Western Ontario Rotator Cuff Index (WORC)

Last Updated

June 30, 2025

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Purpose

A 21-item questionnaire representing five domains pertinent to health-related quality of life.

Link to Instrument

Acronym WORC

Area of Assessment

Activities & Participation

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

Requires access to journal article

CDE Status

Not a CDE--last searched 6/30/2025

Arthritis and Joint Conditions

Mixed Conditions

Musculoskeletal Conditions

Non-Patient

21-item questionnaire
Each item is scored from 0 (asymptomatic) to 100 (most symptomatic) using the Visual Analogue Scale (100 mm VAS)
Total Scores range from 0 (best possible score) to 2100 (worst possible score)
The score can be reported as a percentage by subtracting the total from 2100, dividing by 2100, and multiplying by 100
As a percentage, scores ranging from 0 (poor QoL) to
100 (high QoL)

Number of Items

5-10 minutes

Required Training

No Training

Adult

16 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Tiana Hess SPT and Kevin Nguyen SPT, under the supervision of Dr. Neha Dewan PT, PhD, Western University of Health Sciences, Lebanon, Oregon

Body Structure

Upper Extremity

ICF Domain

Body Structure
Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
Motor
Emotion

Professional Association Recommendation

None found--last searched 6/30/2025

Considerations

WORC is used to assess health-related quality of life for those with shoulder conditions.
WORC can be either self- or interviewer-administered.
WORC can be used for anyone 18 years or older.
WORC has been used for many rotator cuff related conditions including partial or full thickness rotator cuff tears with or without surgical intervention, tendinitis, tendinosis, tendinopathy, calcific tendonitis, biceps tendonitis, impingement syndrome, frozen shoulder, bursitis, scapula alata, and shoulder osteoarthritis.
The assessment is available in English and several translations:
- Brazilian version (Diniz Lopes et al., 2008; Lopes et al. 2009; Lopes et al., 2009)
- Greek version (Karanasios et al., 2023)
- Persian version (Daghiani et al., 2022; Mousavi et al., 2009)
- Canadian French version (St-Pierre et al., 2015)
- Japanese version (Kawabata et al., 2013)
- Dutch version (Massier et al., 2021; Wessel et al., 2013; Wessel et al., 2018; Wiertsema et al., 2013)
- Italian version (De Santis et al., 2025)
- Turkish version (Özal et al., 2021)
- Danish version (Brix et al., 2020)
- Swedish version (Zhaeentan et al., 2016)
- Polish version (Bejer et al., 2018; Bejer et al., 2023)
- Chinese version (Wang et al., 2017)
- Norwegian version (Ekeberg et al., 2008)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Turkish Adults: (Özal et al., 2021; n = 67, mean age = 61.5 (8.7) years, age range = 45-80, female = 51 (76%), patients with shoulder arthritis, Turkish translation of WORC)

Excellent correlation between WORC and Western Ontario Osteoarthritis of the Shoulder (WOOS) index (r = 0.847, p < 0.001
Excellent correlations between WORC and WOOS corresponding subsections (all p < 0.001) of physical symptoms (r = 0.664), sports and recreation (r = 0.779), work (r = 0.701), lifestyle (r = 0.776), and emotions (r = 0.669)

Standard Error of Measurement (SEM)

Rotator Cuff Repair: (Dewan et al., 2016; n = 153; mean age = 56.78 (9.97) years, male = 92 (60%), patients diagnosed with rotator cuff disorder, Short-WORC (7-Item) extracted from full 21-Item WORC)

SEM for full 21-Item WORC (n = 43): 7.7
SEM for 7-Item WORC (n = 43): 8.8

Polish Adults with rotator cuff repair: (Bejer et al., 2018; n = 69, mean age = 55.5 years, age range = 40-65 years; inclusion criteria: native Polish speakers >18 years old who provided informed consent and had arthroscopic reconstruction of the rotator cuff; Polish translation of WORC)

SEM for WORC Total (n = 57): 1.62

Minimal Detectable Change (MDC)

Rotator Cuff Repair: (Dewan et al., 2016)

Individual and Group MDC₉₀values for 21- and 7-Item WORC

Measure	MDC₉₀ (individual)	MDC₉₀ (group)
21-Item WORC	17.8	4.5
7-Item WORC	20.4	5.1

Polish Adults with rotator cuff repair: (Bejer et al., 2018)

MDC₉₅ for WORC Total (n = 57): 4.48

Test/Retest Reliability

Rotator Cuff Repair: (Dewan et al., 2016)

Individual and Group MDC₉₀values for 21- and 7-Item WORC

Measure	MDC₉₀ (individual)	MDC₉₀ (group)
21-Item WORC	17.8	4.5
7-Item WORC	20.4	5.1

Polish Adults with rotator cuff repair: (Bejer et al., 2018)

MDC₉₅ for WORC Total (n = 57): 4.48

Internal Consistency

Rotator Cuff Repair: (Dewan et al., 2016)

Excellent for 21-Item WORC: (Cronbach's alpha = 0.90)
Excellent for 7-Item WORC: (Cronbach's alpha = 0.84)

Swedish Adults with subacromial pain, or a rotator cuff tear, treated surgically: (Zhaeentan et al., 2016)

Excellent for WORC total score combined (preoperative and postoperative material merged): (Cronbach's alpha = 0.97)

Polish Adults with rotator cuff repair: (Bejer et al., 2018)

Excellent for WORC Total: (Cronbach's alpha = 0.94)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Swedish Adults with subacromial pain, or a rotator cuff tear, treated surgically: (Zhaeentan et al., 2016)

Excellent correlation between WORC and WOOS (r = 0.97, p < 0.001)

Construct Validity

Construct validity:

Polish Adults with rotator cuff repair: (Bejer et al., 2018)

