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Purpose
To assess functional disability of the shoulder
Link to Instrument
Acronym
SST
Area of Assessment
Range of MotionUpper Extremity Function
Primary Image
Simple Shoulder Test
Upper Extremity Function
Populations
Key Descriptions
- ? 12 items
? Minimum score is 0 % and maximum is 100%
? Items are scores as no=0 and yes=1. Overall score is calculated by: number of “yes”/number of completed items ?100 = % of “yes” response. 0 = worst and 100 = best function.
? It is self-reported outcome measure.
? The items on the scale measure the ability of the affected shoulder to perform work duties, dressing, bathing, lifting, carrying and throwing.
Number of Items
12
Time to Administer
2-3 minutes
Required Training
No TrainingAge Ranges
Adult
18 - 64
yearsOlder Adults
+
yearsInstrument Reviewers
Manish Nagwani, University of Indiana
Body Part
Upper ExtremityICF Domain
ActivityMeasurement Domain
MotorMusculoskeletal Conditions
back to PopulationsStandard Error of Measurement (SEM)
Shoulder Disorder:
(Roddey et al, 2000, n = 192, mean age = 47 (15) years)
SEM = 4.75 - 11.65
Minimal Detectable Change (MDC)
Shoulder Disorder:
(Roddey et al, 2000)
- MDC95 = 32.3
Minimally Clinically Important Difference (MCID)
Rotator cuff disease:
(Tashjian et al, 2010, n = 216, mean age = 27.8 (8.0) years)
- MCID for Rowe = 9.7
- MCID for ASES = 8.5
Shoulder Arthroplasty:
(Roy et al, 2010, n = 120, mean age 68.1 (9.8) years)
- MCID = 3.00
Shoulder Arthroplasty:
(Tashjian et al, 2017, n = 326, mean age = 67.4 (9.4) years)
- MCID = 2.4
Normative Data
Shoulder Arthroplasty:
(Roy et al, 2010, n = 120, mean age 68.1 (9.8) years)
|
|
Baseline (Pre-operative) |
6 months (post-operative) |
|
Hemiarthroplasty (n = 27) |
|
|
|
SST (0-12) |
1.6 ± 1.6 |
4.1 ± 2.6 |
|
Total shoulder arthroplasty (n = 62) |
|
|
|
SST (0-12) |
2.3 ± 2.2 |
7.1 ± 2.9 |
|
Reverse shoulder arthroplasty (n = 31) |
|
|
|
SST (0-12) |
1.6 ± 1.7 |
4.8 ± 2.8 |
|
SST, Simple Shoulder Test. |
|
|
Test/Retest Reliability
Shoulder instability and Rotator cuff injury:
(Godfrey et al, 2007, n = 1006)
- Excellent test-retest reliability (ICC = .98)
Internal Consistency
Shoulder Disorder:
(Roddey et al, 2000, n = 192, mean age = 47 (15) years)
- Excellent internal consistency (Cronbach’s alpha = 0.85)
Criterion Validity (Predictive/Concurrent)
Shoulder instability and Rotator cuff injury:
(Godfrey et al, 2007, n = 1006)
Concurrent Validity
- Adequate Correlation between the SST scale and physical functioning component of SF-12 scale (r = 0.439, P <.001)
- Excellent correlation between the SST scale and the ASES scale (r = 0.807, P <.001)
Construct Validity
|
Shoulder Arthroplasty: (Roy et al, 2010, n = 120, mean age 68.1 (9.8) years)
|
Convergent Validity:
Shoulder Disorder:
(Roddey et al, 2000, n = 192, mean age = 47 (15) years)
- Excellent correlation was found between the SPADI disability subscale score and the SST score (r = - .80). The negative value of r is because higher score in SPADI means more disability and higher score in SST means more functional.
- Adequate correlation between UCLA functional subscale score and the SST score (r = .60).
