The Development and Validation of a Functional Assessment Tool for the Upper Extremity in the Overhead Athlete

Abstract

Background There are no validated upper extremity instruments designed specifically to evaluate the performance and function of overhead athletes. Current shoulder and elbow scoring systems may not be sensitive to subtle changes in performance in this high-demand population. Hypothesis The scoring system developed in this study will be valid, reliable, and responsive in the evaluation of overhead athletes. Study Design Cross-sectional study; Level of evidence, 3. Methods Based on the results of a pilot questionnaire administered to 21 overhead athletes, a final 10-item questionnaire was developed. Two hundred eighty-two healthy, competitive overhead athletes completed the new questionnaire, as well as 2 established upper extremity questionnaires, and were self-assigned into injury categories: (1) playing without pain, (2) playing with pain, and (3) not playing due to pain. Correlations between the scores and differences between injury categories were measured. Responsiveness testing was performed in an additional group of 55 injured athletes, comparing their scores before and after an intervention. Results The new score showed high correlation with the Disabilities of the Arm, Shoulder and Hand (DASH) score and the DASH sports/performing arts module. The new score correctly stratified overhead athletes by injury category (P < .0001). The new score also demonstrated excellent responsiveness, varying appropriately with improvements in injury category after treatment of injuries (P < .05). Conclusion The new patient-reported instrument is valid and responsive in the evaluation of overhead athletes. Reliability was also demonstrated for the 13-item pilot questionnaire. The results support its use for the functional assessment of overhead athletes in future studies.