Responsiveness of the Liverpool Elbow Score in elbow arthroplasty.

Vishwanathan, Karthik and Alizadehkhaiyat, Omid and Kemp, Graham J and Frostick, Simon P (2013) Responsiveness of the Liverpool Elbow Score in elbow arthroplasty. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], 22 (3). pp. 312-7. ISSN 1532-6500

Total Elbow Arthroplasty - A Prospective Clinical Outcome Study of Discovery Elbow System.pdf

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Responsiveness and floor and ceiling effect are important parameters for evaluating the sensitivity of an outcome instrument in detecting the changes in the clinical condition of patients after an intervention as well as evaluating the content validity of the instrument. The aim of this prospective observational study was to assess these parameters for the Liverpool Elbow Score (LES) in total elbow replacement (TER).


The study included 121 cemented TER cases with linked elbow prosthesis (Discovery Elbow, Biomet Orthopaedics, Swindon, UK) for various conditions, including inflammatory arthritis, noninflammatory arthritis, trauma, and loosening. The proportion of patients with the lowest score (0 points; floor effect) and maximum score (10 points; ceiling effect) was checked preoperatively and 1 year postoperatively. Distribution-based methods (effect size [ES], standardized response mean [SRM], Guyatt responsiveness ratio [GRR]) and anchor-based methods (receiver operating characteristic [ROC] curve and Spearman correlation coefficient) were used to assess responsiveness. Patient satisfaction after TER was used as an external anchor.


Patients were a mean age of 63 years (range, 20-86 years). Large ES (1.64), SRM (1.25), and GRR (1.69) were found during the follow-up period. Area under the ROC curve was 0.71 (95% confidence interval, 0.56-0.87; P = .03). There was significant positive correlation (Spearman correlation coefficient, 0.35; P = .004) between changes in LES and satisfaction level. LES showed no floor and ceiling effect preoperatively and at 1 year postoperatively.


LES is a responsive measure and has no floor and ceiling effect.


This encourages its use as an outcome instrument for TER. Basic Science Study, Development or Validation of Outcome Instruments.

Item Type: Article
Additional Information and Comments: “NOTICE: this is the author’s version of a work that was accepted for publication in Journal of Shoulder and Elbow Surgery. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Elbow and Shoulder Surgery, [VOL 22, ISSUE 3, (March 2013)] DOI#10.1016/j.jse.2012.09.003¨
Keywords: Liverpool Elbow Score; total elbow replacement; responsiveness; floor effect; ceiling effect; outcome measure
Faculty / Department: Faculty of Science > School of Health Sciences
Depositing User: Omid Khaiyat
Date Deposited: 27 May 2016 13:48
Last Modified: 08 Dec 2017 13:02

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