Factor structure of the Oxford Shoulder Score: secondary analyses of the UK FROST and PROFHER trial populations
Ontology highlight
ABSTRACT:
SUBMITTER: Simpson J
PROVIDER: S-EPMC10631035 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundTo explore and compare the factor structure of the 12-item Oxford shoulder score (OSS) and 13-item shoulder pain and disability index (SPADI).MethodsExploratory factor analysis (EFA) and confirmatory factor analysis (CFA) of data from 660 patients attending 46 hospitals in the UK. Complete OSS and SPADI data were available for 648 (98.2%) and 628 (95.2%) participants, respectively.ResultsFor both instruments, either one or two factors were indicated, depending on the extraction method. On EFA, most OSS items loaded saliently on either of two "Pain" (4 items) and "Function" (8 items) factors, although some items cross-loaded. Cronbach's alphas were 0.75, 0.90, and 0.91 for "Pain" and "Function" subscales, and all 12 OSS items, respectively. CFA suggested marginally better fit for two factors, with neither one- nor two-factor models rejected. EFA indicated two factors for the SPADI, with three of the eight "Disability" items contributing to an 8-item "Pain factor", with 2 items within the 5-item "Disability factor" cross-loading. Cronbach's alpha was 0.87 and 0.93 for the original 5- and 8-item pain and disability scales; 0.94 for all 13 SPADI items, respectively. CFA suggested marginally better fit for the two-factor (original conceptualization) model of the SPADI, with neither one- nor two-factor models rejected.ConclusionEFA and CFA demonstrated that, in addition to single summary scales usage, separate information on pain and self-reported disability/function can be extracted in a meaningful way, as subscales, from both the OSS and the SPADI. This information can help researchers in choosing primary study endpoints appropriately.
| S-EPMC5123655 | biostudies-literature
Project description:PurposeIn order to enable cost-utility analysis of shoulder pain conditions and treatments, this study aimed to develop and evaluate mapping algorithms to estimate the EQ-5D health index from the Oxford Shoulder Score (OSS) when health outcomes are only assessed with the OSS.Methods5437 paired OSS and EQ-5D questionnaire responses from four national multicentre randomised controlled trials investigating different shoulder pathologies and treatments were split into training and testing samples. Separate EQ-5D-3L and EQ-5D-5L analyses were undertaken. Transfer to utility (TTU) regression (univariate linear, polynomial, spline, multivariable linear, two-part logistic-linear, tobit and adjusted limited dependent variable mixture models) and response mapping (ordered logistic regression and seemingly unrelated regression (SUR)) models were developed on the training sample. These were internally validated, and their performance evaluated on the testing sample. Model performance was evaluated over 100-fold repeated training-testing sample splits.ResultsFor the EQ-5D-3L analysis, the multivariable linear and splines models had the lowest mean square error (MSE) of 0.0415. The SUR model had the lowest mean absolute error (MAE) of 0.136. Model performance was greatest in the mid-range and best health states, and lowest in poor health states. For the EQ-5D-5L analyses, the multivariable linear and splines models had the lowest MSE (0.0241-0.0278) while the SUR models had the lowest MAE (0.105-0.113).ConclusionThe developed models now allow accurate estimation of the EQ-5D health index when only the OSS responses are available as a measure of patient-reported health outcome.
| S-EPMC9911508 | biostudies-literature
Project description:BackgroundThe use of validated patient reported outcome scores is critical to the reporting and monitoring of the effectiveness of clinical treatment. The aim of this study was to translate and culturally validate the English Oxford Shoulder Score (OSS) to Romanian.MethodsApproximately, 125 patients with disorders of the rotator cuff and proximal humerus fractures completed the translated Oxford Shoulder Score (OSS_RO), the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and EuroQol 5-Dimension (EQ-5D-5L). The patients repeated the evaluation using the OSS_RO after 2 days.ResultsThe OSS_RO had a high degree of internal consistency and reliability with a Cronbach's α of 0.954 at the initial completion and 0.945 at the second testing. The intraclass correlation coefficient (ICC, 2-way mixed effects model) was 0.953 (single measures) and 0.976 (average), P < .001. The OSS_RO was reproducible (Pearson's r = 0.953; P < .001). The OSS_RO was divergently valid with QuickDASH score (Pearson's r = -0.633 first and r = -0.672 second; P < .001) and convergent with the EQ-5D VAS (Pearson's r = 0.627 first and r = 0.640 second; P < .001) and the EQ-5D Index (Pearson's r = 0.759 first and r = 0.771 second; P < .001).ConclusionOur study showed that the Romanian translation of the OSS is a reliable, reproducible and valid measure of shoulder function in patients with variable shoulder pathology.
