Background 

The Western Ontario Shoulder Instability (WOSI) questionnaire is a 21-item questionnaire to evaluate quality of life in patients with shoulder instability. Completing the questionnaire is time-consuming because each item is evaluated on a visual analog scale. Telephone or email versions of the score are appealing alternatives to administering it during the standard in-person patient visit; however, their validity and reliability remain unknown.

Questions/purposes 

(1) Does the numerical scale (NS) version of the WOSI correlate with the original WOSI and Quick-DASH? (2) Do telephone and email administration of the NS-WOSI have good reliability and consistency? (3) Compared with the original WOSI form, does the NS form lead to faster completion for patients and quicker data extraction for researchers?

Methods 

Between 2014 and 2019, 50 patients with a documented history of shoulder dislocation with persistent symptomatic shoulder instability, whether anterior, posterior, or multidirectional; patients scheduled for surgery; and patients with traumatic or nontraumatic injuries were prospectively recruited from the outpatient clinic of two university hospitals acting as Level 1 trauma centers and sports traumatology tertiary referral centers. The median (IQR) age was 28 years (24 to 36), and 80% (40 of 50) were men. Most (52% [26 of 50]) patients had two to five lifetime shoulder dislocations. Validity of the NS-WOSI was assessed using the Pearson correlation coefficient during an in-person visit; the original WOSI questionnaire (or its previously validated French-language version), NS-WOSI, and Quick-DASH questionnaires were administered in a random order. After a minimum 7-day interval, 78% (39 of 50) of patients completed the phone interview, and 74% (37 of 50) of patients completed the email version of the NS-WOSI score to evaluate NS-WOSI’s reliability using the intraclass correlation coefficient (ICC), which was interpreted as poor (< 0.5), moderate (0.50-0.75), strong (0.75-0.90), and very strong (> 0.90). The standard error of measurement (SEM) was used to evaluate variability around the true score, with a low value indicating a high reliability. The 95% minimal detectable change (MDC_95%) was calculated to evaluate the minimal change in score that was not related to measurement errors. Lastly, the Cronbach alpha was used to assess internal consistency (intercorrelation strength), where a value > 0.70 was considered good. The time needed for the patient to complete the various versions and for researchers to extract data was recorded.

Results 

The NS-WOSI score was very strongly correlated with the original WOSI score (r = 0.96 [95% confidence interval (CI) 0.93 to 0.98]; p < 0.001). Although telephone-acquired and email-acquired data for the NS-WOSI questionnaires were correlated with the NS-WOSI (telephone r = 0.91 [95% CI 0.83 to 0.95]; p < 0.001; email r = 0.84 [95% CI 0.71 to 0.91]; p < 0.001), the ICC was higher for telephone interviews (0.92 [95% CI 0.86 to 0.96] versus email 0.80 [95% CI 0.64 to 0.89]), indicating that although both had good reliability, the phone interview was more suitable. The phone interview was also preferable to email regarding SEM (3% [52 of 2100 points] versus 6% [132 of 2100 points]) and the MDC_95% (7% [144 of 2100 points] versus 17% [366 of 2100 points]). The 95% CI of the MDC acquired by email was superior to the reported minimum clinically important difference for the original WOSI (7% [152 of 2100 points]), meaning that an error of measurement could wrongly be interpreted as a clinically significant change in score. Internal consistency was deemed good, with a Cronbach alpha of 0.96 (95% CI 0.92 to 98) and 0.89 (95% CI 0.79 to 0.94) for NS-WOSI telephone and email, respectively. The time to complete the NS-WOSI was reduced compared with the original WOSI (221 ± 153 seconds versus 266 ± 146 seconds, mean difference -45 seconds [95% CI -72 to -12]; p = 0.009). Lastly, data extraction was faster (62 ± 15 seconds versus 209 ± 52 seconds, mean difference -147 seconds [95% CI -164 to -130]; p < 0.001) with the NS-WOSI than with the original WOSI.

Conclusion 

The NS-WOSI in person, by telephone, or by email is a valid, reliable, and timesaving alternative to the original WOSI questionnaire. However, the reliability of data acquisition by telephone interviews was superior to that of email.

Clinical Relevance 

Given that there were no important differences in performance for the NS-WOSI, regardless of whether it was administered in person or by phone, we suggest that physicians use both interchangeably based on patient convenience. However, we do not recommend using the email version, especially for research purposes, since it was not as reliable when compared with in-person administration. The responsiveness of the modified NS-WOSI, as well as factors influencing response rates to phone interview, are questions that remain to be explored.

