Translation and cultural adaptation of the Oxford Shoulder Score to Swedish and validation of a new 7-day recall version in patients with a proximal humerus fracture
DOI:
https://doi.org/10.2340/17453674.2026.46975Keywords:
Fractures, ShoulderAbstract
Background and purpose: The Oxford Shoulder Score (OSS) is a widely applied patient-reported outcome measure (PROM) designed to assess function and pain in individuals with shoulder disorders. We primarily aimed to evaluate a translated and culturally adapted Swedish version of the original OSS and secondarily to evaluate a version with a 7-day recall period, intended for rapidly changing conditions such as the early phase following fractures and surgeries.
Methods: The OSS was translated according to Beaton’s guidelines for cross-cultural adaptation. 246 patients with a nonoperatively treated proximal humerus fracture completed the Swedish OSS and the QuickDASH at 1 week (T1, 7-day recall period), 3 months (T2, 7-day recall period), and 12 months (T3, 4-week recall period).
Results: Convergent validity between OSS and QuickDASH (Spearmans’s rho) was rs −0.75 (95% confidence interval [CI] –0.80 to –0.68) at T1, –0.88 (CI –0.91 to –0.84) at T2, and –0.86 (CI –0.90 to –0.81) at T3. Responsiveness for change scores (T2–T1) was –0.77 (CI –0.82 to –0.70) and (T3–T2) –0.80 (CI –0.85 to –0.74). Internal consistency for the respective domains was for pain at T1 0.73 (CI 0.68–0.78), at T2 0.84 (CI 0.80–0.87), at T3 0.87 (CI 0.84–0.89), and for function at T1 0.74 (CI 0.68–0.78), at T2 0.88 (CI 0.86–0.90), at T3 0.91 (CI 0.89–0.92). Intra-rater reliability was ICC = 0.94 (CI 0.90–0.96) between T3 and 2 weeks later.
Conclusion: The Swedish translation of the OSS demonstrated excellent measurement properties. The 7-day recall version demonstrated equivalent good validity, responsiveness, and reliability and seems valuable for monitoring fresh injuries such as proximal humerus fractures.
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References
Brorson S, Borg S A, Houkjær L L, Holtz K B, Issa Z. Patient-reported outcome was close to the Danish background population 6 months after non-surgical treatment of Neer 2-part surgical neck fractures: a prospective cohort study in patients aged 60 or above. Acta Orthop 2024; 95: 619-24. doi:10.2340/17453674.2024.42301.
Südkamp N, Jaeger M, Adolfsson L, Berndt T, Blauth M, Joeris A, et al. Total shoulder arthroplasty for glenohumeral osteoarthritis leads to better outcomes than hemiarthroplasty at a minimum 5 years: an intraoperative randomization-controlled trial of 79 patients. Acta Orthop 2025; 96: 904-13. doi:10.2340/17453674.2025.44946.
Mokkink L B, Terwee C B, Patrick D L, Alonso J, Stratford P W, Knol D L, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 2010; 63: 737-45. doi: 10.1016/j.jclinepi.2010.02.006.
Lowry K J, Brox W T, Naas P L, Tubb C C, Muschler G F, Dunn W. Musculoskeletal-based patient-reported outcome performance measures, where have we been—where are we going. J Am Acad Orthop Surg 2019; 27: e589-e595. doi: 10.5435/JAAOS-D-18-00429.
Lee M K, Zaniletti I, Larson D R, Lewallen D G, Berry D J, Maradit Kremers H. Nuts and bolts of patient-reported outcomes in orthopaedics. J Arthroplasty 2023; 38: 616-21. doi: 10.1016/j.arth.2022.11.011.
Dawson J, Fitzpatrick R, Carr A. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br 1996; 78: 593-600. PMID: 8666621.
Xu X, Wang F, Wang X, Wei X, Wang Z. Chinese cross-cultural adaptation and validation of the Oxford shoulder score. Health Qual Life Outcomes 2015; 13: 193. doi: 10.1186/s12955-015-0383-5.
Bejer A, Szczepanik M, Płocki J, Szymczyk D, Kulczyk M, Pop T. Translation, cross-cultural adaptation and validation of the polish version of the Oxford Shoulder Score in patients undergoing arthroscopic rotator cuff repair. Health Qual Life Outcomes 2019; 17: 191. doi: 10.1186/s12955-019-1263-1.
Fang Y Y, Ackerman I N, Page R, Harris I A, Cashman K, Lorimer M, et al. Measurement properties of the Oxford shoulder score and minimal clinically important changes after primary total shoulder replacement surgery. Arthritis Care Res (Hoboken) 2024; 76: 895-903. doi: 10.1002/acr.25304.
Roh Y H, Noh J H, Kim W, Oh J H, Gong H S, Baek G H. Cross-cultural adaptation and validation of the Korean version of the Oxford shoulder score. Arch Orthop Trauma Surg 2012; 132: 93-9. doi: 10.1007/s00402-011-1393-3.
