aBsTRacT. INTRODUCTION: The Constant Score (CS), developed as a . centimetre “paper” visual scale both for pain and for .. Constant CR, Murley AHG. Home / Free online Constant Shoulder Score calculator The Constant-Murley score contains both physician-completed and patient-reported portions. The four . : Datum: Constant-Murley Scale. Schoudergewricht. Datum. ______. ______. ______. Pijn. – geen. – mild. ______.

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The articles on which the standardized evaluations were based are presented in Online Appendix 2. Individual standardized evaluations are available from the corresponding author, upon reasonable request. The objective of this study was to evaluate the psychometric properties of the Constant—Murley Score CMS in various shoulder pathologies, based on a systematic kurley and expert standardized evaluations. Titles and abstracts were reviewed and finally the included articles were grouped according umrley patients’ pathologies.

Two expert evaluators independently assessed the CMS properties of reliability, validity, responsiveness to change, interpretability and burden score in each group, using the EMPRO Evaluating Measures of Patient Reported Outcomes tool. The CMS properties were assessed per attribute and overall for each considered group. Only the concept and measurement model was assessed globally. Five individual pathologies i. Responsiveness to change was the only quality to obtain at least 50 points across all groups, but for frozen shoulder.

Insufficient information was obtained in relation to the concept and measurement model and great variability was seen in the svale evaluated attributes. The current evidence does not support the CMS as a gold standard scsle shoulder evaluation.

Constant-Murley Shoulder Outcome Score

Its use is advisable for subacromial pathology; but data are inconclusive for other shoulder conditions. Prospective studies exploring the psychometric properties of the scale, particularly for fractures, arthritis, instability and frozen shoulder are needed. The online version of this article The Constant—Murley Score CMS was presented in as an instrument to evaluate overall shoulder function, irrespective of diagnosis [ 1 ].

It was approved and recommended by the executive committee of the European Society for Surgery of the Shoulder and the Elbow and has been widely used as an assessment method ever since [ 2 — 4 ]. The CMS scale assesses four aspects related to shoulder pathology; two subjective: The subjective components can receive up to 35 points and the objective 65, resulting in a mufley maximum total score of points best function.

Pain and ADL are answered by the patient; ROM and strength require a physical evaluation and are answered by the orthopaedic surgeon or the physiotherapist [ 1 ]. Mirley its wide acceptance and frequent use, certain concerns related to the suitability of the CMS scale have been raised over the years.

A number of publications mention lack of information, as far as the methodology used during its development process, item selection criteria, score distribution, reliability and validity are concerned [ 2356 ].

Others have questioned its application to certain shoulder pathologies [ 578 ]; differences according to age and sex murkey been observed [ 910 ] and lack of standardization in measuring the strength component has been criticized [ 1112 ].

A visual analog scale VAS was suggested for the pain item, and part of the ADL questions and specific instructions on how to evaluate the strength component were presented. It was also stated that the CMS is not valid for evaluating episodic severe pain, as in dislocation.

Finally, a score modification, adjusting for age and sex was proposed [ 13 ]. The psychometric properties of the CMS questionnaire have been the subject of literature reviews [ 34 ], general systematic reviews [ 14 ] and reviews on specific shoulder pathologies [ 1516 ].

However, up to date, no standardized evaluation of mudley properties in various shoulder diagnoses has been presented. The evaluating measures of patient reported outcomes EMPRO tool was created for evaluating the psychometric properties of patient reported outcomes PRO [ 17 ].


This tool is composed of a broad spectrum of questions and specific recommendations on how each property should be assessed.

Constant Murley Score

It requires the murlwy of expert evaluators and offers standardized and comparable results. It assesses the concept and measurement model scal a scale as well as the cosntant of reliability, validity and responsiveness to change, among others; and it has been previously used in the evaluation of different PRO scales [ 18 — 20 ].

The purpose of the current study was to perform a systematic literature review and a standardized evaluation of the CMS properties. The evidence was grouped according to the type of shoulder diagnosis. Subacromial, fractures, arthritis, instability and frozen shoulder pathologies were assessed, while data on various pathologies and healthy subjects were also evaluated.

The current results will offer clinicians and researchers more insight on the CMS psychometric properties, allowing for the latter to be compared between different diagnostic groups.

To the best of our knowledge, it is the first time that a CMS evaluation with these characteristics is performed. For specific strategies see Online Appendix 1. Articles presenting information on the development process, the psychometric properties and the administration of the CMS tool were eligible for inclusion. Articles written in English, Spanish, French, German and Italian were included in the evaluation stage.

