Introduction: To assess overall shoulder function a simple examination of the range of motion and strength may not be sufficiently representative. because the shoulder in its daily use is often required for repetitive activities, fatigue at an early stage could be a sign of disturbed shoulder function. Therefore the shoulder function test (SFT) was created to incorporate the factor time into shoulder assessment. With this study the SIFT was evaluated for its clinical use in the prospective follow-up of a series of patients operated on for rotator cuff tears. Methods: Using forward flexion, the patient had to lift a 500-g weight onto a shelf placed at a height which he could reach with his extended arm. The achieved height (5 levels possible) and the time he needed for 5 repetitions were recorded. The SFT value was calculated by division of the time required by the level of the reached shelf Thus, a lower SFT score represents a better shoulder function. This was tested on 45 patients prior to rotator cuff repair and at 3, 6 and 12 months postoperatively. As validation the SF-36 and the Constant score were evaluated in parallel. Construct, criterion, content and discriminative validity and responsiveness were calculated Results: At all assessments the SFT correlated with the Constant score (r = -0.47 to r = -0.62) and the SF-36 (r = -0.26 to r = -0.61) demonstrating construct validity. As criterion validity the SFT correlated with the reported pain (r = 0.34 to r = 0.61), patients' self-estimation (r = 0.38 to r = 0.59) and doctors' estimation of the patients shoulder function (r = 0.36 to r = 0.54). Known groups validity was positive as the SFT could differentiate between shoulders with and without rotator cuff tears. The SFT demonstrated a good responsiveness with significant improvement (p = 0.01) after rotator cuff repair. Conclusion: Repetitive forward flexion is an important function of the shoulder in daily activities. The SFT allows a reliable and valid quantitative measurement of this function. In order to improve functional assessment of the shoulder and scoring we would recommend using this patient- and function-orientated test in combination with the Constant score to document the current status of shoulder function.

In a prospective clinical trial, first the German Short Musculoskeletal Function Assessment questionnaire (SMFA-D) was tested for reliability, validity, and responsiveness in 23 patients with rotator cuff tears, and secondly the Short Form (SF)-36, and the Constant score were evaluated comparatively in 45 patients with rotator cuff tear undergoing open repair. Retest reliability was excellent for the functional index of the SMFA-D and satisfactory for the bother index. The SMFA-D showed good validity and responsiveness. All three instruments demonstrated significantly the positive effect of rotator cuff repair at 12-month follow-up. Using comparable scales, effect sizes were bigger with the SMFA-D than with the SF-36 and as big as the Constant score. Significant correlations of the SMFA-D indices with the SF-36 scales and the Constant score could be shown preoperatively. At 12-month follow-up, all correlations between SMFA-D indices, SF-36 scales, and Constant score function scales were still significant. We recommend use of the SMFA-D to assess changes in functional status concerning patients with rotator cuff tear undergoing open repair.

INTRODUCTION:To assess overall shoulder function a simple examination of the range of motion and strength may not be sufficiently representative. because the shoulder in its daily use is often required for repetitive activities, fatigue at an early stage could be a sign of disturbed shoulder function. Therefore the shoulder function test (SFT) was created to incorporate the factor time into shoulder assessment. With this study the SFT was evaluated for its clinical use in the prospective follow-up of a series of patients operated on for rotator cuff tears.METHODS:Using forward flexion, the patient had to lift a 500-g weight onto a shelf placed at a height which he could reach with his extended arm. The achieved height (5 levels possible) and the time he needed for 5 repetitions were recorded. The SFT value was calculated by division of the time required by the level of the reached shelf. Thus, a lower SFT score represents a better shoulder function. This was tested on 45 patients prior to rotator cuff repair and at 3, 6 and 12 months postoperatively. As validation the SF-36 and the Constant score were evaluated in parallel. Construct, criterion, content and discriminative validity and responsiveness were calculated Results: At all assessments the SFT correlated with the Constant score (r = - 0.47 to r = - 0.62) and the SF-36 (r = - 0.26 to r = - 0.61) demonstrating construct validity. As criterion validity the SFT correlated with the reported pain (r = 0.34 to r = 0.61), patients' self-estimation (r = 0.38 to r = 0.59) and doctors' estimation of the patients shoulder function (r = 0.36 to r = 0.54). Known groups validity was positive as the SFT could differentiate between shoulders with and without rotator cuff tears. The SFT demonstrated a good responsiveness with significant improvement (p = 0.01) after rotator cuff repair.CONCLUSION:Repetitive forward flexion is an important function of the shoulder in daily activities. The SFT allows a reliable and valid quantitative measurement of this function. In order to improve functional assessment of the shoulder and scoring we would recommend using this patient- and function-orientated test in combination with the Constant score to document the current status of shoulder function.