中文翻译：

---

西安大略肩部不稳定性指数的电话管理比通过电子邮件管理更可靠

 背景

西安大略肩部不稳定 (WOSI) 问卷是一份包含 21 项的问卷，用于评估肩部不稳定患者的生活质量。完成调查问卷非常耗时，因为每个项目都是通过视觉模拟量表进行评估的。电话或电子邮件版本的评分是标准面对面患者就诊期间管理评分的有吸引力的替代方案；然而，它们的有效性和可靠性仍然未知。

 问题/目的

(1) WOSI 的数值比例 (NS) 版本与原始 WOSI 和 Quick-DASH 相关吗？ （2）NS-WOSI的电话和电子邮件管理是否具有良好的可靠性和一致性？ (3) 与原来的WOSI表格相比，NS表格是否可以让患者更快地填写、让研究人员更快地提取数据？

 方法

2014 年至 2019 年间，有 50 名有肩关节脱位病史并伴有持续肩关节不稳定症状的患者，无论是前向、后向还是多向；计划进行手术的患者；前瞻性地从两所大学医院的一级创伤中心和运动创伤三级转诊中心的门诊招募创伤性或非创伤性损伤患者。中位年龄 (IQR) 为 28 岁（24 至 36 岁），80%（50 人中的 40 人）为男性。大多数（52% [50 人中的 26 人]）患者一生中曾经历过 2 至 5 次肩关节脱位。 NS-WOSI 的有效性是在亲自访问期间使用皮尔逊相关系数进行评估的；原始 WOSI 调查问卷（或其先前验证的法语版本）、NS-WOSI 和 Quick-DASH 调查问卷以随机顺序进行。至少间隔 7 天后，78%（50 名中的 39 名）患者完成了电话访谈，74%（50 名中的 37 名）患者完成了电子邮件版本的 NS-WOSI 评分，以使用以下指标评估 NS-WOSI 的可靠性：组内相关系数（ICC），解释为差（< 0.5）、中等（0.50-0.75）、强（0.75-0.90）和非常强（> 0.90）。测量标准误差 (SEM) 用于评估真实分数周围的变异性，值低表明可靠性高。计算 95% 最小可检测变化 (MDC _95% )，以评估与测量误差无关的分数最小变化。最后，Cronbach alpha 用于评估内部一致性（互相关强度），其中值 > 0.70 被认为是良好的。记录患者完成各个版本和研究人员提取数据所需的时间。

 结果

NS-WOSI 评分与原始 WOSI 评分密切相关（r = 0.96 [95% 置信区间 (CI) 0.93 至 0.98]；p < 0.001）。尽管 NS-WOSI 问卷的电话获取和电子邮件获取数据与 NS-WOSI 相关（电话 r = 0.91 [95% CI 0.83 至 0.95]；p < 0.001；电子邮件 r = 0.84 [95% CI 0.71 至0.91]；p < 0.001），电话访谈的 ICC 较高（0.92 [95% CI 0.86 至 0.96] 与电子邮件 0.80 [95% CI 0.64 至 0.89]），表明尽管两者都具有良好的可靠性，但电话访谈的可信度较高。更加合适。关于 SEM（3% [2100 分中的 52 分] 对 6% [2100 分中的 132 分]）和 MDC _95% （7% [2100 分中的 144 分] 对 17% [2100 分中的 366 分]），电话面试也比电子邮件更可取点]）。通过电子邮件获得的 MDC 的 95% CI 优于报告的原始 WOSI 的最小临床重要差异（7% [2100 点中的 152 点]），这意味着测量误差可能会被错误地解释为临床显着变化分数。内部一致性被认为良好，NS-WOSI 电话和电子邮件的 Cronbach alpha 分别为 0.96（95% CI 0.92 至 98）和 0.89（95% CI 0.79 至 0.94）。与原始 WOSI 相比，完成 NS-WOSI 的时间减少了（221 ± 153 秒与 266 ± 146 秒，平均差 -45 秒 [95% CI -72 至 -12]；p = 0.009）。最后，与原始 WOSI 相比，NS-WOSI 的数据提取速度更快（62 ± 15 秒与 209 ± 52 秒，平均差 -147 秒 [95% CI -164 至 -130]；p < 0.001）。

 结论

亲自、通过电话或电子邮件进行的 NS-WOSI 是原始 WOSI 调查问卷的有效、可靠且省时的替代方案。然而，通过电话访谈获取数据的可靠性优于电子邮件。

 临床相关性

鉴于 NS-WOSI 的性能没有显着差异，无论是亲自进行还是通过电话进行，我们建议医生根据患者的方便程度交替使用两者。但是，我们不建议使用电子邮件版本，尤其是出于研究目的，因为与面对面管理相比，它的可靠性不高。修改后的 NS-WOSI 的响应能力，以及影响电话采访响应率的因素，都是有待探讨的问题。