Monday, March 19, 2018

How important is range of motion to shoulder function before and after reverse total shoulder?

Clinical measurements versus patient-reported outcomes: analysis of the American Shoulder and Elbow Surgeons physician assessment in patients undergoing reverse total shoulder arthroplasty

These authors evaluated the relationship of the ASES physician-assessment measurements with patient-reported shoulder and general health outcomes for 74 patients at two years after a reverse total shoulder arthroplasty.

Preoperative physician measurements and patient scores were not significantly correlated. At two years postoperatively, only improvements in active forward flexion had a modest correlation with improvements in ASES patient scores (R = 0.36, P < .01).

Comment: While it is traditional to use range of motion as an outcome measure for shoulder arthroplasty, there are a number of problems with this tradition:
(1) range of motion measurements are observer dependent and may be subject to observe bias and inter observer variability
(2) range of motion measurements require patients to return to the office, excluding from followup those patients who cannot return
(3) as shown in the graph above, some patients with 140 degrees of active flexion have poor self-assessed comfort and function (as measured by the patient reported ASES score) while other patients have good self-assessed function with only 80 or 100 degrees of active flexion.

In this study active range of motion accounted for less than 30% of the variance in patient-reported shoulder function. What is of great importance is the investigation of the factors that determine the other 70%.

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