downloadOutcome measures are tests or questionnaires used by therapists at the commencement of therapy intervention, which are then often repeated again at various points during patient care. Scores on the measure can be compared over time, or before and after an intervention, to help the therapist and patient to determine whether improvement has occurred. In this way they can be used to track progress and determine the effectiveness of an intervention.


The Disabilities of the Arm, Shoulder and Hand questionnaire has been shown to perform consistently well in terms of properties such as reliability, validity, responsiveness to change. It is a 30-item, self-report questionnaire designed to measure physical function and symptoms in patients with disorders of the shoulder, elbow, wrist and hand. The DASH Outcome Measure was jointly developed by the Institute for Work & Health in Ontario and the American Academy of Orthopaedic Surgeons (AAOS). It is suitable for a broad range of shoulder pain presentations, including rotator cuff disorders, shoulder osteoarthritis, shoulder fractures, and frozen shoulder. The DASH questionnaire can be accessed here

You can also directly access an online version of the DASH score on the Orthopaedic scores website, which will calculate the score for you.

The summaries of DASH and QuickDASH articles which were reviewed by our Shoulder CoP core group members are available here:

Mintken PE, Glynn P, Cleland JA (2009) Psychometric properties of the shortened disabilities of the arm, shoulder, and hand questionnaire (QuickDash) and numeric pain rating scale in patients with shoulder pain. J Shoulder Elbow Surg 18(6):920-6

Angst F, Goldhahn J, Drerup S, Flury M, Schwyzer H-K, Simmen BR (2009)How sharp is the short quickDASH? A refined content and validity analysis of the short form of the disabilities of the shoulder, arm and hand questionnaire in the strata of symptoms and function and specific joint conditions. Qual Life Res. 18(8):1043-51.

Young Hak Roh, Jung Ho Noh, Joo Han Oh, Goo Hyun Baek, Hyun Sik Gong (2012) To What Degree do Shoulder Outcome Instruments Reflect Patient’s Psychological Distress? Clin Orthop Relat Res 470:3470-3477

Rotator cuff

The DASH score has been validated and recommended for use in people with rotator cuff disorders. The Western Ontario Rotator Cuff (WORC) Index is a condition-specific outcome measures for people with rotator cuff disorder.

Western Ontario Rotator Cuff (WORC) Score:
The WORC is a 21 item self-report questionnaire with each item scored on a visual analogue scale. De Witte et al (2012) confirmed that the validity, test-retest reliability and responsiveness of the WORC in people with RC disorders. However they cautioned that it did not seem to discriminate as well as the DASH score between those with more severe versus less severe shoulder symptoms.

A pdf copy of the WORC can be accessed here: Western Ontario Rotator Cuff Index (WORC)

The summary of the WORC article which was reviewed by our Shoulder CoP core group members is available here:

de Witte PB, Henseler JF, Nagels J, Vliet Vlieland TP, Nelissen RG (2012) The Western Ontario Rotator Cuff Index (WORC) in Rotator Cuff (RC) Disease Patients. Am J Sports Med 40(7):1611-9

Shoulder Instability

Two systematic reviews of outcome scores for shoulder instability have identified the Western Ontario Shoulder Instability Score as having the best evidence to support its psychometric properties
(Plancher & Lipnick 2009, Rouleau et al al 2010)

Western Ontario Shoulder Instability Score: WOSI (Kirkley et al 1998)
The WOSI consists of 21 items, each scored on a 100mm Visual Analogue Scale, and organised into four domains : Physical, Sports/Recreation/Work, Lifestyle and Emotions. Excellent test-retest reliability, and validity have been confirmed in a number of studies in people with shoulder instability. There is no published value for minimal clinically important change.

You can access an online version of the WOSI on the Orthopaedic scores website, which will also calculate the score for you.

The summary of the related article which was reviewed by our Shoulder CoP core group members is available here:

Kemp KAR, Sheps DM, Beaupre LA, Styles-Tripp F, Luciak-Corea C, Balyk R (2012) An Evaluation of the Responsiveness and Discriminant Validity of Shoulder Questionnaires among Patients Receiving Surgical Correction of Shoulder Instability. Scientific World Journal 2012:410125. Epub 2012 May 1.


The Patient-Specific Functional Scale (PSFS) is a patient-specific questionnaire, which aims to assess function in people with musculoskeletal problems. Stratford et al (1995) developed the questionnaire in response to a need for more individualised, user-friendly outcome measure for this population.

The respondent identifies up to five activities that are causing difficulty for them, due to their musculoskeletal problem. They then rate (on a numerical rating scale 0-10) the level of difficulty associated with carrying out each activity identified. At follow-up visits the patient is asked to rate the same activities again and can nominate new activities if the initial ones have resolved. This approach to assessment aligns very well with the normal history taking process in physiotherapy, and therefore may serve as a time-saving method of including a validated outcome measure in routine practice. It also gives the opportunity for the patient to identify activities that are important to them, which may not be captured on standardised measures.

A systematic review of the properties of the PSFS by Kowalchuk Horn et al (2012) confirms that the PSFS is reliable, valid, and responsive to change in a range of musculoskeletal conditions (i.e. knee pain , back and neck pain), however they did not identify any evidence for its use in shoulder pain. Subsequently Hefford et al (2012) demonstrated that it was moderately reliable, valid and responsive in a group of 180 people with upper extremity disorders. The minimal important change value from this study was 1.2 points, for an average score, while Stratford et al (1995) reported that change of 3 points was required for a single activity score to confirm clinically important change. These authors suggest that that the PSFS is better recommended for evaluating outcome for an individual patient (i.e. in clinical practice), rather than for group comparisons (e.g. research studies).

Copy of the Patient Specific Functional Scale:
Patient-specific functional scale

Other articles reviewed by the Shoulder CoP core group members in our Journal Club can be found here:

Hill CL, Lester S, Taylor AW, Shanahan ME, Gill TK (2011) Factor Structure and Validity of the SHoulder Pain and Disability Index in a Population-Based Study of People with Shoulder Symptoms. BMC Musculoskeletal Disorders 12:8

MacDermid JC, Solomon P, Prkachin K (2006) The Shoulder Pain and Disability Index demonstrate factor, construct and longitudinal validity. BMC Musculoskeletal Disorders 7:12


Rouleau DM, Faber K, MacDermid JC. 2010 Systematic review of patient-administered
shoulder functional scores on instability. J Shoulder Elbow Surg; 19(8):1121-8.
Plancher KD, Lipnick SL 2009 Analysis of evidence-based medicine for shoulder instability. Arthroscopy; 25(8):897-908
Hefford C, Abbott JH, Arnold R, Baxter GD 2012 The patient-specific functional scale: validity, reliability, and responsiveness in patients with upper extremity musculoskeletal problems. J Orthop Sports Phys Ther. 42(2):56-65. doi: 10.2519/jospt.2012.3953.
Stratford P (1995) Assessing disability and change on individual patients: a report of a
patient specific measure Physiother Can 47: 258-263.
Kirkley A, Alvarez C, Griffin S 2003 The development and evaluation of a disease-specific
quality-of-life questionnaire for disorders of the rotator cuff: The Western Ontario Rotator
Cuff Index. Clin J Sport Med; 13(2):84-92
Kirkley A, Griffin S, McLintock H, Ng L.1998 The development and evaluation of a disease specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med; 26(6):764-72
de Witte PB, Henseler JF, Nagels J, Vliet Vlieland TP, Nelissen RG. 2012 The Western Ontario rotator cuff index in rotator cuff disease patients: a comprehensive reliability and
responsiveness validation study. Am J Sports Med; 40(7):1611-9. doi: