Some measures, such as the VAS Pain score , ask the patient characterize their pain as a single number on a visual analog scale extending from 0 (no pain) to 10 (worst possible pain). Other measures, such as the SANE score, ask the patient to rate the shoulder on a scale from 0 to 100, with 100 being the patient’s normal. By contrast, the Simple Shoulder Test provides greater granularity of outcome asking the patient to indicate their ability to perform each of 12 activities relating to their shoulder comfort and function, recognizing that some of these functions may be important to one patient, but less important to another.
Which metric to use depends on the question being addressed. The importance of selecting the appropriate outcome measure is demonstrated by Internal rotation based activities of daily living show limitations following reverse shoulder arthroplasty versus anatomic shoulder arthroplasty The authors of this work conducted a retrospective study of patients who underwent total shoulder arthroplasty between 2009-2020.
Included were 208 patients, 114 anatomic total shoulders (aTSA), and 94 reverse total shoulders (rTSA). While the age, sex and followup averages for the two groups were similar, the indications for surgery were different: 110/114 aTSAs were performed for arthritis, 70/94 rTSAs were performed for cuff tear arthropathy.
As shown below, the SANE, VAS pain and ASES scores were similar for the two procedures, whereas the total SST scores averaged lower for the rTSA group.
The activities that showed significant disparity between aTSA and rTSA were toileting (p=0.001), donning a coat (p=0.017), reaching one’s back (p=0.017), as well as throwing overhand (0.013) with rTSA patients reporting more difficulty in all these ADLs.
Comment: An interesting facet of this study is that the measured ranges of motion were similar for the two procedures (144 degrees of forward flexion and internal rotation to L5), however patients with rTSA had less functional ability to lift 1 and 8 pounds onto a shelf, lifting 10 pounds overhead, throwing overhand, toileting, dressing, and reaching behind the head. These functional differences may relate to the difference in cuff status between the to groups.
This study points to the value of outcome metrics that provide information on specific functions, rather than reporting a single number. Only with function specific measures will researchers be able to identify the factors associated with the patient's ability do perform their desired activities.
Comments welcome at shoulderarthritis@uw.edu
You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link
Follow on twitter/X: https://x.com/RickMatsen
Follow on facebook: https://www.facebook.com/shoulder.arthritis
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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).
You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link
Follow on twitter/X: https://x.com/RickMatsen
Follow on facebook: https://www.facebook.com/shoulder.arthritis
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
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).
