The Oxford Shoulder Score (OSS)

The Oxford Shoulder Score (OSS) is a 12-item patient-reported PRO specifically designed and developed for assessing outcomes of shoulder surgery e.g. for assessing the impact on patients’ quality of life of degenerative conditions such as arthritis and rotator cuff problems.

Background

The development of the OSS was driven by demands for a suitable PRO by orthopaedic surgeons who wished to measure the outcomes of their treatments from the patient’s perspective.

The OSS was designed and developed by researchers (within the Health Services Research unit, part of the Nuffield Department of Population Health at the University of Oxford) who also created the Oxford Hip and Knee scores, which are used for assessment of all NHS hip and knee surgeries (approximately 120,000) since April 2009. Designed and developed in association with surgical colleagues at the Nuffield Orthopaedic Centre the OSS has been tested in a surgical context with patients and shown to be reliable, valid and responsive.

First published in 1996, the OSS has gradually been adopted as an outcome measure and is now widely used in clinical studies.

The PRO

The Oxford Shoulder Score is a unidimensional score comprising 12 questions. A single score is derived from the PRO. Substantial evidence from clinical studies shows that the PRO has high internal consistency and is a valid and reliable measure of patient well-being.

Measurement properties

Properties of the Oxford Shoulder Score include:

the only condition-specific PRO designed and developed for use in assessing surgery intervention of the shoulder;
has undergone rigorous testing for validity, reliability and sensitivity to change and has been shown to be a robust tool for assessing the outcome of shoulder surgery;
can be employed in surveys or clinical trials for shoulder surgery patient groups;
has been shown to be highly responsive to interventions and can be used as an indicator for recovery and general improvement in quality of life following shoulder surgery;
brief and easy to complete resulting in good return rates;
the PRO can be completed anywhere and delivered by post/electronically, making follow-up of large numbers of patients much more feasible (and cheaper) than conducting clinical assessments;
easy to interpret scores.

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Example studies

The OSS is primarily used to assess outcomes of shoulder surgery including total shoulder replacement and reverse shoulder replacement. Other uses of the OSS include:

Assessment of patient outcomes following alternative non-surgical interventions, including physical therapy, cortisone injections, joint supplements and anti-inflammatory medications.
Orthopaedic products companies have used the OSS to optimise their products and associated surgical procedures in order to improve patient outcomes from surgeries employing their products.
Public and private healthcare providers have used the OSS to assess patient outcomes across multiple facilities as a measure of the performance of individual treatment centres, which can be used to identify high-performing centres and to raise standards through sharing best practices.

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Development

The development protocol is described in:
Dawson J., Fitzpatrick R., Carr A. Questionnaire on the Perceptions of Patients About Shoulder Surgery. J Bone Joint Surg [Br] 1996; 78: 593-600.

Intraclass Correlation

The intraclass correlation has been calculated as 0.83 (Ekeberg,2008 ). Ekeberg,O.M., Bautz-Holter,E., Tveita,E.K., Keller,A., Juel,N.G., Brox,J.I. Agreement, reliability and validity in 3 shoulder questionnaires in patients with rotator cuff disease. BMC Musculoskeletal Disorders 2008, 9:68

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