Le lussazioni acute dell’articolazione acromioclavicolare (lesioni di Rockwood di tipo IV,V,VI e alcune di tipo III) solitamente richiedono una ricostruzione chirurgica. In questi casi, si utilizza una doppia stabilizzazione: acromioclavicolare e coracoclavicolare. Dopo aver effettuato un’incisione “a spallina” e isolato l’articolazione acromioclavicolare, la fascia muscolare che ricopre i muscoli trapezio e deltoide, e i legamenti coracoclavicolari, si procede a riduzione dell’articolazione acromioclavicolare, stabilizzata con un singolo filo di Kirschner di 2 mm di diametro. Per eseguire la fissazione coracoclavicolare, utilizziamo un filo in PDS del diametro di 2 mm, per realizzare un cerchiaggio a “8” che passa attra-verso un foro transosseo délia clavicola e intorno alla base della coracoide. Si esegue inoltre una ricostruzione dei legamenti acromioclavicolari e coracoclavicolari.

Fragestellung: Wie gestaltet sich der Rehabilitationsverlauf bei Patienten mit Gon- und Koxarthrose nach endoprothetischer Versorgung?

In a prospective clinical trial, the German short musculoskeletal function assessment (SMFA-D), the short form (SF)-36, and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) were evaluated in 63 patients with primary osteoarthritis undergoing total knee arthroplasty. All instruments were sensitive to change, demonstrating the effect of total knee arthroplasty at 1-year follow-up. The SMFA-D effect sizes in comparable scales were bigger than in the SF-36 and similar to those of the WOMAC. Significant correlations of the SMFA-D indices with the SF-36 and WOMAC scales preoperatively could be shown. After 1-year follow-up, all correlations between the SMFA-D indices and SF-36 scales were significant. In other comparison, only the correlation between the SMFA-D function index and the WOMAC function scales remained significant. The correlation of the SMFA-D function index with external validation criteria was higher than that using the other instruments. We recommend the SMFA-D for assessing change in functional status of patients with primary osteoarthritis of the knee following arthroplasty.

The XSMFA-D (German Extra Short Musculoskeletal Function Assessment Questionnaire) was developed on the basis of the SMFA-D to provide a short questionnaire for assessment of the functional status from patient's perspective in routine use.Based on psychometric and medical aspects 16 items were extracted from the SMFA-D during an iterative process. 633 SMFA-D questionnaires of 199 patients were used as basic data. The XSMFA-D was evaluated on 67/51 patients with primary osteoarthritis of the knee/hip undergoing total joint replacement.The tests for reliability and internal consistency produced favorable results. The Knee Score, Harris Hip Score, WOMAC and SMFA-D showed significant correlations to the XSMFA-D indicating construct validity. The criterion validity could be demonstrated successfully by relations with external parameters like walking distance, patients reported pain, mobility judgements by physicians and degree of osteoarthritis. The discriminant validity could also be demonstrated by significant differences between several different patient groups. Almost all effect sizes were generally large.The XSMFA-D could be demonstrated to be an appropriate short questionnaire for the evaluation of therapy results from patient's perspective. The use of the XSMFA-D can be recommended for routine use. Further investigations of the instrument will be undertaken.

Aim: The XSMFA-D (German Extra Short Musculoskeletal Function Assessment Questionnaire) was developed on the basis of the SMFA-D to provide a short questionnaire for assessment of the functional status from patient's perspective in routine use. Methods: Based on psychometric and medical aspects 16 items were extracted from the SMFA-D during an iterative process. 633 SMFA-D questionnaires of 199 patients were used as basic data. The XSMFA-D was evaluated on 67/51 patients with primary osteoarthritis of the knee/hip undergoing total joint replacement. Results: The tests for reliability and internal consistency produced favorable results. The Knee Score, Harris Hip Score, WOMAC and SMFA-D showed significant correlations to the XSMFA-D indicating construct validity. The criterion validity could be demonstrated successfully by relations with external parameters like walking distance, patients reported pain, mobility judgements by physicians and degree of osteoarthritis. The discriminant validity could also be demonstrated by significant differences between several different patient groups. Almost all effect sizes were generally large. Conclusions: The XSMFA-D could be demonstrated to be an appropriate short questionnaire for the evaluation of therapy results from patient's perspective. The use of the XSMFA-D can be recommended for routine use. Further investigations of the instrument will be undertaken.