Discriminant Validity:
Shoulder Disorder:
(Roddey et al, 2000, n = 192, mean age = 47 (15) years)
- Adequate association was found between SPADI pain subscale and the SST score (r = -.69)
- Adequate association was found between UCLA pain subscale and the SST score (r = .48)
Floor/Ceiling Effects
Shoulder instability and Rotator cuff injury:
(Godfrey et al, 2007, n = 1006)
- Adequate floor effect was observed < 10% across age group and by injury type.
- Adequate celling effect was observed < 10% across age group and by injury type.
|
|
Floor effect % |
Celling effect % |
|
Overall |
1.6 |
7.1 |
|
Age group |
|
|
|
< 40 years |
2.3 |
9.5 |
|
40-60 years |
0.5 |
4.6 |
|
>60 years |
1.8 |
5.5 |
|
Injury type |
|
|
|
Instability |
2 |
9.3 |
|
Rotator cuff |
1.2 |
5.1 |
Rotator cuff disease:
(Beckmann et al, 2015, n = 187; mean age 59.5 (13.1) years)
- The SST demonstrated significant floor effects (21%) compared with the ASES (2.3%) and PF CAT (3.2%). Therefore, the SST has difficulty distinguishing between patients with lower shoulder function, with >20% of patients approaching the minimal score on the instrument.
- Adequate celling effect was observed among all three test PF CAT, ASES, and SST.
|
|
SST |
PF CAT |
ASES |
|
Floor effect |
20% |
3.2% |
2.3% |
|
Celling effect |
6% |
0.53% |
2.3% |
ASES, American Shoulder and Elbow Surgeons score; SST, Simple Shoulder Test; PF CAT, Patient-Reported Outcomes Measurement In- formation System (PROMIS) Physical Function Computerized Adaptive Test
Responsiveness
Shoulder instability and Rotator cuff injury:
(Godfrey et al, 2007, n = 1006)
|
|
n |
Effect size |
Standardized response mean |
|
Overall |
597 |
0.83 |
0.82 |
|
Age group |
|
|
|
|
< 40 years |
289 |
0.62 |
0.60 |
|
Instability |
239 |
0.61 |
0.61 |
|
Rotator cuff |
50 |
0.67 |
0.61 |
|
40-60 years |
211 |
1.06 |
1.05 |
|
instability |
47 |
0.63 |
0.83 |
|
Rotator cuff |
164 |
1.21 |
1.13 |
|
> 60 years |
97 |
1.12 |
1.08 |
|
Instability |
2 |
0.35 |
2.10 |
|
Rotator cuff |
95 |
1.14 |
1.10 |
|
Injury type |
|
|
|
|
Instability |
288 |
0.61 |
0.63 |
|
< 40 years |
239 |
0.61 |
0.61 |
|
40-60 years |
47 |
0.63 |
0.83 |
|
> 60 years |
2 |
0.35 |
2.10 |
|
Rotator cuff |
309 |
1.08 |
1.01 |
|
< 40 years |
50 |
0.67 |
0.61 |
|
40-60 years |
164 |
1.21 |
1.13 |
|
> 60 years |
95 |
1.14 |
1.10 |
Shoulder Arthroplasty:
(Roy et al, 2010, n = 120, mean age 68.1 (9.8) years)
- Responsiveness of self-reported measure in hemiarthroplasty, Total shoulder arthroplasty, and Reverse shoulder arthroplasty.
|
|
Improved (n = 94) |
Equivocal or worse (n = 26) |
||
|
|
ES |
SRM (95% CI) |
ES |
SRM (95% CI) |
|
SST |
2.23 |
1.73(1.41,2.05) |
0.76 |
0.50 (0.09,0.91) |
CI, confidence interval; ES, effect size; SRM, standardized response means; SST, simple shoulder test.
