Mauriziano Umberto I Hospital, Department of Orthopaedics and Traumatology, University of Turin Medical School, Turin, TO, Italy.
J Shoulder Elbow Surg. 2012 Jan;21(1):4-12. doi: 10.1016/j.jse.2011.07.014. Epub 2011 Oct 17.
The Constant-Murley score (CMS) is one of the most used scales for shoulder dysfunction. The aim of this study is to determine whether the reliability of the CMS can be improved by enhancing the standardization of the items.
Two consecutive series of 55 patients with shoulder dysfunction were enrolled in a test-retest study and examined by 2 orthopedic surgeons with different levels of expertise. The following scores were measured: CMS, individual relative CMS, relative CMS, and standardized CMS. For each variable, the intraobserver and interobserver reliability was calculated.
The less experienced observer had worse intraobserver reliability using the CMS (error, 4 points; 95% limit of agreement, 22) than the expert observer (error, 2.4 points; 95% limit of agreement, 16). The standardized CMS showed better intraobserver reliability, with an error of 0.4 points and 95% limits of agreement of 9 for the expert observer and 13 for the less experienced observer. The correction against the contralateral unaffected side and the reference population determined a worsening of reliability in both observers. Interobserver reliability showed an improvement similar to that of intraobserver reliability (systematic error, 4; 95% limit of agreement, 24) by use of the CMS and improved to 1 point when the standardized CMS was adopted (95% limit of agreement, 12).
This study showed that the standardization of the items significantly improved both the intraobserver reliability and interobserver reliability of the CMS. The level of expertise of the observer has less of an effect on reliability when the score is applied with a higher level of standardization.
Constant-Murley 评分（CMS）是用于肩部功能障碍的最常用量表之一。本研究旨在通过增强项目的标准化来确定 CMS 的可靠性是否可以提高。
对 55 例连续的肩部功能障碍患者进行了测试-再测试研究，并由 2 名具有不同专业水平的骨科医生进行了检查。测量了以下评分：CMS、个体相对 CMS、相对 CMS 和标准化 CMS。对于每个变量，计算了观察者内和观察者间的可靠性。
经验较少的观察者使用 CMS 进行观察者内可靠性较差（误差为 4 分；95%的一致性界限为 22），而专家观察者的误差为 2.4 分；95%的一致性界限为 16）。标准化 CMS 显示出更好的观察者内可靠性，专家观察者的误差为 0.4 分，95%的一致性界限为 9，经验较少的观察者为 13。对健侧未受影响侧和参考人群的校正导致了两位观察者可靠性的下降。观察者间可靠性的改善与观察者内可靠性相似（CMS 的系统误差为 4；95%的一致性界限为 24），采用标准化 CMS 时，可改善至 1 分（95%的一致性界限为 12）。
本研究表明，项目的标准化显著提高了 CMS 的观察者内可靠性和观察者间可靠性。当评分采用更高的标准化水平时，观察者的专业水平对可靠性的影响较小。
