These authors correlated the percentage of maximal possible improvement (%MPI) in the Simple Shoulder Test (SST) score and American Shoulder and Elbow Surgeons (ASES) with satisfaction after reverse shoulder arthroplasty (RSA) in 198 patients at a minimum 2-year follow-up.
The % of maximum possible improvement at a given time after surgery is easy to calculate:
They found that 61.3% (P < .001) and 68.2% (P < .001) of maximal possible improvement in the SST and ASES scores, respectively, predicted excellent satisfaction.
Patients achieving 61.3% of maximal possible SST score improvement or 68.3% of maximal possible ASES score improvement can be expected to reach excellent satisfaction about 80% of the time, whereas patients who do not reach these thresholds have excellent satisfaction only about 45% of the time.
Surgery on the dominant hand, greater baseline visual analog scale pain score, and cuff arthropathy were independent predictors for achieving the respective SST and ASES score thresholds.
Comment: There are five compelling features of using the %MPI. First, it is easy for surgeons to calculate. Second it is easy for patients to understand. Third, it avoids the "floor and ceiling" issues. Fourth, in contrast to the MCID (minimal clinically important difference) it differentiates an improvement in SST from 0 to 3 from an improvement in SST from 7 to 10. Fifth, as shown in this study and in others it yields very similar results for different patient self-assessment tools (note the similarity in values for the SST and ASES score). As a result it enables comparisons of studies in which different outcome measures are used. See for example this study:
One and two-year clinical outcomes for a polyethylene glenoid with a fluted peg: one thousand two hundred seventy individual patients from eleven centers, which showed essentially the same %MPI for the SST, ASES, Constant, and Penn scores.
The utility of the %MPI is that it enables surgeons to contrast the characteristics of patients, shoulders and techniques that yield outcomes above and below the desired %MPI threshold.
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Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
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