- Responsiveness of self-reported measures in patient improved following shoulder arthroplasty
|
|
ES |
SRM (95% CI) |
|
Hemiarthroplasty (n=17) |
|
|
|
SST |
2.17 |
1.72 (0.95,2.48) |
|
Total shoulder arthroplasty (n = 54) |
|
|
|
SST |
2.22 |
1.94 (1.48,2.39) |
|
Reverse shoulder arthroplasty (n = 23) |
|
|
|
SST |
2.87 |
1.43 (1.02,1.83) |
CI, confidence interval; DASH, Disabilities of the Arm, Shoulder and Hand questionnaire; ES, effect size; SRM, standardized response means; SST, simple shoulder test.
- Responsiveness of Impairment measure in patients improved following shoulder arthroplasty.
|
|
ES |
SRM (95% CI) |
|
Range of Motion |
|
|
|
Flexion |
1.25 |
0.98 (0.48,1.48) |
|
Abduction |
1.88 |
0.89 (0.46,1.33) |
|
External rotation in siting |
0.82 |
0.64 (0.35,1.60) |
|
External rotation in supine |
1.39 |
1.03 (0.47, 1.60) |
|
Internal rotation supine |
0.56 |
0.80 (0.28,1.32) |
|
Strength |
|
|
|
Flexion |
0.71 |
0.69 (0.31, 1.06) |
|
External rotation |
0.67 |
0.62 (0.28,0.96) |
|
Internal rotation |
0.25 |
0.32 (0.00, 0.64) |
ES, effect size; SRM, standardized response means
- Very short and easy to use and widely used in the United States.
- Good construct validity.
- Highly reliable and responsive for rotator cuff diseases.
- Highly responsive following shoulder arthroplasty.
Bibliography
Angst, F., Schwyzer, H., Aeschlimann, A., Simmen, B. R., & Goldhahn, J. (2011). Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care & Research, 63 Suppl 11S174-S188. doi:10.1002/acr.20630
Beaton, D. E., & Richards, R. R. (1996). Measuring function of the shoulder. A cross-sectional comparison of five questionnaires. The Journal of Bone and Joint Surgery. American Volume, 78(6), 882-890.
Beckmann, J. T., Hung, M., Bounsanga, J., Wylie, J. D., Granger, E. K., & Tashjian, R. Z. (2015). Psychometric evaluation of the PROMIS Physical Function Computerized Adaptive Test in comparison to the American Shoulder and Elbow Surgeons score and Simple Shoulder Test in patients with rotator cuff disease. Journal of Shoulder and Elbow Surgery, 24(12), 1961-1967. doi:10.1016/j.jse.2015.06.025
Godfrey, J., Hamman, R., Lowenstein, S., Briggs, K., & Kocher, M. (2007). Reliability, validity, and responsiveness of the simple shoulder test: psychometric properties by age and injury type. Journal of Shoulder and Elbow Surgery, 16(3), 260-267.
Roddey, T. S., Olson, S. L., Cook, K. F., Gartsman, G. M., & Hanten, W. (2000). Comparison of the University of California-Los Angeles Shoulder Scale and the Simple Shoulder Test with the shoulder pain and disability index: single-administration reliability and validity. Physical Therapy, 80(8), 759-768.
Roy, J., Macdermid, J. C., Faber, K. J., Drosdowech, D. S., & Athwal, G. S. (2010). The simple shoulder test is responsive in assessing change following shoulder arthroplasty. The Journal of Orthopaedic and Sports Physical Therapy, 40(7), 413-421. doi:10.2519/jospt.2010.3209
Tashjian, R. Z., Deloach, J., Green, A., Porucznik, C. A., & Powell, A. P. (2010). Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. The Journal of Bone and Joint Surgery. American Volume, 92(2), 296-303. doi:10.2106/JBJS.H.01296
Tashjian, R. Z., Hung, M., Keener, J. D., Bowen, R. C., McAllister, J., Chen, W., & ... Chamberlain, A. M. (2017). Determining the minimal clinically important difference for the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and visual analog scale (VAS) measuring pain after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery, 26(1), 144-148. doi:10.1016/j.jse.2016.06.007