Psychometric Properties of Performance-Based Functional Tests in Patients With Shoulder Pathologies: A Systematic Review and Meta-analysis

Abstract Objectives To identify, critically appraise and synthesize the reported psychometric properties of shoulder performance-based functional tests in patients with shoulder diseases. Data sources Medline, Embase, Scopus and CINAHL databases from inception till March 2019 were searched. Study selection or eligibility criteria Randomized/prospective studies, that included patients with shoulder diseases, that reported on the psychometric properties (reliability, validity, responsiveness) of performance-based functional tests (Standardized Index of Shoulder Function (FI2S), Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA), Closed kinetic chain upper extremity stability test (CKCUEST), Timed Functional Arm and Shoulder Test (TFAST), Shoulder Function Index (SFInX), and Hand to neck/scapula and opposite scapula). Data extraction We used a the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) 2018 guideline for systematic reviews. We performed a qualitative synthesis in which the results were summarized based on reported measurement properties and study quality. Data synthesis Eight eligible studies were included with 28 measures (16 reliability; 10 validity; 2 responsiveness). Performance-based functional tests reliability (test-retest, intra- and inter-eater) measures indicated excellent reliability properties. Intra-class Correlation Coefficient (ICC) was ≥ 0.83 and Standard Error of Measurement (SEM) ranged from 0.03 – 13.3 points. Validity (construct/convergent/concurrent) measures displayed correlations of -0.76 – 0.91 between performance-based functional tests and other patient reported outcomes (DASH, Constant, SPADI). Two studies assessed the responsiveness measures performance-based functional tests. Effect sizes of 0.44 and 1.50, and minimal clinically important differences of 10.3 using the anchor-based approach were reported. Conclusion The Standardized Index of Shoulder Function (FI2S) and the Shoulder Function Index (SFInX) tests are reliable, valid and responsiveness in patients with shoulder-related diseases.