| S-EPMC5999452 | biostudies-literature
Project description:ObjectivesTo explore the experiences and perceptions of trial participants and healthcare professionals in the UK Frozen Shoulder Trial (UK FROST), a multicentre randomised controlled trial that compared manipulation under anaesthesia (MUA), arthroscopic capsular release (ACR) with a 12-week early structured physiotherapy programme (ESP) in people with unilateral frozen shoulder referred to secondary care.DesignNested qualitative study with semistructured interviews. We used constant comparison method to develop our themes.SettingThis qualitative study was nested within the UK FROST.Participants44 trial participants (ESP: 14; MUA: 15; ACR: 15), and 8 surgeons and 8 physiotherapists who delivered the treatments in the trial.ResultsTrial participants found UK FROST treatments acceptable and satisfactory in terms of content, delivery and treatment benefits. Participants in all arms experienced improvements in pain, shoulder movements, and function. Participants said they would choose the same treatment that they received in the trial.Surgeons and physiotherapists felt that the content and delivery of UK FROST treatments was not significantly different to their routine practice except for the additional number of physiotherapy sessions offered in the trial. They had mixed feelings about the effectiveness of UK FROST treatments. Both stressed the value of including hydrodilatation as a comparator of other treatment options. Physiotherapists raised concerns about the capacity to deliver the number of UK FROST physiotherapy sessions in routine clinical settings.Shared perceptions of trial participants, surgeons and physiotherapists were: (1) Pain relief and return of shoulder movements and function are important outcomes and (2) Adherence to exercises leads to better outcomes.ConclusionIn general, our findings indicated that trial participants, and surgeons and physiotherapists who delivered the treatments had positive experiences and perceptions in the UK FROST. Early qualitative investigations to explore the feasibility of delivering treatments in real-world settings are suggested in future trials in the frozen shoulder.Trial registration numberInternational Standard Randomised Controlled Trial Register, ID: ISRCTN48804508. Registered on 25 July 2014; Results.
| S-EPMC8202103 | biostudies-literature
Project description:BackgroundThe choice of patient-reported outcome measure (PROM) used in shoulder studies varies based on clinician's preference and location. This creates difficulties when attempting to compare studies which have used different PROMs as their outcome measure. This study aims to assess the agreement between the American Shoulder and Elbow Surgeons score (ASES) and the Oxford Shoulder Score (OSS), and identify factors associated with agreement.MethodsPatients with shoulder pathology were identified from a multi-cohort observational practice registry. 1050 paired ASES and OSS pre-treatment scores were prospectively collected. Linear regression was performed to assess the agreement between the PROMs. Mixed-effects analysis of variance was performed to assess the influence of factors associated with agreement.ResultsRegression for mean total and mean function ASES and OSS demonstrated good fit (adjusted R2 57.7%, P < 0.001; and 63.9%, P < 0.001). Mean pain subscore demonstrated a poorer fit (adjusted R2 39.4%, P < 0.001). Crosswalks to convert between mean scores were produced with reasonable precision. Veterans RAND 12-Item Health Survey score, age and diagnosis cohort influenced agreement.ConclusionMean total and mean function ASES and OSS scores agree well with each other. This allows for a more informed comparison of studies using either PROMs as their outcome measure.
