The Japanese Orthopaedic Association
Shoulder Evaluation Sheet“ Shoulder 36 V. 1.3 ” User Manual
1.

The following assessment sheet: “ Shoulder 36 V. 1.3 ” can be downloaded from thewebsites of the Japan Shoulder Society and The Japanese Orthopaedic Association.

2. The assessment sheet has been completed and authorized for publication by The
Japanese Orthopaedic Association and Japan Shoulder Society. Unauthorized
modification is prohibited. You are admitted to use this assessment sheet for study
or research purposes	   and a copy can be obtained for free of charge. However, it
MUST NOT be used for any commercial purposes, unless you obtain permission by
The Japanese Orthopaedic Association. You must refer to the cited paper and theversion number when using this material for presentation and publications.
3. For each of the 36 questions, patients are asked to self-interpret their symptoms using ascoring system divided into five levels (0~4).
Please circle to choose level of difficulty in the space () provided on theright-hand side of each question. Larger numbers indicate a better level of symptoms.
I have no difficulties
I have minor difficulties
I have some difficulties but I can manage on my own
I have major difficulties and require help from someone
I can not do it (at all)For example;

0(0,1,2,3,4)

4. It is preferable that the patients answer their questions in the waiting rooms or at theirhomes as the presence of a doctor or other medical staff can inflict bias.
5. When the patient comes across a situation or activities he/she may not have done
before, he/she must try to imagine the situation and choose level of difficulty he/she ismost comfortable with. If questions are not clear to the patient, he/she may leave themunanswered and move on to complete the questionnaire. Unanswered questions may bereviewed with designated doctor (or person in charge) afterwards.

The Japanese Orthopaedic Association
6. A total of thirty-six questions are categorized into six domains (Pain, Range of motion,Muscle strength, General health, Ability of daily living (ADL) and Sports ability ).
7. Domain score is calculated by taking the average of severity scores (0~4) , assigned
for each domain. When there are questions left blank or invalid for assessment, theaverage domain score will be calculated without these responses. However, if a domaincollects less than a half of assigned responses, it will be deemed invalid for assessment,
thus the average is not taken. Domain scores are calculated by two decimal places,
rounded up into the second digit.
8. If less than a half of the scores in pain domain section are collected, special
circumstances apply, whereby responses fromto make up the number. Further procedural explanation for this circumstance will beprovided later in the manual.
9. In order to maintain the reliability of the assessment, please encourage patients toanswer as many questions as possible.
10. For patients with both shoulders affected, two questionnaires must be filled out, one foreach shoulders.
11. Please be aware that scores for each domain are based onstandpoint. It does not therefore represent the same value as docto
severity.
12. Each domain (from the total of six) represents a value and should be used forcomparison. The sum of all six domains should not be used for comparison so pleaserefrain from doing so.

Scoring System for Each Domain
A question number is represented inside these brackets
between.

. Each question is scored

Domain score valid for assessment can be calculated by finding the average ofseverity scores for each domain.

The Japanese Orthopaedic AssociationA) Pain
questionsB) Range of motion
questions(ROM)C) Muscle strength
questionsD) General healthquestions
E) Ability of daily living
questions(ADL)
questionsF) Ability for sports

32
12
13
1
6

16
4
18
20
17
1035

36

22
524
728
832
91123
25
1427
26
15

29
31
1934
33
2130

-Due to the significance of the pain domain section, special rules apply when three ormore questions required for assessment are not collected. When the pain domain collects less10186
than a half of all responses, questions from other domain sections ( 2034 respectively,borrowed
number of three questions.

Answer Sheet
Overall Score (Avg)
Sum of Scores / Number of Questions

DomainSeverity Scores for each Questions= Domain Score

Pain

Range of motion

Muscle strength

General health
Ability of dailylivingbility for sports

Changing the content of the assessment criteria without permission is strictly prohibited.

The Japanese Orthopaedic Association
All right reserved by the Japanese Orthopaedic Association (2010)