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Reliability of a novel, web-based, shoulder-specific, patient-reported outcome instrument

Smith, Matthew J.; Marberry, Kevin M.

doi: 10.1097/BCO.0b013e3182781c05
Original Research

Background: Paper versions of patient-reported outcomes instruments frequently are used in clinical settings, but the use of multiple or time intensive instruments may reduce response rate because of responder burden.

Methods: Using questions from eight commonly used existing shoulder-specific patient-reported outcomes instruments, a single, condensed, web-based instrument was created. Existing instruments include 108 questions and the condensed questionnaire has 68 or fewer questions. Sixty consecutive patients within a single surgeon's academic shoulder and elbow practice completed a paper version of the Disabilities of the Arm, Shoulder, and Hand (DASH) and the entire web-based instrument before and after an office visit. Patients were randomized to which instrument was completed before their visit and completed the other instrument after the visit.

Results: Fifty-five patients completed both surveys. The mean score for the paper version of the DASH was 41.7 (SEM ±3.5, 95% CI: 34.6-48.8) and the mean for the web-based extracted score was 41.3 (SEM ±3.4, 95% CI: 34.4-48.1). Comparing the paper version with the web-based version of the DASH, the mean difference in scores was found to be −0.42 (SEM 1.0, 95% CI: −2.4-1.6, range −25.0-16.7).

Conclusions: The web-based shoulder specific outcomes instrument used in this study was able to generate a DASH score that was statistically similar to the traditional paper-based version of the DASH.

aDepartment of Orthopaedic Surgery, University of Missouri, Missouri Orthopaedic Institute, Columbia, MO

bA. T. Still University of Health Sciences, Kirksville College of Osteopathic Medicine, Kirksville, MO

Financial Disclosure: Dr. Smith is a consultant for DePuy and owns stock in Universal Research Solution. The authors report no financial conflicts of interest, and no external funding support was used to produce this study manuscript.

Correspondence to Matthew J. Smith, MD, University of Missouri Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, 1100 Virginia Ave., Columbia, MO 65212 Tel: +573 884 9037; fax: +573 882 1760; e-mail:

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