Responsiveness of patient-reported outcomes in shoulder arthroplasty: what are we actually measuring?
These authors reviewed 74 article that reported preoperative and at least 2 year postoperative measures of comfort and function after primary total shoulder arthroplasty (TSA) for glenohumeral arthritis.
Anatomic TSA was evaluated in 35 studies, reverse TSA in 32 studies, and both anatomic and reverse in 7 studies. There were a total of 7624 patients, and 25 different PRO tools were used.
The most commonly reported PRO tools were the American Shoulder and Elbow Surgeons,
Constant, the visual analog scale for pain, and the Simple Shoulder Test.
The effect size for each PRO was calculated by dividing the difference between postoperative and preoperative mean scores by the preoperative standard deviation. Effect size is a measure of magnitude of change within the tool after surgical intervention. An effect size is considered small if it is between 0.20 and 0.49, moderate if between 0.50 and 0.79, and large if 0.80. All instruments had comparable effect sizes >2.
Comment: The primary value of a surgeon's documenting patient reported measures of comfort and function before and after each surgery to determine what procedures for which patients work best in his or her hands.
An added value of a surgeon's documenting patient reported measures of comfort and function before and after each surgery is to compare his or her results with those published for similar procedures for similar patients. Initially it may seem that this would require the use of a common measure of patient comfort and function. However, in a prior 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), we showed that the commonly used patient reported measures of comfort and function showed essentially the same results for patients before and after total shoulder arthroplasty.
One of the convenient ways to compare studies using different measures is to determine the improvement expressed as a percent of maximum possible improvement:
(post op score - pre op score)/(perfect score - pre op score). In the study above, both the SST and the ASES scores showed a precent of maximal possible improvement of 80%.
Important considerations in selecting a measure of patient comfort and function are
(1) it should facilitate ongoing participation by the maximum number of patients (minimizing the percent of patients lost to followup while enabling the capture of data 5, 10 or more years after the procedure). The requirement that patients return for measurements (e.g. with the Constant score) or access to a computer (e.g. with the PROMIS system) may pose barriers to the desired followup.
(2) it should pose a minimal burden on office staff in scoring and data entry.
(3) it should provide data on specific functions that patients can easily comprehend, rather than a numerical value that may not have meaning to patients.
For these reasons we use the Simple Shoulder Test (see this
link).
(1) It is accessible and low tech - completable with pencil and paper from the patient's home without needing a computer connection or office visit
(2) It is simple to score (count the "yes" responses 0 to 12).
(3) It yields information patients can understand "does your shoulder allow you to sleep at night?"
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link). How to x-ray the shoulder (see this link). The ream and run procedure (see this link). The total shoulder arthroplasty (see this link). The cuff tear arthropathy arthroplasty (see this link). The reverse total shoulder arthroplasty (see this link). The smooth and move procedure for irreparable rotator cuff tears (see this link). Shoulder rehabilitation exercises (see this link).