Excellent correlations (all p < 0.001) between WORC-total and SF-36 PCS (r = 0.81), SF-36 MCS (r = 0.62), and QuickDash (r = -0.91)

Polish Adults with rotator cuff repair: (Bejer et al., 2023; n = 47, mean age = 55.87 (5.55) years, age range = 40-65 years; tested 6 and 12 months post arthroscopic rotator cuff repair surgery; Polish translation of WORC)

At 6 months post-surgery: Adequate correlation between WORC total and VAS (r = -0.567, p < 0.001) and external rotator muscle strength total work at 90 degrees (r = 0.531, p < 0001)
At 12 months post-surgery: Adequate to Excellent correlation between WORC total and VAS (r = -0.771, p < 0.001) and external rotator muscle strength total work at 90 degrees (r = 0.596, p < 0.001)

Arthroscopic Rotator Cuff Repair: (Baumgarten et al., 2021; no overall mean age stated; retrospective review)

Excellent correlation between American Stroke and Elbow Score (ASES) and WORC for all patients undergoing arthroscopic rotator cuff repair (n = 1312, r = 0.90, p < 0.0001)
Excellent correlation between ASES and WORC for preoperative scores (n = 823, r = 0.69, p < 0.0001) and postoperative scores (n = 498, r = 0.86, p < 0.0001)
Excellent correlation between ASES and WORC at all postoperative time points assessed (all p < 0.0001):
- 6 weeks (n = 37, r = 0.75)
- 12 weeks (n = 49, r = 0.78)
- 18 weeks (n = 38, r = 0.87)
- 6 months (n = 46, r = 0.79)
- 1 year (n = 8, r = 0.88)
- Final follow-up: mean = 3.7 years (range = 2-7.5 years) (n = 280, r = 0.81)

Convergent validity:

Rotator Cuff Repair: (Dewan et al., 2018; n = 223; mean age = 56.7 (11.08) years; male = 151 (68%); taken at baseline (preoperatively), 3-months, and 6-months postoperatively; inclusion criteria: age between 18 and 85, slated for rotator cuff repair, and completion of WORC)

Cross-sectional convergent construct validity (n = 88): Adequate to Excellent correlation at baseline between WORC and SF-12v2 Mental Component Summary (MCS) (r = 0.48), SF-12v2 Physical Component Summary (PCS) (r = 0.53), Shoulder Pain and Disability Index (SPADI) (r = -0.63), Simple Shoulder Test (SST) (r = 0.68), Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) (r = -0.82), and Short-WORC (r = 0.92)
Cross-sectional convergent construct validity (n = 83): Adequate to Excellent correlation at 3-month follow-up between WORC and SF-12v2 MCS (r = 0.35), SST (r = 0.53), SF-12v2 PCS (r = 0.60), DASH (r = -0.69), SPADI (r = -0.80), and Short-WORC (r = 0.89)
Cross-sectional convergent construct validity (n = 99): Adequate toExcellent correlation at 6-month follow-up between WORC and SF-12v2 MCS (r = 0.58), SF-12v2 PCS (r = 0.76), SST (r = 0.84), DASH (r = -0.84), SPADI (r = -0.89), and Short-WORC (r = 0.96)
Longitudinal convergent construct validity (n = 53): Adequate to Excellent correlation from 0-3 months between WORC and SF-12v2 MCS (r = 0.32), SPADI (r = -0.51), SST (r = 0.53), SF-12v2 PCS (r = 0.55), DASH (r = -0.60), and Short-WORC (r = 0.86)
Longitudinal convergent construct validity (n = 61): Adequate to Excellent correlation from 0-6 months between WORC and SF-12v2 MCS (r = 0.39), SF-12v2 PCS (r = 0.56), DASH (r = -0.63), SPADI (r = -0.67), SST (r = 0.75), and Short-WORC (r = 0.92)

Surgical Rotator Cuff Pathology: (Razmjou et al., 2012; n = 166; mean age = 57 (11) years; age range = 32-80 years; male = 86 (52%); patients with a rotator cuff pathology requiring surgical treatment)

Cross-sectional convergent validity: Excellent correlation between WORC and Relative Constant-Murley Score (RCMS) (r = 0.82*), Short-WORC (r = 0.93**), and American Shoulder and Elbow Surgeons questionnaire (ASES) (r = 0.75**) *Post-operative coefficients; **Preoperative coefficients

Floor/Ceiling Effects

Floor effects:

Swedish Adults with subacromial pain, or a rotator cuff tear, treated surgically: (Zhaeentan et al., 2016)

Excellent: No floor effects for WORC preoperatively (0.0%) or postoperatively (0.0%)

Polish Adults with rotator cuff repair: (Bejer et al., 2018; n = 69)

Adequate ceiling effect of 1.4% for WORC

Rotator Cuff Repair: (Dewan et al., 2018;)

Adequate floor effects for WORC at baseline (n = 213; 12.0%) and 6-month follow-up (n = 190; 5.2%)

Ceiling effects:

Swedish Adults with subacromial pain, or a rotator cuff tear, treated surgically: (Zhaeentan et al., 2016)

Excellent: No ceiling effects for WORC preoperatively (0.0%)
Adequate ceiling effect of 7.7% for WORC postoperatively

Polish Adults with rotator cuff repair: (Bejer et al., 2018)

Adequate ceiling effect of 1.4% for WORC (n = 69)

Rotator Cuff Repair: (Dewan et al., 2018)

Excellent: No ceiling effects for WORC at baseline (n = 213; 0%)
Adequate ceiling effects of 13.7% for WORC at 6-month follow-up (n = 190)

Responsiveness

Swedish Adults with subacromial pain, or a rotator cuff tear, treated surgically: (Zhaeentan et al., 2016)

