Saturday, March 1, 2014

Measurement of the results of the treatment of shoulder disorders

Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence.

There has been an important shift toward the use of patient-reported outcome measures in the determination of the effectiveness and value of interventions for shoulder disorders. Having the patient report the outcomes accomplishes a number of things: (1) it places the emphasis on the patient's perception rather than the provider's perception of the comfort and function of the shoulder, removing provider bias, (2) it enables comparison of results obtained in different centers, removing concern over differences among provider observers, (3) because it does not require the patient to come to the office for evaluation, it reduces the cost and inefficiencies of provider derived metrics and (4) because of its practicality and simplicity it enables inclusion of the maximal number of patients in clinical research. Furthermore, simple, patient-reported outcomes facilitate the determination of the amount of improvement as a percent of the maximal possible improvement (IMPI).

These authors conducted a systematic review of articles with information regarding shoulder-specific patient-reported outcome measures. They identified 11 instruments and 112 articles (2-30 articles per instrument). They found that the American Shoulder and Elbow Surgeons shoulder assessment, Simple Shoulder Test , and Oxford Shoulder Score.

The authors recommend the simple shoulder test for longitudinal studies or clinical trials, the Dutch Shoulder Disability Questionnaire for clinical practice to minimize administration burden, and the ASES or OSS to discriminate among patients' or groups' evaluations at one point of time.

Comment: we use the Simple Shoulder Test because it is inexpensive, convenient, provider and observer independent, patient-reported, enabling of capture of data over long periods of time independent of patient location or ability to come to the office, and reflective of the individual functions that are important to patients.

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