Systematic review| Volume 101, ISSUE 6, P1053-1063, June 2020

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

Published:December 28, 2019DOI:



      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 Cumulative Index to Nursing and Allied Health databases from inception until March 2019 were searched.

      Study Selection

      Randomized/prospective studies of 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, Closed Kinetic Chain Upper Extremity Stability Test, Timed Functional Arm and Shoulder Test, Shoulder Function Index [SFInX], and hand to neck, scapula, and opposite scapula).

      Data Extraction

      We used the Consensus-Based Standards for the Selection of Health Measurement Instruments 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 interrater) measures indicated excellent reliability properties. Intraclass correlation coefficient (ICC) was ≥0.83 and standard error of the mean (SEM) ranged from 0.03-13.3 points. Validity (construct/convergent/concurrent) measures displayed correlations of −0.76 to 0.91 between performance-based functional tests and other patient-reported outcomes (Disabilities of the Arm, Shoulder, and Hand, Constant, Shoulder Pain and Disability Index). 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.


      The FI2S and the SFInX are reliable, valid, and responsive in patients with shoulder-related diseases.


      List of abbreviations:

      CKCUEST (Closed Kinetic Chain Upper Extremity Stability Test), COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments), DASH (Disabilities of the Arm, Shoulder, and Hand), ES (effect size), FI2S (Standardized Index of Shoulder Function), FIT-HaNSA (Functional Impairment Test–Hand and Neck/Shoulder/Arm), GRADE (Grading of Recommendations Assessment, Development, and Evaluation), ICC (intraclass correlation coefficient), MCID (minimum clinically important difference), MDC (minimal detectable change), PROM (patient-reported outcome measure), ROM (range of motion), SEM (standard error of the mean), SFInX (Shoulder Function Index), SPADI (Shoulder Pain and Disability Index), SRM (standardized response mean), TFAST (Timed Functional Arm and Shoulder Test)
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