Wednesday, March 22, 2017

Patient outcomes - what's the score?

Clinical outcomes of arthroscopic rotator cuff repair: correlation between the University of California, Los Angeles and American Shoulder and Elbow Surgeons scores

These authors performed a retrospective study of 143 patients who underwent arthroscopic rotator cuff repair using the University of California, Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) scores preoperatively and at 6, 12, and 24 months after surgery. They found that the UCLAand ASES scores showed a very high correlation (r = 0.91). In all the postoperative clinical evaluations, the scores obtained from the 2 scales were highly or very highly correlated (r = 0.87-0.92, P < .001). For the preoperative scores, the correlation was moderate (r = 0.67, P < .001).

Comment: Documenting the effectiveness of treatment is of great importance to shoulders surgeons and their patients.  Recently, authors have pointed to the observer dependence of scales that include measurements of strength and range of motion, such as the Constant and UCLA scores. Theses scales also have the disadvantage of requiring return of patients for an in-person examination, resulting in attrition of those available for followup. In contrast, scales such as the modified ASES, SANE and Simple Shoulder Test (SST) are purely patient reported metrics with the advantages of absence of observer dependence and the ability to complete the assessment without return to the office. The convenience of these forms puts outcome assessment within reach of all shoulder surgeons, so that they can learn the effectiveness of their treatments of their own patients.

As for the choice among the different patient reported measures, each has its own characteristics of convenience, brevity, and assessment of different aspects of shoulder comfort and function. Some, such as the SANE, boil everything down to one number, loosing the ability to assess different components of the shoulder's status. Others, such as the ASES score, require the patient to choose among "unable to do", very difficult to do", "somewhat difficult" and "not difficult" for each shoulder function. Still others, such as the Simple Shoulder Test, provide "yes" or "no" questions regarding twelve common activities of daily living.

In that surgeons from multiple countries desire to compare outcomes, having the scale validated in different languages can be helpful.

The authors of this paper are from São Paulo, Brazil; so it would be of interest to know how generally applicable the UCLA and ASES scores were to their Portuguese-speaking patients.

Of possible interest to them is this link.
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