Schulterhöhe zu heben?

GESAMT:_________(max. 400 )

Gar nicht Extrem stark

NichtVorhanden

ExtremStark

Keine Probleme

Extreme Probleme

III. Teil: Alltag:

In den folgenden Fragen geht es darum wie stark Ihre Schulterproblematik Ihre

Lebensweise in der letzten Woche beeinfl ußt hat. Bitte tragen Sie wiederum den

Schweregrad mittels eines "X" auf der horizontalen Linie ein.

15. Wie groß ist die Angst auf Ihre betroffene Schulter zu fallen ?

16. Wie schwierig ist es für Sie, auf Grund Ihrer Schulterprobleme Ihre gewünschte Fitness beizubehalten?

17. Wie stark ist Ihr Freizeitvergnügen mit Familie und Freunden eingeschränkt ?

18. Wie stark beeinträchtigt die Schulter Ihren Schlaf ?

GESAMT:__________(max. 400 )

NichtVorhanden

ExtremGroß

NichtSchwer

Extremschwer

Nichteingeschränkt

ExtremEingeschränkt

Gar Nicht

Extrem Stark

794 Arch Orthop Trauma Surg (2010) 130:787–796

123

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TOTAL SCORE : .............. (max.2100)

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