| S-EPMC9720864 | biostudies-literature
Project description:PurposeThe Oxford Knee Score (OKS) is a validated 12-item measure of knee replacement outcomes. An algorithm to estimate EQ-5D utilities from OKS would facilitate cost-utility analysis on studies analyses using OKS but not generic health state preference measures. We estimate mapping (or cross-walking) models that predict EQ-5D utilities and/or responses based on OKS. We also compare different model specifications and assess whether different datasets yield different mapping algorithms.MethodsModels were estimated using data from the Knee Arthroplasty Trial and the UK Patient Reported Outcome Measures dataset, giving a combined estimation dataset of 134,269 questionnaires from 81,213 knee replacement patients and an internal validation dataset of 45,213 questionnaires from 27,397 patients. The best model was externally validated on registry data (10,002 observations from 4,505 patients) from the South West London Elective Orthopaedic Centre. Eight models of the relationship between OKS and EQ-5D were evaluated, including ordinary least squares, generalized linear models, two-part models, three-part models and response mapping.ResultsA multinomial response mapping model using OKS responses to predict EQ-5D response levels had best prediction accuracy, with two-part and three-part models also performing well. In the external validation sample, this model had a mean squared error of 0.033 and a mean absolute error of 0.129. Relative model performance, coefficients and predictions differed slightly but significantly between the two estimation datasets.ConclusionsThe resulting response mapping algorithm can be used to predict EQ-5D utilities and responses from OKS responses. Response mapping appears to perform particularly well in large datasets.
| S-EPMC3607737 | biostudies-literature
Project description:PurposeThe aim of this study was to determine the correlation between functional outcome scores and treatment success after arthroscopic rotator cuff repair.MethodsWe conducted a retrospective cohort study of patients who underwent unilateral rotator cuff repair at a tertiary hospital between 2010 and 2015. University of California at Los Angeles Shoulder Score (UCLASS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) were measured before and at 6, 12, and 24 months after surgery. Patients were divided into 2 groups at each follow-up: (1) those with successful treatment and (2) those with unsuccessful treatment. Treatment success was defined as simultaneous fulfilment of 3 criteria: clinically significant improvement in pain, expectations for surgery met, and patient satisfied with surgery.ResultsA total of 214 subjects met the inclusion criteria. UCLASS was a consistent significant predictor of treatment success at 6 months (odds ratio [OR] 1.192, P = .005, 95% confidence interval [CI] 1.054-1.348), 12 months (OR 1.274, P < .001, 95% CI 1.153-1.406), and 24 months (OR 1.266, P < .001, 95% CI 1.162-1.380). Lower preoperative CSS was significant in predicting treatment success at 6 months (OR 0.952, P = .001, 95% CI 0.926-0.979), while larger tear size was significant in predicting treatment success at 24 months (OR 1.773, P = .043, 95% CI 1.019-3.083).ConclusionUCLASS is a better tool for predicting treatment success than CSS and OSS in patients undergoing arthroscopic rotator cuff repair, up to a minimum of 24 months' follow-up. A holistic assessment of shoulder function, taking into account both subjective and objective evaluation of function, as well as patient-reported satisfaction, is important in determining treatment success after arthroscopic rotator cuff repair.Level of evidenceIII, retrospective comparative study.
| S-EPMC8129435 | biostudies-literature
Project description:IntroductionThe UK Biobank cognitive assessment data has been a significant resource for researchers looking to investigate predictors and modifiers of cognitive abilities and associated health outcomes in the general population. Given the diverse nature of this data, researchers use different approaches - from the use of a single test to composing the general intelligence score, g, across the tests. We argue that both approaches are suboptimal - one being too specific and the other one too general - and suggest a novel multifactorial solution to represent cognitive abilities.MethodsUsing a combined Exploratory Factor (EFA) and Exploratory Structural Equation Modeling Analyses (ESEM) we developed a three-factor model to characterize an underlying structure of nine cognitive tests selected from the UK Biobank using a Cattell-Horn-Carroll framework. We first estimated a series of probable factor solutions using the maximum likelihood method of extraction. The best solution for the EFA-defined factor structure was then tested using the ESEM approach with the aim of confirming or disconfirming the decisions made.ResultsWe determined that a three-factor model fits the UK Biobank cognitive assessment data best. Two of the three factors can be assigned to fluid reasoning (Gf) with a clear distinction between visuospatial reasoning and verbal-analytical reasoning. The third factor was identified as a processing speed (Gs) factor.DiscussionThis study characterizes cognitive assessment data in the UK Biobank and delivers an alternative view on its underlying structure, suggesting that the three factor model provides a more granular solution than g that can further be applied to study different facets of cognitive functioning in relation to health outcomes and to further progress examination of its biological underpinnings.