Large responsiveness pre vs. postoperatively (Standardized Response Mean (SRM) = 1.01, Effect Size (ES) = 1.35)

Rotator Cuff Repair: (Dewan et al., 2018)

Large responsiveness at 0-3 months (n = 53; SRM = 0.81; ES = 0.92) and 0-6 months (n = 61; SRM = 0.89; ES = 1.12)

Rotator Cuff Repair: (MacDermid et al., 2006; n = 149; Mean Age (SD) = 55 (10.2) years; subject groups: Positive Responders (n = 86) = positive change in their total score on all 3 shoulder measures—Disabilities of the Arm, Shoulder, & Hand (DASH), Simple Shoulder Test (SST); Negative Responders (n = 15) = negative response across all 3 scales; and Equivocal Responders (n = 36) = all remaining patients with a mixed response across the 3 scales)

Large responsiveness for Positive Responders (SRM = 2.02)

Surgical Rotator Cuff Pathology: (Razmjou et al., 2012)

Large responsiveness (SRM = 1.25)

Arthroscopic Rotator Cuff Repair: (Baumgarten et al., 2021)

Large responsiveness (SRM = 2.3, ES = 2.9)

Standard Error of Measurement (SEM)

Brazilian Adults with tendinopathy or rotator cuff tear: (Diniz Lopes et al., 2008; n = 100; female = 69 (69%); Mean Age (SD) = 56.6 (10.8) years; patients ≥ 18 years of age w/rotator cuff disorders whose primary language is Brazilian Portuguese; translation and cultural adaption of WORC into Brazilian Portuguese)

SEM interrater: 5.2
SEM intrarater: 3.0

Greek Adults with partial and full thickness rotator cuff tear, calcific tendonitis, or rotator cuff tendinopathy: (Karanasios et al., 2023; n = 104; Mean Age (SD) = 44.9 (15.01) years; age range = 19-85; adults >18 years old who are fluent in the Greek language; Greek translation and cultural adaption of WORC)

SEM for total score (n = 99): 5.03

Canadian French Adults with a rotator cuff disorder: (St-Pierre et al., 2015; n = 87; Mean Age (SD) = 49.7 (12.4) years; male = 65.5%; adults >18 years old who’s native or principle language is French; Canadian French translation and cultural adaption of WORC)

SEM for total score (n = 44): 5.3

Japanese Adults with full- or partial-thickness rotator cuff tear, impingement syndrome, or tendinopathy: (Kawabata et al., 2013; n = 75; Mean Age (SD) = 63.4 (11.1) years; patients >20 years old; Japanese translation of WORC)

SEM calculated from Kawabata et al., 2013 (n = 50): 8.84

Dutch Adults with partial or full rotator cuff tear, rotator cuff calcifying tendonitis, tendinosis, bursitis, and shoulder instability: (Wessel et al., 2018; n = 111; Mean Age (SD) = 46.9 (9.75) years; Dutch translation of WORC)

SEM for rotator cuff repair (n = 30): 6.0
SEM for disorders of rotator cuff without rupture (n = 34): 7.3
SEM for shoulder instability (n = 26): 9.1

Dutch Adults with rotator cuff disorders: (Wessel et al., 2013; n = 57; Mean Age (SD) = 54.2 (10.8) years; age range = 24-75 years; patients >18 years old who had 3 months duration of disorders of the rotator cuff; Dutch translation of WORC)

SEM for WORC Total Score (n = 57): 6.0

Italian Adults with a clinical diagnosis of rotator cuff tear conservatively managed: (De Santis et al., 2025; n = 149; Mean Age (SD) = 58.8 (10.7) years; patients > 18 years old; WORC translated and cross-culturally adapted into Italian)

SEM for all WORC subscales (n = 71): Physical symptoms (6.1), Sport (8.7), Work (9.0), Lifestyle (9.9), Emotional (8.9)

Shoulder Disorders: (de Witte et al., 2012; n = 92; Mean Age (SD) = 55.0 (8.7) years; patients with symptomatic full rotator cuff tears (n = 35, age range 18-75 years), partial thickness rotator cuff tears (n = 22, age range 35-65 years), or calcific tendonitis or impingement (n = 35, age range 18-65 years); Dutch translation of WORC)

SEM for total WORC score (n = 92): 6.9

Minimal Detectable Change (MDC)

Brazilian Adults with tendinopathy or rotator cuff tear: (Diniz Lopes et al., 2008)

MDC₉₀ intrarater: 7.1

Greek Adults with partial and full thickness rotator cuff tear, calcific tendonitis, or rotator cuff tendinopathy: (Karanasios et al., 2023)

MDC₉₅: 13.95% of the total score (n = 99)

Canadian French Adults with a rotator cuff disorder: (St-Pierre et al., 2015)

MDC₉₀ (n = 44): 12.3

Japanese Adults with full- or partial-thickness rotator cuff tear, impingement syndrome, or tendinopathy: (Kawabata et al., 2013)

MDC₉₅ calculated from Kawabata et al., 2013 (n = 50): 24.5

Dutch Adults with partial or full rotator cuff tear, rotator cuff calcifying tendonitis, tendinosis, bursitis, and shoulder instability: (Wessel et al., 2018)

MDC for rotator cuff repair (n = 30): 16.7
MDC for disorders of rotator cuff without rupture (n = 34): 20.3
MDC for shoulder instability (n = 26): 25.4

Dutch Adults with rotator cuff disorders: (Wessel et al., 2013)

MDC for WORC Total Score (n = 57): 16.7

Italian Adults with a clinical diagnosis of rotator cuff tear: (De Santis et al., 2025)

MDC₉₅ for all WORC subscales (n = 71): Physical symptoms (17.0), Sport (24.0), Work (24.0), Lifestyle (27.4), Emotional (24.6)

