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Measuring up to shoulder pain
  1. Industrial and Community Health Research Centre, North Staffordshire Medical Institute, Hartshill, Stoke on Trent ST4 7NY

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Shoulder pain is common, affecting 15–30% of adults at any one time,1 of whom 1 in 20 will visit a general practitioner in the course of a year.2 What is the most useful way to categorise such a common symptom to measure its impact, study its aetiology, and determine the efficacy and effectiveness of treatment?

The clinical literature gives primacy to classifications based on presumed pathology. There is little concrete evidence that exalting most shoulder pain with terms such as tendonitis, bursitis or impingement syndrome is either reliable or useful, and such classifications cannot anyway provide a measure of outcome. Clinical measures of shoulder function, such as range of movement, provide a means to classify shoulder problems into subgroups and to assess change over time. However, they do not necessarily reflect patient well being or the ability to carry out usual activities. So the field is open for self completed questionnaires that assess symptom severity and the impact of shoulder pain on everyday living.

At least four instruments that measure function in this way have appeared recently.3-7 They include one (the Dutch Shoulder Disability Questionnaire or SDQ), which has received further study in this issue,6 ,7 two American schedules: the SPADI,3 and the Shoulder Rating Questionnaire or SRQ,4 and a British disability questionnaire.5 A number of others, such as the Dutch Shoulder Function Assessment,8 incorporate range of movement measurements by an observer, in addition to items completed by the patient. Each, like many new scales accepted for publication these days, have met some or all of the technical criteria of a “good” instrument (repeatability, validity, and responsiveness to change). Readers who are seeking a simple standard tool for use in clinical practice, audit or research, may …

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