Upper Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery

Smith, Matthew V.; Calfee, Ryan P.; Baumgarten, Keith M.; Brophy, Robert H.; Wright, Rick W.

doi:10.2106/jbjs.j.01744

Cited by 243 publications

(157 citation statements)

References 62 publications

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“…Substantial efforts have been directed at developing outcome instruments that adequately characterize the outcomes of orthopaedic interventions, including physician-directed and patient self-evaluation [13,16]. The importance of simple, reliable, and validated self-assessed outcome measures to evaluate patient function and to show satisfactory results after surgery has continued to increase as greater emphasis is placed on quality, outcomes, and patient satisfaction [1,15].…”

Section: Introductionmentioning

confidence: 99%

What Change in American Shoulder and Elbow Surgeons Score Represents a Clinically Important Change After Shoulder Arthroplasty?

Werner

Chang

Nguyen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

177

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Background The American Shoulder and Elbow Surgeons (ASES) questionnaire was developed to provide a standardized method for evaluating shoulder function. Previous studies have determined the clinical responsiveness of this outcome measure for heterogenous populations or patients with nonoperatively treated rotator cuff disease. Currently, to our knowledge, no studies exist that establish the clinically relevant change in the ASES score after shoulder arthroplasty. Questions/purposes We asked: (1) What are the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the ASES score after primary and reverse shoulder arthroplasties? (2) Are the MCID and SCB for the ASES score different between primary and reverse shoulder arthroplasties? (3) What patient-related factors are associated with achieving the MCID and SCB after total shoulder arthroplasty and reverse shoulder arthroplasty? Methods A longitudinally maintained institutional shoulder arthroplasty registry was retrospectively queried for patients who underwent primary shoulder arthroplasty, including anatomic or reverse total shoulder arthroplasty from 2007 to 2013, with a minimum 2-year followup. Seven hundred ninety-four patients were identified and eligible; 304 of these patients did not have 2 years of followup or complete datasets, resulting in a study cohort of 490 patients (62% of the 794 potentially eligible). The MCID and SCB of the ASES score for these patients was calculated using an anchor-based method, using four different anchors measuring satisfaction with work, activities, overall, and activity from the SF-36. The MCID (anchored to somewhat satisfied) and SCB (very satisfied) of the ASES score were calculated for the entire cohort and stratified by arthroplasty type. Multivariate logistic regression of patient-related factors that influence the MCID and SCB achievement was performed. Results The MCID for all patients combined ranged from 6.3 to 13.5; for the overall satisfaction anchor, the MCID was 13.5 ± 4.5 (95% CI, 4.8-22.3). The SCB for the overall cohort ranged from 12.0 to 36.6; for the overall satisfaction anchor, the SCB was 36.6 ± 3.8 (95% CI, 29.1-44.1). There were no differences in the MCID of the ASES score between anatomic and reverse shoulder arthroplasty for any of the anchors (p = 0.159-0.992) or the SCB for any of the anchors (p = 0.467-0.977). CombiningOne of the authors certifies that he (LVG), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Biomet, Inc (Warsaw, IN, USA). One of the authors certifies that he, (DMD) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Biomet, Inc (Warsaw, IN, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certif...

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Section: Introductionmentioning

confidence: 99%

What Change in American Shoulder and Elbow Surgeons Score Represents a Clinically Important Change After Shoulder Arthroplasty?

Werner

Chang

Nguyen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

177

View full text Add to dashboard Cite

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“…Finding the most effective way to measure coping strategies in response to nociception and magnitude of disability and avoiding redundancy is important. These measurements might help hand surgeons identify opportunities for psychological support in daily practice [26]. The widespread adoption of PROMIS-based questionnaires may not only lead to a reduction in respondent and researcher burden, but also in sample size requirements and ultimately study costs [17].…”

Section: Discussionmentioning

confidence: 99%

What Is the Most Useful Questionnaire for Measurement of Coping Strategies in Response to Nociception?