Dutch Adultswith partial or full thickness rotator cuff rupture, calcific tendonitis, or rotator cuff tendinopathy: (Wiertsema et al., 2013; n = 52; Mean Age (SD) = 54.2 (9.7) years; age range = 38-80 years; native Dutch speaking patients >18 years old with partial or full thickness rotator cuff rupture, calcific tendonitis, or rotator cuff tendinopathy; translation and cultural adaption of WORC into Dutch)

MDC₉₅ for WORC total score = 355.7

Shoulder Disorders: (de Witte et al., 2012)

MDC₉₅ for total WORC score (n = 92): 19.1

Minimally Clinically Important Difference (MCID)

Persian Adults withshoulder pain, including frozen shoulder, impingement syndrome, rotator cuff tear, tendinitis, and bursitis: (Daghiani et al., 2022; n = 130; Mean Age (SD) = 46 (12.79) years; age range = 18-85 years; Persian translation of WORC)

MCID (n = 100): 26.28

Dutch Adults with partial or full rotator cuff tear, rotator cuff calcifying tendonitis, tendinosis, bursitis, and shoulder instability: (Wessel et al., 2018)

ROC cut-off for rotator cuff repair: 34.0
ROC cut-off for disorders of rotator cuff without rupture: 22.9
ROC cut-off for shoulder instability: 31.8

Rotator Cuff Disease: (Ekeberg et al., 2010; n = 121; Mean Age (SD) = 51 (11) years; patients >18 y/o with rotator cuff disease)

MCID on the 0-2100 scale: 275 points

Full-Thickness Rotator Cuff Tear: (Gagnier et al., 2018; n = 222; Mean Age (SD) = 60.6 (9.88) years; patients >18 y/o with full-thickness rotator cuff tears with or without surgical intervention)

Anchor-based MCID for WORC (n = 19): -282.6
Distribution-based MCID for 1/2 of the SD for WORC (n = 221): -588.7
Distribution-based MCID for 1/3 of the SD for WORC (n = 221): -392.5

Cut-Off Scores

Canadian French Adults with a rotator cuff disorder: (St-Pierre et al., 2015)

17.5 (sensitivity = 81%; specificity = 81%)

Normative Data

Shoulder Pathologies: (Kemp et al., 2020; n = 988; Age groups: 18-25 (n = 99), 26-35 (n = 110), 36-45 (n = 166), 46-55 (n = 216), 56-65 (n = 193, 66-75 (n = 147), 76+ (n = 57); United States adults >18 years old with shoulder pathologies)

WORC Total Scores by Age Group and Sex

Age range and sex of total score	N	Median score	1st to 3rd quartile
18-25 Male	54	96.8	92.4 – 99.5
18-25 Female	45	98.5	93.4 – 100.0
26-35 Male	61	98.3	93.0 – 100.0
26-35 Female	49	99.6	93.5 – 100.0
36-45 Male	66	97.5	93.7 – 100.0
36-45 Female	100	98.4	94.4 – 100.0
46-55 Male	89	97.9	92.4 – 100.0
46-55 Female	127	98.3	95.6 – 100.0
56-65 Male	71	98.6	94.6 – 100.0
56-65 Female	122	98.8	95.2 – 100.0
66-75 Male	65	99.7	96.9 – 100.0
66-75 Female	82	100.0	96.9 – 100.0
76+ Male	28	100.0	93.8 – 100.0
76+ Female	29	100.0	93.7 – 100.0

Test/Retest Reliability

Greek Adults with partial and full thickness rotator cuff tear, calcific tendonitis, or rotator cuff tendinopathy: (Karanasios et al., 2023)

Excellent test-retest reliability (n = 99): (ICC = 0.942)

Canadian French Adults with a rotator cuff disorder: (St-Pierre et al., 2015)

Excellent test-retest reliability (n = 44): (ICC = 0.96)

Japanese Adults with full- or partial-thickness rotator cuff tear, impingement syndrome, or tendinopathy: (Kawabata et al., 2013)

Acceptable test-retest reliability (n = 50): (ICC = 0.84)

Italian Adults with a clinical diagnosis of rotator cuff tear: (De Santis et al., 2025)

Excellent test-retest reliability (n = 71) for all WORC subscales: Physical symptoms (ICC = 0.929), Sport (ICC = 0.897), Work (ICC = 0.908), Lifestyle (ICC = 0.883), Emotional (ICC = 0.873)

Dutch Adults with partial or full thickness rotator cuff rupture, calcific tendonitis, or rotator cuff tendinopathy: (Wiertsema et al., 2013)

Excellent test-retest reliability for WORC total score: (ICC = 0.94)

Dutch Adults with rotator cuff disorders: (Wessel et al., 2013)

Excellent test-retest reliability for WORC total score: (ICC = 0.91)

Danish Adultsdiagnosed with subacromial disease such as impingement, biceps tendinitis and/or rotator cuff tears and were candidates for surgical treatment: (Brix et al., 2020; n = 109: Mean Age (SD) = 55.4 (11.7) years; inclusion criteria: age >18 years; Danish translation and cross-cultural adaption of WORC)

Excellent test-retest reliability for WORC total score: (ICC = 0.80)

Chinese Adultsdiagnosed with rotator cuff disorders: (Wang et al., 2017; n = 124; Mean Age (SD) = 47.3 (9.5) years; patients >18 years old with Chinese as their mother tongue; Chinese translation and cross-cultural adaption of WORC)

Acceptable test-retest reliability: (ICC = 0.893)

Persian Adults with rotator cuff disorders: (Mousavi et al., 2009; n = 120, Mean Age (SD) = 46.7 (15.4) years; native Persian speaking patients; Persian translation and cultural adaptation of WORC)