INTRODUCTION:The patient-based evaluation of outcome is gaining increased importance. The aim of the study was to translate and culturally adapt the short musculoskeletal function assessment questionnaire (SMFA) into German and to evaluate the practicability, metric properties, and distribution characteristics of the German version (SMFA-D).METHODS:The SMFA is a questionnaire on the functional status of the musculoskeletal system of patients consisting of a function index (34 items) and bother index (12 items) with a 5-point response format. The SMFA was independently translated by orthopaedic-trained, qualified German- and English-speaking translators. A consensus committee review and selection of an optimally comprehensible German version was performed. Patients checked this version for comprehensibility and time to complete the questionnaire. 40 fluently German-speaking patients with primary osteoarthritis of the knee completed the SMFA-D twice at a one week interval. The test-retest reliability and internal consistency were evaluated. The values are standardized on an scale from 0-100. High values indicate a poor function.RESULTS:The SMFA-D is comprehensible and can be completed within 20 minutes in the mean. There were no skewness and no floor or ceiling effects. The mean function index was 47 (SD 17, range 16-80). The mean bother index was 44 (SD 19, range 5-75). Test-retest reliability were 0.88 (function index) and 0.71 (bother index), respectively. Internal consistency (Cronbach's alpha) was 0.92 (function index) and 0.88 (bother index), respectively.CONCLUSIONS:The SMFA-D is a practical and reliable questionnaire for patient-based evaluation of functional problems of the musculoskeletal system.

The patient-based evaluation of outcome is gaining increased importance. The aim of the study was to translate and culturally adapt the short musculoskeletal function assessment questionnaire (SMFA) into German and to evaluate the practicability, metric properties, and distribution characteristics of the German version (SMFA-D).The SMFA is a questionnaire on the functional status of the musculoskeletal system of patients consisting of a function index (34 items) and bother index (12 items) with a 5-point response format. The SMFA was independently translated by orthopaedic-trained, qualified German- and English-speaking translators. A consensus committee review and selection of an optimally comprehensible German version was performed. Patients checked this version for comprehensibility and time to complete the questionnaire. 40 fluently German-speaking patients with primary osteoarthritis of the knee completed the SMFA-D twice at a one week interval. The test-retest reliability and internal consistency were evaluated. The values are standardized on an scale from 0-100. High values indicate a poor function.The SMFA-D is comprehensible and can be completed within 20 minutes in the mean. There were no skewness and no floor or ceiling effects. The mean function index was 47 (SD 17, range 16-80). The mean bother index was 44 (SD 19, range 5-75). Test-retest reliability were 0.88 (function index) and 0.71 (bother index), respectively. Internal consistency (Cronbach's alpha) was 0.92 (function index) and 0.88 (bother index), respectively.The SMFA-D is a practical and reliable questionnaire for patient-based evaluation of functional problems of the musculoskeletal system.

The patient-based evaluation of outcome is gaining increased importance. The aim of the study was to translate and culturally adapt the short musculoskeletal function assessment questionnaire (SMFA) into German and to evaluate the practicability, metric properties, and distribution characteristics of the German version (SMFA-D). Methods:The SMFA is a questionnaire on the functional status of the musculoskeletal system of patients consisting of a function index (34 items) and bother index (12 items) with a 5-point response format. The SM FA was independently translated by orthopaedic-trained, qualified German- and English-speaking translators. A consensus committee review and selection of an optimally comprehensible German version was performed. Patients checked this version for comprehensibility and time to complete the questionnaire. 40 fluently German-speaking patients with primary osteoarthritis of the knee completed the SMFA-D twice at a one week interval. The test-retest reliability and internal consistency were evaluated. The values are standardized on an scale from 0-100. High values indicate a poor function. Results: The SMFA-D is comprehensible and can be completed within 20 minutes in the mean. There were no skewness and no floor or ceiling effects. The mean function index was 47 (SD 17, range 16-80). The mean bother index was 44 (SD 19, range 5-75). Test-retest reliability were 0.88 (function index) and 0.71 (bother index), respectively. Internal consistency (Cronbach's alpha) was 0.92 (function index) and 0.88 (bother index), respectively. Conclusions: The SMFA-D is a practical and reliable questionnaire for patient-based evaluation of functional problems of the musculoskeletal system.