Interpretation and content validity of the items of the numeric rating version short-WORC to evaluate outcomes in management of rotator cuff pathology: a cognitive interview approach

Abstract

Background: The shortened version of the Western Ontario Rotator Cuff Index (Short-WORC) is a patient reported outcome measure that evaluates quality of life (QoL) of patients with rotator cuff pathology. However, formal content validation of the full or Short-WORC has not been reported. This study aims to understand how 1) people interpret and calibrate responses to items on the Short-WORC and 2) compensatory strategies that might enhance function and thereby affect responses. Methods: This study uses cognitive interviewing, a qualitative methodology that focuses on the interpretation of questionnaire items. Patients with rotator cuff disorders (n = 10), clinicians (n = 6) and measurement researchers (n = 10) were interviewed using a talk aloud structured interview that evaluated each of the 7 items of the Short-WORC. All interviews were recorded and transcribed verbatim by one researcher (R.F). Analysis was done through an open coding scheme using a previously established framework. Results: Overall, the items on the Short-WORC were well received by participants. Through the interviews, the 6 themes of: Comprehension, Inadequate response definition, Reference Point, Relevance, Perspective Modifiers and Calibration Across Items emerged. The items of working above the shoulder (90%), compensating with the unaffected arm (88%) and lifting heavy objects (92%) were the most relevant to participants. Participants calibrated their scores on the items of sleeping and styling (19%) the most. Perspective modifiers of gender, influenced the calibrations of items of styling your hair (30%) and dressing or undressing (19%). Compensatory strategies of task-re allocation and using assistive devices/resources were frequently mentioned by participants. Overall, participants had minor comprehension issues, but found the 7-items of the Short-WORC to be relevant to QoL.

Patient gender and rotator cuff surgery: are there differences in outcome?

“…Alternatively, our clinical tools are not well configured to detect gender-based differences in patient-reported outcomes. Furtado et al reflect on the short-WORC and the variably applicability of items such as dressing/undressing and hair styling across genders [ 25 ]. Whether enough gender difference exists to merit rethinking our patient-reported outcomes is beyond the scope of this study, and assuming no important differences exist may be premature.…”

How to Assess Shoulder Functionality: A Systematic Review of Existing Validated Outcome Measures

“…On the other hand, RC assessment methods stand out due to the large number of validations that support them [ 27 , 47 , 72 , 73 , 142 , 144 , 159 , 160 , 161 , 162 , 207 , 258 ]. In fact, these validations are both of their specific and general scales.…”

A narrative review and content analysis of functional and quality of life measures used to evaluate the outcome after TSA: an ICF linking application

“…The single item measure SANE, and SSV, that investigate to what extent a patient would rate their shoulder as being normal, was classified as HRQoL perspective since it address a global evaluation, whereas researchers and clinicians commonly use it as a functional outcome since it assumed to be rating physical function on a scale of 0-100% [36]. A previous study found that patients have a lot of confusion about what is being calibrated when responding to this questions, which reflect the ambiguity in its definition [37]. It is important to have a conceptual distinction between measures designed to assess HRQoL which is intended to be comprehensive, versus those designed to measure physical functioning which a smaller construct that might affect QoL.…”