Excellent test-retest reliability for the Persian WORC total score: (ICC = 0.90, p < 0.01)

Norwegian Adults with rotator cuff disease: (Ekeberg et al., 2008; n = 55; Mean Age (SD) = 51 (10) years; median test-retest interval = 7 days; Norwegian speaking patients)

Acceptable test-retest reliability for the Norwegian WORC: (ICC = 0.84)

Shoulder Disorders: (de Witte et al., 2012, n = 83)

Excellent test-retest reliability for total WORC score: (ICC = 0.89, p < 0.0001)

Rotator Cuff Pathology: (Kirkley et al., 2003; n = 100; Mean Age (SD) = 52.7 (12.25) years; patients >18 years old with acute rotator cuff tendinitis, rotator cuff tendinosis with no tear, partial thickness rotator cuff tears, full-thickness rotator cuff tears (small to massive), and rotator cuff arthropathy; WORC completed at two weeks following baseline)

Excellent test-retest reliability: (ICC = 0.96)

Interrater/Intrarater Reliability

Brazilian Adults with tendinopathy or rotator cuff tear: (Diniz Lopes et al., 2008)

Excellent interrater reliability: (ICC = 0.97)
Excellent intra-rater reliability: (ICC = 0.99)

Internal Consistency

Greek Adults with partial and full thickness rotator cuff tear, calcific tendonitis, or rotator cuff tendinopathy: (Karanasios et al., 2023)

Excellent internal consistency: (Cronbach's alpha = 0.943*)

Canadian French Adults with a rotator cuff disorder: (St-Pierre et al., 2015)

Excellent internal consistency (n = 44): (Cronbach's alpha = 0.98*)

Japanese Adults with full- or partial-thickness rotator cuff tear, impingement syndrome, or tendinopathy: (Kawabata et al., 2013)

Excellent internal consistency: (Cronbach's alpha = 0.95*)

Italian Adults with a clinical diagnosis of rotator cuff tear: (De Santis et al., 2025)

Excellent internal consistency for all WORC subscales: Physical symptoms (Cronbach's alpha = 0.843), Sport (Cronbach's alpha = 0.856), Work (Cronbach's alpha = 0.900), Lifestyle (Cronbach's alpha = 0.883), Emotional (Cronbach's alpha = 0.933*)

Dutch Adults with partial or full thickness rotator cuff rupture, calcific tendonitis, or rotator cuff tendinopathy: (Wiertsema et al., 2013)

Excellent internal consistency for WORC total score: (Cronbach's alpha = 0.97*)

Dutch Adults with rotator cuff disorders: (Wessel et al., 2013)

Excellent internal consistency for WORC total score: (Cronbach's alpha = 0.95*)

Danish Adults diagnosed with subacromial disease such as impingement, biceps tendinitis and/or rotator cuff tears and were candidates for surgical treatment: (Brix et al., 2020)

Excellent internal consistency for WORC total score: (Cronbach's alpha = 0.94*)

Chinese Adults diagnosed with rotator cuff disorders: (Wang et al., 2017)

Excellent internal consistency for WORC total score: (Cronbach's alpha = 0.95*)

Persian Adults with rotator cuff disorders: (Mousavi et al., 2009; n = 120)

Excellent internal consistency for Persian WORC: (Cronbach's alpha = 0.92*)

Norwegian Adults with rotator cuff disease: (Ekeberg et al., 2008)

Excellent internal consistency for Norwegian WORC total: (Cronbach's alpha = 0.91*)

Shoulder Disorders: (de Witte et al., 2012)

Excellent internal consistency: ( Cronbach's alpha = 0.95* for total WORC scale and Cronbach's alpha = 0.96*, 0.91*, & 0.95* for rotator cuff tear, impingement, and calcific tendinitis, respectively)

Chronic Full-Thickness Rotator Cuff Tear: (Richards et al., 2022; n = 66; Mean Age = 59 (10) years; 2-year follow-up on patients >18 years old)

Excellent internal consistency: (Cronbach's alpha = 0.910*)

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Brazilian Adults with tendinopathy or rotator cuff tear: (Diniz Lopes et al., 2008)

Excellent correlations* between WORC and Pain VAS at rest (r = -0.68), on movement (r = -0.75), at night (r = -0.69), DASH (r = -0.86), UCLA Shoulder Rating Scale (r = 0.80), SF-36 domains of Physical functioning (r = 0.63), Physical role (r = 0.66), Bodily pain (r = 0.69)
Adequate correlations* between WORC and Range of motion in Forward flexion (r = 0.57), Strength in Forward flexion (r = 0.56), External rotation (r = 0.34, p < 0.05), Internal rotation (r = 0.35), SF-36 domains of General health (r = 0.37), Vitality (r = 0.41), Social functioning (r = 0.52), Emotional role (r = 0.55), Mental health (r = 0.47).
Poor correlations between WORC and Range of motion in External rotation (r = 0.23, p<0.05), Internal rotation (r = -0.22, p < 0.05)

*All p < 0.001 unless specified

Chronic Full-Thickness Rotator Cuff Tear: (Richards et al., 2022)

Excellent correlation between WORC and Rotator Cuff-Quality of Life (RC-QOL) (r = 0.87, p < 0.001)

Construct Validity

Construct validity:

Persian Adults withshoulder pain, including frozen shoulder, impingement syndrome, rotator cuff tear, tendinitis, and bursitis: (Daghiani et al., 2022)

Excellent correlation between WORC and Short-WORC (r = 0.93, p < 0.001) and Quick-DASH (r = 0.74, p < 0.001)

Japanese Adults with full- or partial-thickness rotator cuff tear, impingement syndrome, or tendinopathy: (Kawabata et al., 2013)

