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RehabMeasures Instrument

Western Ontario Shoulder Instability Index

Last Updated

Purpose

The WOSI is a 21-item scale used to measure shoulder related quality of life in patients with symptomatic shoulder instability.

Link to Instrument

instrument details

Acronym WOSI

Area of Assessment

Activities of Daily Living
Behavior
Functional Mobility
General Health
Life Participation
Mental Health
Motivation
Occupational Performance
Pain
Patient Satisfaction
Quality of Life
Range of Motion
Sleep
Strength
Stress & Coping
Upper Extremity Function

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Pain Management

Key Descriptions

  • 21 item instrument.
  • Each item scored 0-100 using a visual analog scale.
  • Each item falls into 1 of 4 domains (listed below).
  • 10 items pertain to physical symptoms.
  • 4 items pertain to sports, recreation, and work.
  • 4 items pertain to lifestyle.
  • 3 items pertain to emotion.
  • 0 is the best possible score, meaning the patient is experiencing no decrease in shoulder related quality of life.
  • 2100 signifies an extreme decrease in shoulder related quality of life.

Number of Items

21

Time to Administer

Approximately 10 minutes

Estimated 3 minutes to administer, 6 minutes to score

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Michelle Anumba, SPT Kathryn Csete, SPT Kathleen Decina, SPT Danyelle Dye, SPT Steven Higbie, SPT Shawn Hoffman, SPT Mary Jackson, SPT Molly Mazich, SPT Meghan O’Hara, SPT and Andrea Rawley, SPT in 5/2014.

Body Part

Neck
Upper Extremity

ICF Domain

Body Structure
Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
Emotion
General Health
Motor

Considerations

Literature review of measures for shoulder function (Angst et al., 2011): 

  • Recall period for items is one week 

  • There is very little validity and responsiveness information 

  • The 0-2, 100 scale is not comparable to other scales, but it can be converted to a 0-100 point scale

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Musculoskeletal Conditions

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Standard Error of Measurement (SEM)

Recurrent anterior dislocation and SLAP lesion

  • Skare (2013); SEM = 122.4

Minimal Detectable Change (MDC)

Recurrent anterior dislocation and SLAP lesion 

  • Skare (2013); MDC= 339.3

Minimally Clinically Important Difference (MCID)

Post arthroscopic Bankart repair 

  • Kemp et al (2012); MCID= 10%

Test/Retest Reliability

Shoulder instability 

  • Kirkley (1998); Excellent reliability; ICC at 2 weeks= 0.95; ICC at 3 months= 0.91 

 

Literature review of measures for shoulder function 

  • Angst et al (2011); Excellent reliability; ICC= 0.87-0.98 

 

Patients awaiting surgery for shoulder instability 

  • Gaudelli et al (2013); Excellent reliability; ICC= 0.84 

 

Post traumatic shoulder dislocation with closed reduction 

  • Salomonsson (2009); Excellent reliability; ICC= 0.94; ICC for physical domain= 0.90; ICC for sport domain= 0.85; ICC for lifestyle domain= 0.89; ICC for emotion domain= 0.91 

 

Recurrent Anterior Dislocation and SLAP Lesion 

  • Skare (2013); Excellent reliability; ICC= 0.92

Internal Consistency

Literature review of measures for shoulder function 

  • Angst et al (2011); Excellent internal consistency; Cronbach’s alpha= 0.88-0.96 

 

Surgical Stabilization 

  • Salomonsson (2009); Excellent internal consistency; pre-op Cronbach alpha= 0.89; post-op Cronbach alpha= 0.95 

 

Recurrent Anterior Dislocation and SLAP Lesion 

  • Skare (2013); Excellent internal consistency; Cronbach alpha=0.96

Construct Validity

Shoulder instability; Kirkley (1998); Pearson’s product-moment correlations 

  • Excellent after 3 months of change 

    • DASH (r=0.76) 

    • UCLA shoulder rating scale (r=0.69) 

    • Constant score (r=0.65) 

  • Adequate after 3 months of change 

    • Global change (r=0.58) 

    • Rowe rating scale (r=0.52) 

    • ASES (r=0.50) 

    • SF12 physical score (r=0.37) 

  • Poor after 3 months of change 

    • SF12 mental score (r=0.12) 

    • Range of Motion (r=0.11) 

 

Literature review of measures for shoulder function; Angst et al (2011); Pearson’s or Spearman’s correlations 

  • Excellent correlation 

    • VAS for function (r=0.80) 

    • DASH (r=0.77) 

    • SF-12 PCS (r=0.66) 

    • Constant score (r=0.59) 

  • Adequate correlation 

    • Rowe score (r=0.59) 

