Monday, June 29, 2015

Reverse total shoulder - what outcome score to use?

Assessment of the optimal shoulder outcome score for reverse shoulder arthroplasty

These authors used a database of 148 patients having reverse total shoulders to compare preoperative and postoperative Constant-Murley Scores, American Shoulder and Elbow Surgeons Scores, and Subjective Shoulder Values.

They found no significant differences in the mean improvement between the scores.  Multivariate regression analysis the 3 outcome measures was able to predict 38.9% of the variation in improvement in forward elevation.

The authors concluded that the 3 shoulder outcome scores, regardless of whether they were patient reported or physician based, appear to appropriately reflect improvements after RSA with equal validity.

Comment:  This study demonstrates that various outcome instruments can show the benefit of reverse total shoulder arthroplasty. So what is there to choose among them?

It seems to us that the goals of outcome scores are (1) to enable each surgeon to track his/her results so that those patients failing to improve can be identified and the reasons for those failures investigations and (2) to enable different surgeons to compare and contrast results with different surgical approaches for different pathologies.

Keeping in mind that there is a cost with administering and analyzing each score in each patient, we have sought to optimize the benefit / cost ratio for outcome assessment. This consistently leads to the Simple Shoulder Test, a test that is patient-derived, sensitive, validated, short (12 questions), easy to administer and covers the range of complaints of individuals with shoulder disorders. For fun, compare the effort needed to administer the Constant Score or the ASES score and decide if there is enough incremental value (if any) of these instruments to justify the increased cost of administration and analysis.

The use of the Simple Shoulder Test in evaluating reverse total shoulders is illustrated in the articles below:

What is a Successful Outcome Following Reverse Total Shoulder Arthroplasty?

Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years.

The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture


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