Excellent correlation between WORC and DASH (r = 0.78, p < 0.05) and SF-36 bodily pain (r = -0.69, p < 0.05)
Adequate correlation between WORC and SF-36 domains of social functioning (r = -0.54, p < 0.05), role emotional (r = -0.51, p < 0.05), physical functioning (r = -0.50, p < 0.05), role physical (r = -0.50, p < 0.05), vitality (r = -0.49, p < 0.05), mental health (r = -0.45, p < 0.05), and general health (r = -0.34, p < 0.05)

Italian Adults with a clinical diagnosis of rotator cuff tear: (De Santis et al., 2025)

Adequate to Excellent correlation between WORC-physical symptoms and ASES-pain (r = 0.694), ASES-function (r = 0.616), NPRS (r = -0.677), SF36-PCS (r = 0.422), and SF36-MCS (r = 0.436)
Adequate to Excellent correlation between WORC-sport and ASES-pain (r = 0.604), ASES-function (r = 0.724), NPRS (r = -0.604), SF36-PCS (r = 0.583), and SF36-MCS (r = 0.370)
Adequate to Excellent correlation between WROC-work and ASES-pain (r = 0.689), ASES-function (r = 0.769), NPRS (r = -0.681), SF36-PCS (r = 0.543), and SF36-MCS (r = 0.393)
Adequate to Excellent correlation between WROC-lifestyle and ASES-pain (r = 0.742), ASES-function (r = 0.731), NPRS (r = -0.742), SF36-PCS (r = 0.467), and SF36-MCS (r = 0.400)
Adequate to Excellent correlation between WROC-emotional and ASES-pain (r = 0.588), ASES-function (r = 0.635), NPRS (r = -0.604), ASES-pain (r = 0.588), SF36-PCS (r = 0.383), and SF36-MCS (r = 0.532)

Danish Adults diagnosed with subacromial disease such as impingement, biceps tendinitis and/or rotator cuff tears and were candidates for surgical treatment: (Brix et al., 2020)

Adequate to Excellent correlation between Danish WORC total and SF36-MCS (r = -0.39), SF36-PCS (r = -0.39), OSS (r = 0.67), and DASH (r = 0.71)

Dutch Adults with rotator cuff disorders: (Wessel et al., 2013)

Adequate to Excellent correlation between the Dutch WORC total score and Constant Score (r = 0.60, p < 0.001), RAND-36 physical (r = 0.66, p < 0.001) and mental (r = 0.46, p < 0.001) health summary scores, and Shoulder hindrance (r = -0.75, p < 0.001)

Chinese Adults diagnosed with rotator cuff disorders: (Wang et al., 2017; n = 124)

Excellent correlation between Chinese WORC (C-WORC) overall scale and OSS (r = 0.842, p < 0.001) and SF-36 domains of role physical (r = 0.605, p < 0.001) and bodily pain (r = 0.663, p < 0.001)
Adequate correlation between C-WORC overall scale and SF-36 domains of physical function (r = 0.568, p < 0.001), general health (r = 0.579, p < 0.001), social function (r = 0.326, p = 0.001), role emotional (r = 0.391, p < 0.001), and mental health (r = 0.366, p < 0.001)
Poor correlation between C-WORC overall scale and SF-36 domain of vitality (r = 0.248, p = 0.006)

Brazilian Adults with rotator cuff disorders: (Lopes et al., 2009; n = 30; Mean Age (SD) = 55.07 (10.83) years; age range = 27-74 years; adults >18 years old with Brazilian Portuguese as their primary language)

Excellent correlation between Brazilian WORC and DASH in the self-report group (r = -0.87, p < 0.001) and the interviewer-administered group (r = -0.94, p < 0.001)

Shoulder Disorders: (de Witte et al., 2012; n = 92)

Adequate to Excellent correlation between WORC and Constant Score (CS) (r = 0.56, p < 0.001) and DASH (r = -0.65, p < 0.001)

Rotator Cuff Pathology: (Kirkley et al., 2003)

Excellent correlation at baseline (n = 96) between WORC and ASES (r = 0.68) and DASH (r = 0.63)
Adequate correlation at baseline between WORC and Constant Score (r = 0.57), UCLA Shoulder Rating Scale (r = 0.48), Range of motion (r = 0.39), and the SF-36 domains of bodily pain (r = 0.52), role physical (r = 0.56), physical function (r = 0.44), and general health (r = 0.33)
Poor correlation at baseline between WORC and the SF-36 domains of emotional (r = 0.26), mental health (r = 0.12), social function (r = 0.09), and vitality (r = 0.03)
Excellent correlation at 3-month follow-up (n = 50) between WORC and ASES (r = 0.76), UCLA Shoulder Rating Scale (r = 0.72), and DASH (r = 0.66)
Adequate correlation at 3-month follow-up between WORC and Constant Score (r = 0.44), Range of motion (r = 0.31), and the SF-36 domains of role physical (r = 0.52), bodily pain (r = 0.46), and physical function (r = 0.39)
Poor correlation at 3-month follow-up between WORC and the SF-36 domains of mental health (r = 0.18), vitality (r = 0.17), general health (r = 0.07), emotional (r = 0.06), and social function (r = 0.01)

Convergent validity:

Greek Adults with partial and full thickness rotator cuff tear, calcific tendonitis, or rotator cuff tendinopathy: (Karanasios et al., 2023)

Excellent correlation between the Greek version of the WORC (WORC-GR) and the Greek versions of DASH (r = 0.806) and SPADI (r = 0.852)
Moderate correlation between WORC-GR and SF-36 domains of Physical functioning (r = -0.529), Role limitations due to physical health (r = -0.507), Emotional well-being (r = -0.531), Pain (r = -0.519), Social functioning (r = -0.372), General health (r = -0.397), and Health change (r = -0.395)