    • Shoulder rating scale (r=0.59) 

    • ASES (r=0.55-0.67) 

    • SF-36 bodily pain (r=0.56) 

    • SF-36 physical function (r=0.44) 

    • EQ-5D (r=0.44) 

  • Poor correlation 

    • SF12 mental score (r=0.12) 

 

Patients awaiting surgery for shoulder instability; Gaudelli et al (2013); Pearson’s correlations 

  • Excellent correlation 

    • DASH (r=0.65) 

  • Adequate correlation 

    • Walch-Dunlay score (r=-0.31) 

 

Surgical Stabilization; Salomonsson (2009); Pearson’s correlations 

  • Excellent correlation 

    • VAS (r=0.80) 

 

Posttraumatic Shoulder Dislocation with closed reduction; Salomonsson (2009); Pearson’s correlations 

  • Adequate correlation 

    • Rowe score (r=0.59) 

 

Recurrent Anterior Dislocation; Skare (2013); Pearson’s correlations 

  • Excellent correlation 

    • OISS (r=0.80) 

  • Adequate correlation 

    • Rowe score (r=-0.59) 

 

SLAP Lesion; Skare (2013); Pearson’s Correlations 

  • Excellent correlation 

    • OISS (r=0.64) 

  • Adequate correlation 

Rowe score (r=-0.42)

Content Validity

Shoulder instability; Kirkley (1998)

  • The 21 items of the WOSI were generated following a review of the literature regarding shoulder instability and related fields. Items were included from the Constant Score, UCLA Shoulder Rating Scale, and the American Shoulder and Elbow Surgeons Standardized Shoulder Form (ASES). Orthopedic surgeons, primary-care sports medicine physicians, and physical therapists were consulted regarding the creation of the scale. Patients with shoulder instability and their significant others were interviewed regarding the five domains of the scale. 

 

Recurrent Anterior Dislocation and SLAP Lesion; Skare (2013)

  • The questionnaire reflected the constructs to be measured. This was completed using a cross-cultural adaptation and translation process.

Floor/Ceiling Effects

Literature review of measures for shoulder function; Angst et al (2011) 

  • No floor and ceiling effects 

 

Surgical Stabilization; Salomonsson (2009) 

  • 5% floor effect observed pre-op in sport domain; 5% ceiling effect observed post-op in physical, sport, and lifestyle domains; 14% ceiling effect observed post-op in emotion domain 

 

Recurrent Anterior Dislocation and SLAP Lesion; Skare (2013) 

  • No apparent floor or ceiling effects

Responsiveness

Shoulder instability; Kirkley (1998) 

  • Standardized response mean (SRM)= 0.93 

 

Literature review of measures for shoulder function; Angst et al (2011) 

  • Stabilization Surgery 

    • Effect Size (ES) = 1.64 (large) 

    • SRM = 1.40 (large) 

  • Physiotherapy with or without surgery 

    • SRM = 0.93 (large) 

 

Surgical Stabilization; Salomonsson (2009) 

  • Excellent; SRM= 1.67 

  • By domain: 

    • Physical Symptoms, SRM= 1.15 

    • Sport, SRM=1.15 

    • Lifestyle, SRM= 1.43 

    • Emotions, SRM=1.40

Bibliography

Angst, F., H. K. Schwyzer, et al. (2011). "Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI)." Arthritis Care Res (Hoboken) 63 Suppl 11(S11): S174-188. 

Gaudelli, C., F. Balg, et al. (2014). "Validity, reliability and responsiveness of the French language translation of the Western Ontario Shoulder Instability Index (WOSI)." Orthop Traumatol Surg Res 100(1): 99-103. 

Kemp, K. A., D. M. Sheps, et al. (2012). "An evaluation of the responsiveness and discriminant validity of shoulder questionnaires among patients receiving surgical correction of shoulder instability." ScientificWorldJournal 2012: 410125. 

Kirkley, A., S. Griffin, et al. (1998). "The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI)." Am J Sports Med 26(6): 764-772. 

Salomonsson, B., Ahlstrom, S., Dalen, N., and Lillkrona, U. (2009). The Western Ontario Shoulder Instability Index (WOSI): validity, reliability, and responsiveness retested with a Swedish translation. Acta Orthopaedica, 80 (2), 233-238. (please include any citations included in your review, if you find additional citations, please let us know) 

Skare, O., Liavaag, S., Reikeras, O., Mowinckel, P., Brox, J.I. (2013). Evaluation of Oxford instability shoulder score, Western Ontario should instability Index and Euroquol in patients with slap (superior labral anterior posterior) lesions or recurrent anterior dislocations of the shoulder. BMC Research Notes. 2013. 6:273

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