Validity and Reliability of the Turkish Version of LHB Score

Assessment of cross-cultural adaptations and patient-reported outcome measures relevant to shoulder disorders in Turkish: A systematic review using the COSMIN methodology

BACKGROUND

There are many shoulder assessment outcome measures in the literature that have been studied for validity and reliability. However, there is no study examining the Turkish-adapted patient outcome measures (PROMs) on the shoulder according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. In addition, there is a small number of studies that carry out this examination on the shoulder internationally. Determining the most appropriate questionnaires for clinical use will also be an important guide in patient evaluation by filling the gap in both literature and clinical aspects.

OBJECTIVE

Our aim in this study is to identify the valid and reliable Turkish scales used to evaluate shoulder pain and disability, to reveal how compatible these scales are with the aspects of study quality and psychometric quality according to COSMIN criteria list.

METHODS

A systematic search was performed in the following electronic databases: MED-LINE, Web of Science (WOS), EMBASE, SCOPUS, and ULAKBIM were searched from inception to September 2024.

RESULTS

A total of 2890 articles were found in the databases. Four articles were included additionally without a search. Then, after eliminating the duplicates, 2231 articles were included based on the title and abstract search. 63 articles were included in full-text review. After the full-text review, according to our criteria, 29 articles were included in the systematic review. According to the assessment by the COSMIN checklist, 28 articles received the final classification of "inadequate". Only 1 article (UCLA-Tr) received the final classification of "adequate".

CONCLUSION

There is a wide range of Turkish PROMs available for the shoulder, with only one fully meeting COSMIN methodology criteria. However, this does not imply that other PROMs lack clinical utility. Future studies should focus on refining PROMs by incorporating MCID and PASS scores and prioritizing their responsiveness to enhance their clinical relevance. Additionally, variations in PROM performance across different patient populations highlight the need for context-specific evaluations to ensure their applicability in diverse clinical settings.

TRIAL REGISTRATION

PROSPERO registration number: CRD42022298425.

Translation and Cultural Adaptation to Portuguese of the Long Head of Biceps Tendon Score

Objective  To translate and culturally adapt the Long Head of Biceps Tendon (LHB) score into Brazilian Portuguese. Methods  The process involved translations by professionals fluent in the target language, followed by independent back translations. Next, a committee compared the original and translated versions, pretested the final version, and concluded it. Results  We translated and adapted the questionnaire according to the proposed methodology. In the first version in Portuguese (VP1) there was divergence regarding the translation of twelve terms. Compared to the original version, the back translation of VP1 presented eight diverging terms. A committee prepared a second version in Portuguese (VP2) and applied it to a pretest group consisting of 30 participants. Finally, we conceived the third version in Portuguese, called LHB-pt. Conclusion  The translation and cultural adaptation into Brazilian Portuguese of the LBH score was successfully accomplished.

Tenotomy or Tenodesis for Tendinopathy of the Long Head of the Biceps Brachii: An Updated Systematic Review and Meta-analysis

Purpose

The purpose of this meta-analysis was to provide an up-to-date comparison of clinical outcomes of tenotomy and tenodesis in the surgical treatment of long head of the biceps brachii (LHB) tendinopathy.

Methods

A literature search was conducted in EMBASE, Pubmed/Medline and the Cochrane database from January 2000 to May 2020. All studies comparing clinical outcomes between LHB tenotomy and tenodesis were included. Quality was assessed using the Coleman score.

Results

We included 25 studies (8 randomized studies) comprising 2,191 patients undergoing LHB tenotomy or tenodesis, with or without concomitant shoulder procedures (mainly rotator cuff repairs). The Coleman score ranged from 29 to 97 for all studies. When comparing tenodesis and tenotomy in randomized studies, no clinically relevant differences were found in the Constant score (mean difference, 0.9 points), the American Shoulder and Elbow Society Score (mean difference, 1.1 points), shoulder pain (mean difference in visual analogue scale, -0.3 points), elbow flexion strength loss (mean difference, 0%), or forearm supination strength (mean difference, 3%). A Popeye deformity (odds ratio, 0.32) was less commonly seen in patients treated with tenodesis (9% vs 23%).

Conclusion

In our meta-analysis, a Popeye deformity was more frequently observed in patients treated with tenotomy. Based on a substantial number of studies, there is no evidence-based benefit of LHB tenodesis over tenotomy in terms of shoulder function, shoulder pain or biceps-related strength. It is unclear whether LHB tenodesis is of benefit in specific patient groups such as younger individuals.

Level of evidence

Level III, systematic review of level III or higher studies.

Validity and Reliability of the Turkish Version of Western Ontario Osteoarthritis of the Shoulder Index

Objectives

This study aims to adapt the Western Ontario Osteoarthritis of the Shoulder (WOOS) index specific to shoulder osteoarthritis into Turkish and to evaluate its validity and reliability.

Patients and methods

The WOOS index was translated and culturally adapted into Turkish, systematically. It was applied to a total of 68 patients (17 males, 51 females; mean age: 61.5±8.7 years; range, 45 to 80 years) with osteoarthritis of the shoulder treated conservatively. The reliability of the scale was checked through internal consistency and test-retest methods. Internal consistency was analyzed with Cronbach alpha value. Test-retest reliability was assessed using an intraclass correlation coefficient (ICC) with 25 patients. The Western Ontario Rotator Cuff (WORC), the Shoulder Pain and Disability Index (SPADI), and the Society of American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) scores were used to conduct concurrent validity.

Results

The Cronbach alpha value of the scale was found to be excellent as 0.92 (p<0.001). The ICC value was also excellent as 0.97 (p<0.001). There was an excellent positive correlation with WORC (0.847; p<0.001) and a very good positive correlation with SPADI (0.788; p<0.001). It was also negatively very good to correlate with the ASES (-0.754; p<0.001). Additionally, subsections of WOOS had a good correlation with the corresponding subsections of WORC (0.779-0.664; p<0.001).

Conclusion

The Turkish version of the WOOS index is a valid and reliable tool and is recommended for use in the assessment of patients with osteoarthritis of the shoulder.