Schneider S, Broderick J E, Junghaenel D U, Schwartz J E, Stone A A. Temporal trends in symptom experience predict the accuracy of recall PROs. J Psychosom Res 2013; 75: 160-6. doi: 10.1016/j.jpsychores.2013.06.006.
Jonsson E, Wänström J, Björnsson Hallgren H, Adolfsson L. The Oxford Elbow Score demonstrated good measurement properties when used with a shortened 7-day recall period. JSES Int 2023; 7: 499-505. doi: 10.1016/j.jseint.2022.12.023.
Beaton D E, Wright J G, Katz J N. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005; 87: 1038-46. doi: 10.2106/jbjs.D.02060.
Beaton D E, Bombardier C, Guillemin F, Ferraz M B. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000; 25: 3186-91. doi: 10.1097/00007632-200012150-00014.
Dawson J, Rogers K, Fitzpatrick R, Carr A. The Oxford shoulder score revisited. Arch Orthop Trauma Surg 2009; 129: 119-23. doi: 10.1007/s00402-007-0549-7.
Gummesson C, Ward M M, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 2006; 7: 44. doi: 10.1186/1471-2474-7-44.
Pyörny J, Sletten I N, Jokihaara J. Concurrent validity study of QuickDASH with respect to DASH in patients with traumatic upper extremity amputation. BMC Musculoskelet Disord 2024; 25: 86. doi: 10.1186/s12891-024-07183-w.
Fayad F, Lefevre-Colau M M, Gautheron V, Macé Y, Fermanian J, Mayoux-Benhamou A, et al. Reliability, validity and responsiveness of the French version of the questionnaire Quick Disability of the Arm, Shoulder and Hand in shoulder disorders. Man Ther 2009; 14: 206-12. doi: 10.1016/j.math.2008.01.013.
Mukaka M M. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012; 24: 69-71. PMID: 23638278.
Kruger N, Stander L, Maqungo S, Roche S, Held M. The Oxford Shoulder Score: cross-cultural adaptation and translational validation into Afrikaans. SA Orthop J 2018; 17. doi: 10.17159/2309-8309/2018/v17n1a2.
Dawson J, Harris K K, Doll H, Fitzpatrick R, Carr A. A comparison of the Oxford shoulder score and shoulder pain and disability index: factor structure in the context of a large randomized controlled trial. Patient Relat Outcome Meas 2016; 7: 195-203. doi: 10.2147/prom.S115488.
Flora D B, Curran P J. An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychol Methods 2004; 9: 466-91. doi: 10.1037/1082-989x.9.4.466.
Cronbach L J. Coefficient alpha and the internal structure of tests. Psychometrika 1951; 16: 297-334. doi: 10.1007/bf02310555.
Koo T K, Li M Y. A Guideline of Selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15: 155-63. doi: 10.1016/j.jcm.2016.02.012.
Terwee C B, Bot S D, de Boer M R, van der Windt D A, Knol D L, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007; 60: 34-42. doi: 10.1016/j.jclinepi.2006.03.012.
Simpson J, Keding A, Spencer S, Brealey S, Rangan A. Factor structure of the Oxford Shoulder Score: secondary analyses of the UK FROST and PROFHER trial populations. J Orthop Surg Res 2023; 18: 846. doi: 10.1186/s13018-023-04319-x.
Food and Drug Administration. Guidance for industry: Patient-reported outcome measures: use in medical product development of support labeling claims. Federal Register; 2009. Available from: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/patient-reported-outcome-measures-use-medical-product-development-support-labeling-claims
Norquist J M, Girman C, Fehnel S, DeMuro-Mercon C, Santanello N. Choice of recall period for patient-reported outcome (PRO) measures: criteria for consideration. Qual Life Res 2012; 21: 1013-20. doi: 10.1007/s11136-011-0003-8.
Coles T, Plyler K, Hernandez A, Fillipo R, Henke D M, Arizmendi C, et al. Recalling what we thought we knew about recall periods: a qualitative descriptive study of how adults diagnosed with cancer use recall periods for patient-reported outcome items about physical function. Qual Life Res 2025; 34: 857-66. doi: 10.1007/s11136-024-03847-1.
Peasgood T, Caruana J M, Mukuria C. Systematic review of the effect of a one-day versus seven-day recall duration on patient reported outcome measures (PROMs). Patient 2023; 16: 201-21. doi: 10.1007/s40271-022-00611-w.
Masud S, Piche J D, Muralidharan A, Nassr A, Aleem I. Do patients accurately recall their preoperative symptoms after elective orthopedic procedures? Cureus 2023; 15: e36810. doi: 10.7759/cureus.36810.
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Copyright (c) 2026 Per C Lundin, Therése F D Sundh, Lars E Adolfsson, Hanna C Björnsson Hallgren
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