Development and Validation of a Short-Form Version of the Western Ontario Shoulder Instability Scale (Short-WOSI)

Cale A. Jacobs, Shannon F. Ortiz, Keith M. Baumgarten, Julie Y. Bishop, Matthew J. Bollier, Jonathan T. Bravman, Robert H. Brophy, Gregory L. Cvetanovich, Brian T. Feeley, Rachel M. Frank, Grant L. Jones, John E. Kuhn, Drew A. Lansdown, C. Benjamin Ma, Scott D. Mair, Robert G. Marx, Eric C. McCarty, Adam J. Seidl, Rick W. Wright, Alan L. ZhangBrian R. Wolf, Carolyn M. Hettrich

Research output: Contribution to journalArticlepeer-review


Background: Patient-reported outcome measures (PROMs) have transitioned from primarily being used as research instruments to becoming increasingly used in the clinical setting to assess recovery and inform shared decision-making. However, there is a need to develop validated short-form PROM instruments to decrease patient burden and ease incorporation into clinical practice. Purpose: To assess the validity and responsiveness of a shortened version of the Western Ontario Shoulder Instability Index (Short-WOSI) when compared with the full WOSI and other shoulder-related PROM instruments. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: This study was a secondary analysis of data collected as part of an institutional review board–approved, multicenter cohort of 1160 patients undergoing surgical stabilization for shoulder instability. The following PROMs were captured preoperatively and 2 years after surgery: WOSI, American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and 36-Item Health Survey (RAND-36). The cohort was split into 2 data sets: a training set to be used in the development of the Short-WOSI (n = 580) and a test set to be used to assess the validity and responsiveness of the Short-WOSI relative to the full WOSI, ASES, SANE, and RAND-36. Results: The Short-WOSI demonstrated excellent internal consistency before surgery (Cronbach α =.83) and excellent internal consistency at the 2-year follow-up (Cronbach α =.93). The baseline, 2-year, and pre- to postoperative changes in Short-WOSI and WOSI were closely correlated (r > 0.90), with both demonstrating large effect sizes (Short-WOSI = 1.92, WOSI = 1.81). Neither the Short-WOSI nor the WOSI correlated well with the other PROM instruments before (r = 0.21-0.33) or after (r = 0.25-0.38) surgery. The Short-WOSI, WOSI, and SANE scores were more responsive than ASES and RAND-36 scores. Conclusion: The 7-item Short-WOSI demonstrated excellent internal consistency and a lack of floor or ceiling effects. The Short-WOSI demonstrated excellent cross-sectional and longitudinal construct validity and was similarly responsive over time as the full WOSI. Neither the Short-WOSI nor WOSI correlated with more general shoulder PROMs, underscoring the advantage of using instability-specific instruments for this population.

Original languageEnglish
Pages (from-to)2850-2857
Number of pages8
JournalAmerican Journal of Sports Medicine
Issue number11
StatePublished - Sep 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s).


  • dislocation
  • instability
  • patient-reported outcome
  • responsiveness
  • shoulder
  • validity

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Orthopedics and Sports Medicine


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