Opinion letters, congress abstracts, study protocols, case studies, articles on animal and cadaveric studies presenting information on surgical or other techniques applicable to shoulder pathologies were excluded. A third researcher YP was appointed to resolve possible discrepancies if needed. In order to complete the search, the reference lists of all finally selected articles were also hand searched.

Constant Murley Score | Bone and Spine

General shoulder review articles were not given to the evaluators, but were read and their references hand searched by the previous two authors. Review articles on specific shoulder pathologies were not evaluated per se, but were given to the evaluators for consideration and possible identification of further references on relevant data. Patient pathologies of all included articles were noted and were subsequently grouped according to their characteristics.

The grouping criteria were established by one of the co-authors RC: Its score ranges from 0 to points, representing worst and best shoulder function, respectively. In the original publication, the pain experienced during normal activities of daily living was scored as: The most recent publication recommends these options to be replaced by a VAS, maintaining the 15 points score range [ 13 ].

The ADL component is assigned a maximum of 20 points and evaluates limitations in doing normal work, recreational activities, unaffected night sleep and positioning the arm up to a certain level. The first two items were originally scored as: In the latest publication a VAS was suggested for both questions [ 13 ], while the score range of the other two would remain the same.

Night sleep is assessed as: And finally arm positioning: The ROM part evaluates four active ranges of motion, conetant 10 points each, i. Elevation degrees are measured with a goniometer in a seated position and scores range from: External rotation is based muroey five unassisted hand manoeuvers, assigned 2 points each: Internal rotation was initially measured with the dorsum of the hand pointing to certain parts murleyy the body, but in the most recent publication, the thumb was suggested as a pointer to the following anatomic landmarks: The consyant component is given 25 points.

The maximum value of three consecutive repetitions should be used. When desired abduction cannot be reached, then the subject is given 0 points [ 13 ].


Given the importance that age and sex have in the functional capacity of the shoulder, an alternative CMS scoring, adjusting for these two variables, was also proposed. Based on values derived by healthy subjects, the relative CMS is calculated as the original CMS divided by the respective age and sex-matched healthy values [ 13 ].

It is scalw of 39 items divided into 8 attributes: Eleven shoulder PRO scales have also been evaluated with this tool [ 18 ]. All evaluators reviewed the corresponding full text articles, murlry in the assessment tool and were subsequently given access to the evaluation of their pair. Discrepancies were discussed and a final consensus was reached in all cases. An attribute and an overall score were derived per pathology. Mean responses were linearly transformed to a point scale, with higher values suggesting better properties; scores of 50 or more points are considered to be acceptable [ 18 ].

Two sub-scores are estimated for the attributes of reliability i. The burden scores are presented separately and are not affecting any further calculations. This score was calculated if at least 3 of those 5 attributes had a rating and attributes with insufficient information were given 0 points.

It was not deemed necessary for all reviewers to repeat this evaluation, given that the same published information would have to be evaluated by all. For dcale reasons, the two burden attributes were evaluated per pathology group.

Likewise, the alternative forms of administration attribute, cosntant also evaluated per pathology. The systematic literature search identified unique titles, of those were excluded, for not being related to the studied topic.

A total of murlet were reviewed, of which were excluded, mainly for not donstant CMS use 68 or not reporting data on CMS properties The rest were excluded for being secondary research articles, case studies, study protocols, commentaries, animal and cadaveric and no shoulder related studies. Finally, at the full text revision phase, 24 articles were additionally excluded for not fulfilling the inclusion criteria.

Constant Shoulder Score – Orthopaedic Scores

One article was identified by hand search. PRISMA flowchart with numbers of included and excluded articles at each step of the systematic literature review.

The included articles were subsequently divided into five individual pathology groups, named: Studies presenting data on heterogeneous shoulder pathologies various pathologies and studies on healthy subjects were also evaluated. Each pair of evaluators reviewed between 1 i. Articles presenting elaborate data on more than one pathologies were additionally given to the corresponding pathology group evaluators. The subacromial pathology evaluators also assessed the concept and measurement model attribute based on the two publications written by the original CMS author.

The list of all considered publications is presented in Online Appendix 2. The subacromial group was the only one to surpass the threshold of 50 total points. Fractures and arthritis obtained Various pathologies and healthy subjects were assigned Information on CMS properties in frozen shoulder was insufficient.

For this reason, neither attribute but the concept and measurement modelnor total EMPRO scores were derived. IRT item response theory. Internal consistency scores were low and calculated only for the subacromial and various pathologies groups, which obtained 25 and On the other hand, reproducibility scores were noticeably higher.

Over 50 points were given to subacromial and fracture groups. Arthritis was assigned Lack of item response theory IRT information penalized reproducibility evaluations. Validity scores of the five individual pathology groups, oscillated between

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