Comparison of Subjective and Objective Outcomes After Rotator Cuff Repair
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Goal of Rotator Cuff Repair
The primary goals of rotator cuff repair are to reduce pain and increase function. The manner in which these goals are considered and documented is not uniform because a myriad of assessment tools exist. To date, the reliability and validity of several assessment tools within the context of rotator cuff repair have been studied. Current literature includes evaluation of one of these particular tools or direct comparison of multiple tools. Continuous evaluation is necessary considering the growing role of quality reporting and transparency in health care.
Rotator Cuff Repair Outcomes Measurements
This study focused on 4 validated and commonly used measures: the Constant score (CS), the American Shoulder and Elbow Surgeons (ASES) index, the Simple Shoulder Test (SST), and the Short Form 12 (SF-12). The CS, also known as the Constant-Murley score, is a 100-point score in which 35% is populated by subjective patient-reported metrics such as pain and activities of daily living. The remaining 65% consists of clinical parameters composed of range of motion and strength testing. In an introductory study, Constant and Murley validated their score by assessing 100 abnormal shoulders and observing a 3% interobserver error (range, 0% to 8%). The CS was later assessed by Conboy and was found to have low systematic error but also low reliability.
The ASES score, which is also scored out of 100 points, assesses patient pain and function with 50% emphasis on each. Ten questions regarding activities of daily living are used for function analysis, whereas one question, namely the visual analog scale (VAS) score, is used for pain assessment. The ASES shoulder score, which is derived entirely from patient self-evaluation, is most often cited. Although it was not validated at its inception, the ASES shoulder score has since been extensively studied and validated.
The SST was developed by the shoulder service at the University of Washington. The SST consists of 12 dichotomous questions that focus on shoulder function and, like the ASES shoulder score, are based solely on patient self-assessment. The SST has recently been independently validated. The SF-12 is a commonly cited patient-completed questionnaire that is used primarily to measure quality of life. In the context of the shoulder and the rotator cuff in particular, the SF-12 and similar metrics are often used in conjunction with disease-specific measures to quantify the impact of disease and treatment on quality of life.
Subjective vs. Objective Outcomes After Rotator Cuff Repair
To our knowledge, there are no published studies that investigate the degree to which change in strength and change in pain correlate with validated outcome metrics in rotator cuff disease. The purpose of this study was to determine whether subjective (pain by VAS) or objective (strength by dynamometer) measures correlate with disease-specific measures and quality-of-life metrics in arthroscopic rotator cuff repair. The secondary objective was to ascertain the disease and demographic characteristics that drive changes in strength and pain. We hypothesized that quality-of-life metrics (SF-12) would correlate more closely with a decrease in pain rather than an improvement in strength. Conversely, validated functional outcome metrics (ASES score, CS, and SST score) would more closely correlate with strength rather than pain.