Kortlever

Janssen

Berckel

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background There are several measures of coping strategies in response to nociception. These measures all correlate highly both with each other and with symptom intensity and magnitude of disability in patients with upper limb illness. This study aims to determine if distinct measures of coping strategies in response to nociception address the same underlying aspect of human illness behavior. Questions/purposes Our primary study question was: is there one common aspect of human illness behavior measured by (1) the Pain Catastrophizing Scale (PCS); (2) the Psychological Inflexibility in Pain Scale (PIPS); (3) the Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Computer Adaptive Test (CAT); and (4) the Pain Self-Efficacy Questionnaire (PSEQ)? Secondarily, we aimed to determine which of the four questionnaires is most psychometrically sound. We measured correlations among questionnaires, coverage, reliability, completion time, and collinearity of these questionnaires when entered together in a multivariable model with the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) upper extremity disability questionnaire. Methods In this prospective study, 138 consecutive new or followup English-speaking patients aged 18 years or older presenting to a tertiary care referral center with traumatic and nontraumatic upper extremity conditions were invited to participate between March and May 2014. One hundred thirty-four (97%) patients agreed to participate and completed the four questionnaires in random order before their visit with the physician. We used exploratory factor analysis to assess whether there was a single common trait-an underlying aspect of human illness behaviormeasured by these questionnaires. Interquestionnaire correlation was assessed using Spearman rank correlation coefficients; coverage by assessing floor and ceiling effect (proportion of scores at lower and upper limit); reliability by Cronbach's alpha measure of internal consistency; completion time in seconds using Kruskal-Wallis analysis; and collinearity statistics through a regression model with QuickDASH.

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“…In both patients, the normal CTS-6 and NCS results, along with a better history of exam, helped lead to the diagnoses of cervical stenosis. There are multiple diagnostic and outcome measures available to assess treatment effects for CTS, including the Short Form 36 (SF-36), Disability of the Arm, Shoulder, and Hand (DASH), QuickDASH, Boston Carpal Tunnel Questionnaire (BQ), Michigan Hand Outcomes Questionnaire (MHQ), global symptom score, Kamath questionnaire, CTS severity scale, and patient-related wrist evaluation [33,37].…”

Section: Discussionmentioning

confidence: 99%

Prospective Comparison of the Six-Item Carpal Tunnel Symptoms Scale and Portable Nerve Conduction Testing in Measuring the Outcomes of Treatment of Carpal Tunnel Syndrome with Steroid Injection

Craw

Church

Hutchison

2014

Hand (New York, N,Y.)

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Background We prospectively studied patients clinically diagnosed with carpal tunnel syndrome (CTS) and treated with the injection of corticosteroid into their carpal tunnel in order to compare changes in the six-item CTS symptoms scale and portable nerve conduction study (NCS) parameters as outcome tools. Our pilot study was the first to assess the utility of the six-item CTS symptom scale (CTS-6) with steroid injections as a patient-directed outcome measure for the treatment of CTS. Methods We enrolled patients who presented to our county hospital orthopedic surgery clinic from August 2012 through August 2013. The patients were clinically diagnosed with CTS. After completing the six-item CTS symptoms scale questionnaire, portable NCS was obtained. Each patient then received an injection of 1 ml of triamcinolone acetonide 40 mg/ml mixed with 1 ml of 1 % lidocaine into the carpal tunnel. Six weeks postinjection, each patient repeated a CTS-6 questionnaire and underwent a repeat portable NCS. The CTS-6 and NCS results were analyzed using the paired samples t test. A Pearson correlation was used to assess the correlation between the changes in the CTS-6 and the NCS measurements. Statistical significance was set at P<0.05. Results Thirty-two wrists in 20 patients were evaluated. There was a statistically significant difference between the CTS-6 scores before and after injection. There were also statistically significant changes in the five of the NCS parameters. None of the correlations between the CTS-6 and the NCS parameters were statistically significant. Conclusions The six-item CTS symptoms scale and portable NCS are both useful measures for evaluating the results of steroid injections. The CTS-6 is an effective tool because of its ease of use, low cost, correspondence with changes in NCS, and ability to monitor the outcome of steroid treatment for carpal tunnel syndrome.

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Upper Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery

Cited by 243 publications

References 62 publications

What Change in American Shoulder and Elbow Surgeons Score Represents a Clinically Important Change After Shoulder Arthroplasty?

What Change in American Shoulder and Elbow Surgeons Score Represents a Clinically Important Change After Shoulder Arthroplasty?

What Is the Most Useful Questionnaire for Measurement of Coping Strategies in Response to Nociception?

Prospective Comparison of the Six-Item Carpal Tunnel Symptoms Scale and Portable Nerve Conduction Testing in Measuring the Outcomes of Treatment of Carpal Tunnel Syndrome with Steroid Injection

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