Validation of the Liverpool Elbow Score for evaluation of elbow stiffness

Ziyang Sun, Cunyi Fan, Ziyang Sun, Cunyi Fan

Abstract

Background: The Liverpool Elbow Score (LES) has been widely used to assess the outcomes of total elbow replacement in various conditions. However, there have been no published validation studies on LES for patients with stiff elbows undergoing arthrolysis. The purpose of this study was to find out whether LES could be equally applied to evaluate joint function in patients with elbow stiffness.

Methods: A total of 63 patients with elbow stiffness were included in this retrospective validation study. The LES combines a nine-item patient-answered questionnaire (PAQ) and a six-item clinical assessment score (CAS), and can also be divided to evaluate two different parameters: elbow motion capacity (EMC) and elbow-related symptoms (ERS). Construct validity was assessed by correlating LES with previously validated scoring systems, and Spearman correlation coefficients (SCCs) were calculated. Effect size (ES) and standardized response mean (SRM) were calculated to determine responsiveness.

Results: There were no ceiling or floor effects in the target population. Good-to-excellent validity was determined based on total score (0.45-0.89), PAQ (0.42-0.88), CAS (0.35-0.60), EMC (0.46-0.86), and ERS (0.36-0.59). High responsiveness (ES/SRM) was observed in total score (2.80/2.24), PAQ (2.34/1.78), CAS (2.90/2.34), EMC (2.92/2.35), and ERS (0.55/0.52).

Conclusion: Our results suggest that the LES is a valid elbow-specific scoring system that can be used to evaluate joint function in patients with elbow stiffness, though some items included had some weakness either.

Keywords: Elbow stiffness; Liverpool elbow score; Responsiveness; Scoring systems; Validation; Validity.

Conflict of interest statement

Ethics approval and consent to participate

The Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital concluded that no approval is necessary for study based on its retrospective design. Data were analyzed anonymously; all patients approved the results of this study by oral consent. The oral consent approval was documented in the patients’ files. This was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. All clinical investigations were conducted in accordance with the guidelines of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The components of the Liverpool Elbow Score

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