Validation of the Liverpool Elbow Score for evaluation of elbow stiffness

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.