The University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) is one of the oldest shoulder outcomes tools in use today. It was published in 1981 with the purpose of being used in studies for patients with shoulder arthritis undergoing a total shoulder arthroplasty.

The UCLA outcome tool was developed at a time when little information was available on the appropriate methodology for instrument development.

It was also a time when modern psychometric development was not routinely used [1, 2]. Consequently, the methodology used for the development of this tool is not explained and the reasoning behind the question development and its weighting is not understood. Despite this, the UCLA outcome tool is still widely used for specific situations such as following treatment for rotator cuff disease or shoulder instability [2]

The questionnaire is a combined objective and subjective survey and requires completion by both the doctor and patient. It has 5 sub-scales made up of active forward elevation and strength (physician reported) and pain, satisfaction, and function (patient reported). A maximum score of 35 is possible with higher scores indicating better outcomes. The UCLA score can then be converted to a 100-point scale for comparison with other shoulder outcome tools.

Strengths

Although the UCLA tool has not been validated it can be used to assess a variety of shoulder conditions including total shoulder arthroplasty, rotator cuff repair, and subacromial decompression [1]. Completion of the survey is also relatively quick and easy for patients.

Weaknesses

A disadvantage of the UCLA questionnaire is that as one of the first reporting tools of its kind there are unfortunately no publications available with respect to its development or testing [2]. It has also been suggested that at the time of development, the items on this instrument were selected without direct patient input [2]. Additionally, it is also unknown why the developers assigned various weights to the five domains. Although this is not necessarily incorrect, it has thus far been unsupported [4]

Another weakness identified is the items in the pain and function domains are “double-barreled.” For example with regards to the pain scale, options are presented as a coupled response (frequency of pain + analgesia required). This leaves respondents with some difficulty picking an appropriate answer if they agree with half of the response (the frequency of the pain) but disagree with the other half (analgesia required) [3].

The reliability, validity, and responsiveness of the UCLA are also poorly established compared to other outcome measures [3]

Overall, the UCLA shoulder scoring tool may be useful for specific situations such as rotator cuff disease or shoulder instability but researchers planning clinical trials should select a more modern instrument that has been developed with appropriate patient input and established validity and reliability [2].

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Refrences

  1. Smith MV, Calfee RP, Baumgarten KM, Brophy RH, Wright RW. Upper Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery. The Journal of Bone and Joint Surgery American volume. 2012;94(3):277-285. doi:10.2106/JBJS.J.01744. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262183/
  2. Kirkley, A., Griffin, S., & Dainty, K. (2003). Scoring systems for the functional assessment of the shoulder. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 19(10), 1109-1120. https://www.researchgate.net/publication/5656975_Scoring_Systems_for_the_Functional_Assessment_of_the_Shoulder
  3. Wylie, J. D., Beckmann, J. T., Granger, E., & Tashjian, R. Z. (2014). Functional outcomes assessment in shoulder surgery. World journal of orthopedics, 5(5), 623. http://www.wjgnet.com/2218-5836/full/v5/i5/623.htm
  4. Wessel, R. N., Lim, T. E., van Mameren, H., & de Bie, R. A. (2011). Validation of the western ontario rotator cuff index in patients with arthroscopic rotator cuff repair: A study protocol. BMC Musculoskeletal Disorders, 12, 64. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087697/