The Pediatric/Adolescent Shoulder Survey (PASS): A Reliable Youth Questionnaire With Discriminant Validity and Responsiveness to Change

Abstract

Background: Health-related quality of life tools for shoulder pathology in adults have been developed, such as the Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH. However, some content is not applicable to or readily grasped by a younger population. Purpose: To evaluate the psychometric properties of a new 13-item pediatric/adolescent shoulder survey (PASS). Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: An initial development cohort of children was given the PASS, QuickDASH, and single assessment numeric evaluation (SANE) in a prospective fashion. Internal reliability and concurrent validity were evaluated. Subsequent to this, the PASS, along with the QuickDASH, was incorporated into routine clinical evaluation of shoulder injuries. The secondary cohort was established via a retrospective review of patients (age <18 years) evaluated in our sports clinics for shoulder complaints. Discriminant validity and floor/ceiling effects were evaluated. A subset of patients with scores available both pre- and within 6 months postoperatively was analyzed to assess responsiveness to treatment. Results: Overall internal reliability of the shoulder survey was good in the development cohort of 127 patients, with Cronbach α = 0.86. Total score averaged 59.7% ± 17.9% in this cohort (range, 18.75%-100%). Significant correlations between all surveys were observed ( r = 0.51-0.79, P < .05). A total of 127 surveys were available for the secondary cohort. The QuickDASH demonstrated significant differences between sexes with regard to scores ( P < .05). Both tools were able to discriminate between patients with acute injuries and diminished clinical examinations ( P < .05). A significant correlation was observed between duration of symptoms and scores on the PASS. The subset of 25 patients with pre- and postoperative data showed significant change in total score and the symptoms/limitations domain of the PASS, with significant correlation with length of time since surgery. Conclusion: This 13-question pediatric/adolescent-focused shoulder survey shows excellent psychometric properties, good discriminant ability, and early evidence of responsiveness to change, especially when compared with an adult-formatted questionnaire.