Patient-Reported Outcomes of Shoulder Surgery in a Community Orthopedic Practice: A 5-Year Quality Improvement Project Using the QuickDASH Questionnaire

Abstract

There has been a shift in US health care to a system that emphasizes value. Patient-reported outcomes have become a critical component of that valuation. A 5-year quality improvement project at the community private practice level was undertaken to assess the authors' delivery of care and practice processes for shoulder surgery as compared with established standards. QuickDASH questionnaires were collected from 1304 consecutive shoulder surgery patients, and data were collected at 4 time points. Mean QuickDASH scores for each procedure and scores assessing biceps tenodesis, distal clavicle excision, workers' compensation status, and sex were analyzed for statistical significance. Rotator cuff repair patients who also underwent biceps tenodesis had statistically significant worse function preoperatively and at 3 and 6 months postoperatively but not at 1 year postoperatively ( P <.05). Rotator cuff repair patients undergoing concomitant distal clavicle excision had statistically significantly higher pre-operative scores ( P <.01). Male shoulder arthroplasty patients had statistically significant higher preoperative scores ( P <.02). Non–workers' compensation patients had statistically significant higher scores at 1 year ( P <.05), whereas workers' compensation patients were statistically significantly younger ( P <.01). Maximum changes in scores that met minimal clinically important differences occurred between surgery and 6 months postoperatively in all procedures. Quality outcome studies can be performed in private practice by a single surgeon and yield helpful results that lead to quality improvement through practice and delivery of care processes. [ Orthopedics . 2020;43(5):e383–e388.]

Substantial Inconsistency and Variability Exists Among Minimum Clinically Important Differences for Shoulder Arthroplasty Outcomes: A Systematic Review

“…After removing duplicates, applying the eligibility criteria, screening the articles, and reviewing the full texts, we included 43 articles with a total of 16,408 patients (Fig. 1) [1, 3, 4, 5, 6, 7, 9, 14, 17, 18, 19, 22, 23, 25, 28, 31, 35, 36, 38, 39, 42-45, 48, 50, 52-55, 56-60, 63, 64, 65-68, 69, 70]. The median (range) maximum follow-up time for all studies was 20 months (0.75 to 68).…”

“…The application of previously published MCID values to new study populations is especially problematic because patient cohorts, surgical techniques, surgical indications, and follow-up periods can vary widely between studies [10,11,21,32,33]. Two studies included in our review merely cited a prior study rather than providing the MCID threshold used [7,59]. In addition, follow-up durations varied widely among the studies that used previously calculated MCID values (6 to 60 months).…”

The Role of Music-Based Interventions in Orthopaedic Surgery

“…A similar trend has been found regarding the reduction of negative psychological outcomes in the postoperative period. Psychological outcomes were assessed using anxiety NRSs [19], the State-Trait Anxiety Inventory (STAI) [20,23,29], and VAS for anxiety [16,23,29,32] (Table 1). Various incongruities exist in the measures of pain and anxiety as well as the method of administration of MBI in these studies.…”

“…Taking into account all prior studies investigating MBI, it seems likely that MBI is helpful for lowering the subjective postoperative pain and anxiety for patients. With the ever-growing importance of patientreported outcome measures in orthopaedic surgery [32], MBI, which is both feasible and cost-effective, should be considered by orthopaedic departments in the immediate postoperative recovery period.…”