Canadian French Adults with a rotator cuff disorder: (St-Pierre et al., 2015)

Excellent correlation between WORC-CF and DASH-CF (r = -0.78, p < 0.05) and SF-36-CF physical (r = 0.68, p < 0.05) and NPRS average pain level (r = -0.67, p < 0.05), worst pain (r = -0.68, p < 0.05), lowest pain (r = -0.60, p < 0.05), lifting load (r = -0.68, p < 0.05), and elevating the arm (r = -0.65, p < 0.05).
Adequate correlation between WORC-CF and SF-36-CF mental health (r = 0.50, p < 0.05)

Persian Adults with rotator cuff disorders: (Mousavi et al., 2009)

Adequate to Excellent correlation between Persian WORC total score and DASH (r = -0.78), VAS (r = -0.62), and the SF-36 mental (r = 0.54) and physical (r = 0.65) composite scores

Norwegian Adults with rotator cuff disease: (Ekeberg et al., 2008; n = 74; Mean Age (SD) = 51 (11) years)

Excellent correlation between Norwegian WORC total and Shoulder Pain and Disability Index (SPADI) total (r = -0.67) and Oxford Shoulder Scale (OSS) (r = -0.69)

Rotator Cuff Related Conditions: (Holtby & Razmjou, 2005; n = 154; Mean Age (SD) = 48 (14.8) years; mixed population of criteria for surgery (n = 50), surgical findings of rotator cuff tendinitis, partial- or full-thickness tear of the rotator cuff, and/or acromioclavicular joint arthritis (n = 44), and pathologies primarily related to instability with or without internal impingement and/or posterior cuff pathology (n = 6))

Cross-sectional convergent construct validity: Excellent correlation between WORC and Absolute Constant-Murley (n = 152, r = 0.65, p < 0.01), Relative Constant-Murley age-adjusted value (n = 151, r = 0.66, p < 0.01), and ASES (n = 153, r = 0.73, p < 0.01) in all patients
Cross-sectional convergent construct validity: Excellent correlation between WORC and Absolute Constant-Murley (n = 50, r = 0.61, p < 0.01), Relative Constant-Murley age-adjusted value (n = 50, r = 0.61, p < 0.01), and ASES (n = 50, r = 0.75, p < 0.01) in preoperative surgical patients
Cross-sectional convergent construct validity: Excellent correlation between WORC and Absolute Constant-Murley (n = 39, r = 0.72, p < 0.01), Relative Constant-Murley age-adjusted value (n = 39, r = 0.82, p < 0.01), and ASES (n = 44, r = 0.85, p < 0.01) in surgical patients 6 months postoperatively
Longitudinal convergent validity: Excellent correlation between WORC and Absolute Constant-Murley (n = 39, r = 0.77, p < 0.01), Relative Constant-Murley age-adjusted value (n = 39, r = 0.70, p < 0.01), and ASES (n = 44, r = 0.85, p < 0.01) in surgical patients 6 months postoperatively

Rotator Cuff Conditions: (Razmjou et al., 2006; n = 41; Mean Age (SD) = 57 (16) years; patients at outpatient physical therapy with impingement syndrome or post-operative rehabilitation following rotator cuff-related surgeries)

Cross-sectional convergent validity: Excellent correlation at initial assessment between WORC and Rotator Cuff-Quality of Life (RCQOL) (ρ = 0.708), Upper Extremity Functional Index (UEFI) (n = 40, ρ = 0.618), and Arm, Shoulder, and Elbow Surgeons (ASES) (n = 40, ρ = 0.756)
Cross-sectional convergent validity: Strong to Very Strong correlation at interim assessment between WORC and RCQOL (ρ = 0.872) and ASES (ρ = 0.738)
Cross-sectional convergent validity: Strong to Very Strong correlation at final assessment between WORC and RCQOL (n = 40, ρ = 0.913), UEFI (n = 39, ρ = 0.779), and ASES (ρ = 0.813)

Discriminant validity:

Rotator Cuff Related Conditions: (Holtby & Razmjou, 2005)

Cross-sectional discriminant validity: Excellent correlation between WORC and pain level in all patients (n = 153, r = -0.60, p<0.01), in preoperative surgical patients (n = 50, r = -0.65, p<0.01), and in surgical patients 6 months postoperatively (n = 44, r = -0.78, p < 0.01)
Cross-sectional discriminant validity: Adequate correlation between WORC and strength of the affected arm in all patients (n = 152, r = 0.42, p<0.01) and in surgical patients postoperatively (n = 39, r = 0.44, p < 0.01)
Cross-sectional discriminant validity: Poor correlation between WORC and strength in the affected arm in preoperative surgical patients (n = 50, r = 0.20)
Cross-sectional discriminant validity: Poor correlation between WORC and strength in the unaffected arm in all patients (n = 152, r = 0.10), in preoperative surgical patients (n = 50, r = -0.21), and in surgical patients 6 months postoperatively (n = 39, r = 0.21)
Longitudinal discriminant validity: Excellent negative correlation between WORC and pain level in surgical patients 6 months postoperatively (n = 44, r = -0.77, p < 0.01)
Longitudinal discriminant validity: Adequate correlation between WORC and strength in the affected arm in surgical patients 6 months postoperatively (n = 39, r = 0.37, p < 0.01)
Longitudinal discriminant validity: Poor correlation between WORC and strength in the unaffected arm in surgical patients 6 months postoperatively (n = 39, r = 0.20)

Content Validity

Greek Adults with partial and full thickness rotator cuff tear, calcific tendonitis, or rotator cuff tendinopathy: (Karanasios et al., 2023)

