Turkish version of the modified Constant-Murley score and standardized test protocol: reliability and validity

Objective: The Constant-Murley score (CMS) is widely used to evaluate disabilities associated with shoulder injuries, but it has been criticized for relying on imprecise terminology and a lack of standardized methodology. A modified guideline, therefore, was published in 2008 with several recommendations. This new version has not yet been translated or culturally adapted for Turkish-speaking populations. The purpose of this study was to translate and cross-culturally adapt the modified CMS and its test protocol, as well as define and measure its reliability and validity.Methods: The modified CMS was translated into Turkish, consistent with published methodological guidelines. The measurement properties of the Turkish version of the modified CMS were tested in 30 patients (12 males, 18 females; mean age: 59.5±13.5 years) with a variety of shoulder pathologies. Intraclass correlation coefficients (ICC) were used to estimate test-retest reliability. Construct validity was analyzed with the Turkish version of the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form and Short-Form Health Survey (SF-12).Results: No difficulties were found in the translation process. The Turkish version of the modified CMS showed excellent test-retest reliability (ICC=0.86). The correlation coefficients between the Turkish version of the modified CMS and the ASES, SF-12-physical component score, and SF-12 mental component scores were found to be 0.48, 0.35, and 0.05, respectively. No floor or ceiling effects were found.Conclusion: The translation and cultural adaptation of the modified CMS and its standardized test protocol into Turkish were successful. The Turkish version of the modified CMS has sufficient reliability and validity to measure a variety of shoulder disorders for Turkish-speaking individuals.


Patrick DL, Deyo RA. Generic and disease-specific mea- sures in assessing health status and quality of life. Med Care 1989;27(3 Suppl):217-32.

Wright RW, Baumgarten KM. Shoulder outcomes mea- sures. J Am Acad Orthop Surg 2010;18:436-44.

Constant CR, Murley AH. A clinical method of func- tional assessment of the shoulder. Clin Orthop Relat Res ;214:160-4. Bankes MJ, Crossman JE, Emery RJ. A standard method of shoulder strength measurement for the Constant score with a spring balance. J Shoulder Elbow Surg 1998;7:116-

Fialka C, Oberleitner G, Stampfl P, Brannath W, Hexel M, Vécsei V. Modification of the Constant-Murley shoulder score-introduction of the individual relative Constant score Individual shoulder assessment. Injury 2005;36:1159-65.

Leggin B, Iannotti J. Shoulder outcome measurement. In: Iannotti JP, Williams GR. Disorders of the Shoulder: Di- agnosis and Manage-ment. Philadelphia, Pa: Lippincott Williams & Wilkins 1999:1024-40.

Constant CR, Gerber C, Emery RJ, Sİjbjerg JO, Gohlke F, Boileau P. A review of the Constant score: modifica- tions and guidelines for its use. J Shoulder Elbow Surg ;17:355-61. Ban I, Troelsen A, Christiansen DH, Svendsen SW, Kris- tensen MT. Standardised test protocol (Constant Score) for evaluation of functionality in patients with shoulder disorders. Dan Med J 2013;60:A4608.

Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guide- lines for the process of cross-cultural adaptation of self-re- port measures. Spine (Phila Pa 1976) 2000;25:3186-91.

Kane RL. Outcome measures. Understanding Health Care Outcomes Research Gaithersburg. MD: Aspen Publishers :17-8. Landis JR, Koch GG. The measurement of observer agree- ment for categorical data. Biometrics 1977;33:159-74. de Vet HC, Terwee CB, Bouter LM. Current challenges in clinimetrics. J Clin Epidemiol 2003;56:1137-41.

Irrgang JJ, Marx RG. Clinical outcomes in sport and exer- cise physical therapies. In Kolt GS, Synder-Mackler L eds. Physical Therapies in Sports and Exercise. Edinburgh, El- sevier 2007:206-19.

Fayers PM, Machin D. Scores and measurements: valid- ity, reliability, sensitivity. In: Fayers PM, Machin D, eds. Quality of Life: Assessment, Analysis and Interpretation of Patient-Reported Outcomes. 2nd ed. Chichester, UK: Wiley 2007:77-108.

Rocourt MH, Radlinger L, Kalberer F, Sanavi S, Schmid NS, Leunig M, et al. Evaluation of intratester and inter- tester reliability of the Constant-Murley shoulder assess- ment. J Shoulder Elbow Surg 2008;17:364-9.

Blonna D, Scelsi M, Marini E, Bellato E, Tellini A, Rossi R, et al. Can we improve the reliability of the Constant- Murley score? J Shoulder Elbow Surg 2012;21:4-12.

Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoul- der function: a systematic review of four questionnaires. Arthritis Rheum 2009;61:623-32.

Levy O, Haddo O, Massoud S, Mullett H, Atoun E. A patient-derived Constant-Murley score is compa- rable to a clinician-derived score. Clin Orthop Relat Res ;472:294-303.

Moeller AD, Thorsen RR, Torabi TP, Bjoerkman AS, Christensen EH, Maribo T, et al. The Danish version of the modified Constant-Murley shoulder score: reliability, agreement, and construct validity. J Orthop Sports Phys Ther 2014;44:336-40.


Acta Orthopaedica et Traumatologica Turcica
  • ISSN: 1017-995X
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 1962
  • Yayıncı: AVES Yayıncılık


Sayıdaki Diğer Makaleler

Clavicle fracture after reverse total shoulder arthroplasty: a case report with literature review

Young Sin KIM, Seong-Il WANG, Ju Hong LEE

MRI delineation of the morphometric characteristics of type I split cord malformations: a retrospective analysis of 29 cases

Qing XIA, Jian Min SUN

Prevalence and characteristics of noise in a series of 282 ceramic-on-ceramic total hip arthroplasties

Mansur HALAI, Bilal JAMAL, Prem Ruben JAYARAM, David MURRAY, Alberto GREGORI, Kumar PERIASAMY

Comminution plays no role in worsening fracture healing of conservatively treated middle third clavicular fractures


Mobile- versus fixed-bearing total knee arthroplasty: a prospective randomized controlled trial featuring 6-10-year follow-up


Chondromyxoid fibroma of the pubic ramus: a case report and literature review


Effects of the lower extremity external fixators on the sexual life of males


Effects of cilostazol on fracture healing: an experimental study


Effectiveness of closed suction drainage tip culture in hip arthroplasty

Jai Hyung PARK, Hyun-Chul SHON, Ji Wan KİM, Se-Jin PARK, Taeg Su KO, Jong-Hyon PARK

Congenital bizarre parosteal osteochondromatous proliferation in unusual location and age: a case report

Sami SÖKÜCÜ, Osman Emre AYCAN, Yavuz ARIKAN, Yavuz Selim KABUKÇUOĞLU