In the specialty of orthopedic surgery, most conditions impact tremendously on patients' quality of life but not on the length of their life. Therefore, it only makes sense to consider the measurement of health-related quality of life when assessing the relative efficacies of the treatments that are available. Traditional objective measures of patient outcome have included range of motion, strength, and radiographic variables. These measures are usually very poor indicators of the functional and psychological aspects of patient health. Subjective measures of quality of life, when rigorously developed, have been found to be more reliable and valid. Additionally, it has been found that older instruments reflect the fact that they were developed at a time when little information was available on the appropriate methodology for instrument development. However, it is clear that much progress has been made in the area of orthopedic surgery, and currently there is an appropriate instrument for each of the main conditions of the shoulder. Investigators planning clinical trials should select one of the modern instruments developed with appropriate patient input for item generation and reduction, established validity, and reliability. All things being equal, the most responsive instrument available should be used to minimize the sample size for the proposed study. The shoulder instruments reviewed in this article include the Rating Sheet for Bankart Repair (Rowe); ASES Shoulder Evaluation Form; UCLA Shoulder Score; The Constant Score; Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure; the Shoulder Rating Questionnaire; the Western Ontario Osteoarthritis of the Shoulder Index (WOOS); the Western Ontario Rotator Cuff Index (WORC); the Western Ontario Shoulder Instability Index (WOSI); and the Rotator Cuff Quality of Life (RC-QOL).
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