Excellent content validity: (Item-CVI = 0.875-1.00, Scale-CVI/universal agreement = 0.975 and Scale-CVI/average = 0.975)

Scapula Alata: (Gadsboell & Tibaek, 2017; patients with scapula alata (n = 45; Mean Age (IQR) = 52 (38-59) years); experts in the rehab of scapula alata (n = 6; Mean Age (IQR) = 53 (43-62) years))

Fair average scale content validity from the patients with scapula alata (S-CVI = 0.56)
Good average scale content validity from the experts on scapula alata rehab (S-CVI = 0.72)

Face Validity

Greek Adults with partial and full thickness rotator cuff tear, calcific tendonitis, or rotator cuff tendinopathy: (Karanasios et al., 2023)

Adequate face validity with no key concepts missing from the index, the instructions and response options were easily understood in Greek language, the items and responses were appropriately worded, and the response options matched the questions. The patients reported that the items of the PROM were relevant to their condition, the response options were appropriate, as well as the recall period (n = 16)

Floor/Ceiling Effects

Floor effects:

Italian Adults with a clinical diagnosis of rotator cuff tear: (De Santis et al., 2025)

Excellent: No floor effects for Physical Symptoms (0.0%), Lifestyle (0.0%), and Emotional (0.0%) subscales
Adequate floor effects for Sport (0.7%) and Work (1.3%) subscales

Dutch Adults with rotator cuff disorders: (Wessel et al., 2013)

Excellent: No floor effects for the WORC total score

Chinese Adults diagnosed with rotator cuff disorders: (Wang et al., 2017)

Excellent: No floor effects for C-WORC overall scale (0%)

Persian Adults with rotator cuff disorders: (Mousavi et al., 2009)

Excellent: No floor effects in the domains or total score of the Persian WORC (<15%)

Chronic Full-Thickness Rotator Cuff Tear: (Richards et al., 2022)

Excellent: No overall floor effects for WORC at 2-year follow-up (0.0%)

Ceiling effects:

Italian Adults with a clinical diagnosis of rotator cuff tear: (De Santis et al., 2025)

Adequate ceiling effects for Physical Symptoms (2.7%), Sport (4.7%), Work (4.7%), Lifestyle (5.4%), and Emotional (9.4%) subscales

Dutch Adults with rotator cuff disorders: (Wessel et al., 2013)

Excellent: No ceiling effects for the different domains of the WORC (<15%)

Chinese Adults diagnosed with rotator cuff disorders: (Wang et al., 2017)

Excellent: No ceiling effects for C-WORC overall scale (0%)

Persian Adults with rotator cuff disorders: (Mousavi et al., 2009)

Excellent: No ceiling effects in the domains or total score of the Persian WORC (<15%)

Chronic Full-Thickness Rotator Cuff Tear: (Richards et al., 2022)

Adequate overall ceiling effects for WORC at 2-year follow-up (6.3%)

Responsiveness

Persian Adults with shoulder pain, including frozen shoulder, impingement syndrome, rotator cuff tear, tendinitis, and bursitis: (Daghiani et al., 2022)

Excellent responsiveness of the WORC: (AUC = 0.90 (0.85-0.96))

Canadian French Adults with a rotator cuff disorder: (St-Pierre et al., 2015)

Large responsiveness (n = 54): (SRM = 1.54, ES = 1.32)

Dutch Adults with partial or full rotator cuff tear, rotator cuff calcifying tendonitis, tendinosis, bursitis, and shoulder instability: (Wessel et al., 2018)

Large responsiveness for rotator cuff repair: (SRM = 2.45)
Large responsiveness for disorders of rotator cuff without rupture: (SRM = 1.03)
Large responsiveness for shoulder instability: (SRM = 1.70)

Chinese Adults diagnosed with rotator cuff disorders: (Wang et al., 2017)

Large responsiveness (n = 108): (SRM = 2.28, ES = 1.92)

Brazilian Adults with rotator cuff disorders such as tendinopathy or rotator cuff tear: (Diniz Lopes et al., 2009; n = 30)

Large responsiveness for Group 1 (improved following therapy, n = 20): (SRM = 0.76, ES = 0.92)
Moderate change for Group 2 (did not improve following therapy, n = 10): (ES = 0.45)
Low responsiveness for Group 2 (did not improve following therapy, n = 10): (SRM = 0.39)

Shoulder Disorders: (de Witte et al., 2012; n = 34)

Large responsiveness for total WORC: (SRM = -0.91, ES = -0.96)

Rotator Cuff Disease: (Ekeberg et al., 2010)

Large responsiveness in the improved group at 2 weeks (SRM = 1.46) and at 6 weeks (SRM = 1.69)

Subacromial Impingement Syndrome: (Dogu et al., 2013; n = 64; Mean Age (SD) = 55.64 (7.92) years; adults with shoulder pain lasting more than 3 months and diagnosed with subacromial impingement syndrome)

Large responsiveness: (SRM = 1.70, ES = 1.37)

Rotator Cuff Conditions: (Razmjou et al., 2006)

Large responsiveness: (SRM = 1.44)

Normative Data

Dutch Adults: (Massier et al., 2021; n = 426; Mean Age (SD) = 49 (18) years; adults >18 years old with sufficient knowledge of the Dutch language without current shoulder pathologies)

Normative WORC Values by Age Group and Sex (n = 426)

Age category (years)	Total (SD)	Male subjects	Female subjects
<30	94 (10)	93 (11)	94 (10)
31-40	96 (7)	97 (6)	95 (7)
41-50	94 (11)	92 (15)	97 (3)
51-60	93 (9)	93 (10)	94 (9)
61-70	96 (4)	96 (4)	96 (4)
>71	93 (10)	94 (8)	90 (12)

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Body Structure

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Professional Association Recommendation

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Bibliography

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