Basic science
Validation of the Dutch version of the Simple Shoulder Test

https://doi.org/10.1016/j.jse.2011.09.026Get rights and content

Background

The Simple Shoulder Test (SST) is an internationally used patient-reported outcome for clinical practice and research purposes. It was developed for measuring functional limitations of the affected shoulder in patients with shoulder dysfunction and contains 12 questions (yes/no). The purpose of this study was to create a Dutch translation of the SST and to assess the reliability and validity.

Materials and methods

The SST was translated into Dutch using forward and backward translations. A consecutive cohort of patients with shoulder problems visiting an orthopedic clinic completed the Dutch version of the SST twice within 28 days. In addition, the Dutch validated versions of the Disabilities of the Arm, Shoulder and Hand, Oxford Shoulder Score, and Constant-Murley shoulder assessment were completed for assessing construct validity.

Results

One hundred ten patients with a mean age of 39 years (SD, 14 years), 72% male, completed the questionnaires. The internal consistency was high (Cronbach α, 0.78). The test-retest reliability was very good (intraclass correlation coefficient, 0.92) (n = 55). The measurement error expressed in the standard error of measurement was 1.18, and the smallest detectable change was 3.3 on a scale from 0 to 12. The construct validity was supported by expected high correlations between the Dutch version of the SST and the Disabilities of the Arm, Shoulder and Hand (r = −0.74) and between the SST and the Oxford Shoulder Score (r = −0.74) and an expected moderate correlation between the SST and the Constant-Murley shoulder assessment (r = 0.59).

Conclusion

The Dutch version of the SST seems to be a reliable and valid instrument for evaluating functional limitations in patients with shoulder complaints.

Section snippets

Translation procedure

First, the original English version of the SST was translated into Dutch by 3 native Dutch–speaking, medically educated translators independently of each other. Subsequently, they created a consensus version (the Dutch SST), which was also checked for possible cross-cultural differences. Subsequently, 40 patients with shoulder complaints were asked to assess the comprehensibility of the Dutch SST, by looking at the understandability and logic of the independent questions.37 These 40 patients

Results

Forward and backward translation of the SST showed no problems or language difficulties. Because of cross-cultural differences between the United States and the Netherlands, questions 9 and 10, asking about the ability to throw a softball a certain distance, were adapted to the Dutch situation. In the Netherlands, not many people play softball. Tennis is a much more common sport, so we changed “softball” to “tennis ball” and we reduced the distance, based on the different weight of the softball

Discussion

This study shows that the Dutch version of the SST is a valid, reliable, and internally consistent instrument for the assessment of patients with shoulder complaints and has no floor or ceiling effects. In determining the construct validity, we confirmed all of our predetermined hypotheses except one. The SST showed the highest correlation with the OSS, the DASH, and the SF-36 physical functioning subscale. The SST showed a lower correlation with the CM score (0.59). These results are

Conclusion

The Dutch version of the SST is user-friendly and can easily be administered on the Web but also on paper. Eighty-six percent of our predefined hypotheses about the construct validity could be confirmed. We found high reliability (ICC, 0.92) and high internal consistency (Cronbach α, 0.78). Therefore, we consider the SST a valid and reliable instrument suitable for monitoring groups of patients. The SST can be used for clinical trials and for comparison of study results from different

Acknowledgments

We thank Ms M. Boekhorst for her help in the collection of study data, as well as the European Society for Surgery of the Shoulder and the Elbow (2009 SECEC/ESSSE Research Grant) and the Marti-Keuning Eckhardt Foundation for their financial support.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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    Institutional review board: Ethical approval was waived by the ethical committee (Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands).

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