| S-EPMC9937787 | biostudies-literature
Project description:BackgroundThe degree to which a validated instrument is able to detect clinically significant change over time is an important issue for the better management of hip or knee replacement surgery. This study examines the internal responsiveness of the EQ-5D-3L, the Oxford Hip Score (OHS), and the Oxford Knee Score (OKS) by various methods. Data from NHS patient-reported outcome measures (PROMs) linked to the Hospital Episodes Statistics (HES) dataset (2009-2015) was analysed for patients who underwent primary hip surgery (N = 181,424) and primary knee surgery (N = 191,379).MethodsPaired data-specific univariate responsiveness was investigated using the standardized response mean (SRM), the standardized effect size (SES), and the responsiveness index (RI). Multivariate responsiveness was furthermore examined using the defined capacity of benefit score (i.e. paired data-specific MCID), adjusting baseline covariates such as age, gender, and comorbidities in the Box-Cox regression models. The observed and predicted percentages of patient improvement were examined both as a whole and by the patients' self-assessed transition level.ResultsThe results showed that both the OHS and the OKS demonstrated great univariate and multivariate responsiveness. The percentages of the observed (predicted) total improvement were high: 51 (54)% in the OHS and 73 (58)% in OKS. The OHS and the OKS showed distinctive differences in improvement by the 3-level transition, i.e. a little better vs. about the same vs. a little worse. The univariate responsiveness of the EQ-5D-3L showed moderate effects in total by Cohen's thresholds. The percentages of improvement in the EQ-5D-3L were moderate: 44 (48)% in the hip and 42 (44)% for the knee replacement population.ConclusionsDistinctive percentage differences in patients' perception of improvement were observed when the paired data-specific capacity of benefit score was applied to examine responsiveness. This is useful in clinical practice as rationale for access to surgery at the individual-patient level. This study shows the importance of analytic methods and instruments for investigation of the health status in hip and/or knee replacement surgery. The study finding also supports the idea of using a generic measure along with the disease-specific instruments in terms of cross-validation.
| S-EPMC7791983 | biostudies-literature
Project description:Objectives To explore regional variations in donation of cadaveric solid organs and tissues across the four devolved health administrations of the UK (England, Scotland, Wales and Northern Ireland). Design A secondary analysis of databases from NHS Blood & Transplant (1990-2009) and from the National Organ Procurement Service for the Republic of Ireland, Eurotransplant International Foundation and Scandiatransplant. Results After adjusting for time, statistically significant differences were found among the four regions (p<0.001) for liver donations. The only exceptions were between England and Scotland and between Wales and Northern Ireland where the differences were not significant following a Bonferroni correction (p>0.008). England had significantly fewer heart donations than both Wales (p<0.001) and Northern Ireland (p=0.005). There were no significant differences among the four regions for lung donations. Regional variations in kidney and corneal donations were moderated by time. Northern Ireland, however, has had consistently lower corneal donation rates than the other three regions. Conclusion Organ donation rates over the last two decades vary in the four UK regions, and this variation depends on the type of organ donated. Further exploration of underlying factors, organisational issues, practices and attitudes to organ donation in the four regions of the UK, taking into account findings from EU countries with varying approaches to presumed consent, needs to be undertaken before such legislation is introduced across the UK.
| S-EPMC3211055 | biostudies-literature