ArticleCureus2026
Bulgarian Translation, Cross-Cultural Adaptation, and Validation of the Simple Shoulder Test and the American Shoulder and Elbow Surgeons Shoulder Assessment Form.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPatient-reported outcome measures (PROMs) are essential for evaluating functional impairment, treatment effectiveness, and health-related quality of life in patients with musculoskeletal disorders. Among shoulder-specific PROMs, the Simple Shoulder Test (SST) and the American Shoulder and Elbow Surgeons Shoulder Assessment Form (ASES) are widely used instruments with established measurement properties. However, no validated shoulder-specific questionnaire has previously been available in the Bulgarian language.
objectiveTo translate and culturally adapt the SST and ASES questionnaires into Bulgarian and evaluate their reliability, internal consistency, measurement error, convergent validity, and discriminant validity in patients with shoulder disorders.
methodsTranslation and cross-cultural adaptation were conducted following established forward-backward translation guidelines, expert committee review, and pilot testing. A total of 103 patients with shoulder pathology and 42 asymptomatic individuals were included. Construct validity was assessed by examining correlations between the Bulgarian SST (BSST) and Bulgarian ASES (BASES). Test-retest reliability was evaluated using intraclass correlation coefficients (ICC) with a 14-day interval. Internal consistency was determined using Cronbach's alpha. Discriminant validity, floor and ceiling effects, and measurement error were also analyzed.
resultsStrong convergent validity was demonstrated between BSST and BASES (Pearson r = 0.719, p < 0.0001). Test-retest reliability was excellent for both instruments (ICC = 0.96 for BSST and 0.93 for BASES). Internal consistency was acceptable for BSST (Cronbach's α = 0.77) and good for BASES (Cronbach's α = 0.86). No significant floor or ceiling effects were observed. Both questionnaires successfully discriminated between patients with shoulder disorders and healthy controls (p < 0.0001).
conclusionThe Bulgarian versions of the SST and ASES demonstrate good reliability and convergent validity and are suitable for assessing shoulder function and pain in Bulgarian-speaking populations. Their availability facilitates clinical evaluation, outcome monitoring, and participation in international research involving shoulder disorders.
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