Validity and Responsiveness of the Single Alpha-numeric Evaluation for Shoulder Patients

Abstract

Background: There is an ever-increasing demand for widespread implementation of patient-reported outcomes. However, adoption is slow owing to limitations in clinical infrastructure and resources within busy orthopaedic practices. Prior studies showed the single alpha-numeric evaluation (SANE) score to correlate at a single point in time with the American Shoulder and Elbow Surgeons (ASES) score. However, no study has validated the SANE in terms of test-retest reliability, responsiveness, or clinical utility. Purpose: To validate SANE with the ASES across a sample of patients with common orthopaedic shoulder diagnoses. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients undergoing rotator cuff repair (n = 77), total shoulder replacement (n = 55), or physical therapy (n = 80) for signs and symptoms of subacromial impingement syndrome (n = 61) or adhesive capsulitis (n = 19) were administered the SANE and ASES at baseline and again at their 3-month follow-up from initial care or surgery (N = 212, mean ± SD age = 52.6 ± 1.2 years, n = 145 women). Interclass correlation coefficient (ICC2,1) and standard error of the measurement (SEm) were used to evaluate the test-retest reliability of the SANE and the validity between the SANE and ASES scores. Analysis of variance (treatment group × time) was used to evaluate the responsiveness to treatment, and a receiver operating characteristic curve was used to establish the minimal clinically important difference (MCID) for the SANE as compared with the ASES (α = .05). Floor and ceiling effects were evaluated as the percentage of patients who scored the highest or lowest score on each tool. Results: The SANE demonstrated good pretreatment reliability (ICC2,1 = 0.84, SEM = 3.8), similar to the ASES (ICC2,1 = 0.82, SEM = 3.4). The SANE also showed good agreement with the ASES before and after treatment across all treatment groups (rotator cuff repair, ICC2,1 = 0.85, SEM = 3.4; total shoulder replacement, ICC2,1 = 0.72, SEM = 5.2; physical therapy: ICC2,1 = 0.82, SEM = 2.9). The SANE and ASES displayed similar responsiveness after treatment, with similar mean change and SD within each treatment group. The receiver operating characteristic curve revealed an area under the curve of 0.79 (SE, 0.62; P < .001) and a cutoff of 15% on the SANE, with a sensitivity of 85% to establish the MCID. Acceptable and similar floor and ceiling effects were observed for the ASES (4%) and SANE (9%). Conclusion: The study demonstrates that the SANE is valid for a range of common shoulder diagnoses to assess patient outcomes across operative and nonoperative treatment for shoulder complaints. The MCID of 15% is similar to that of the ASES (11%), suggesting that the SANE is a simple and efficient tool to assess treatment effects for shoulder disorders. Future studies are warranted to confirm these results and compare across other body parts and diagnoses.

Sex-related differences in patients undergoing surgery for shoulder instability: a Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort study

“…14 The differences fell below the MCID for the WOSI score (10.5) and SANE score (15.0). 10,24 The MCID for the visual analog scale for pain has not been evaluated for shoulder instability but has been reported as 1.4 for rotator cuff disease, greater than the statistically significant difference of 1.1 shown in our study. 23 The MCID for the RAND-36 score has not been determined for shoulder conditions, although a 5-point difference has been reported as a general minimal detectable change.…”

Patient-Determined Outcomes After Arthroscopic Margin Convergence Rotator Cuff Repair

“…To determine clinically meaningful improvements from arthroscopic rotator cuff repair, the percentage of shoulders that had improvements equal to or greater than the minimal clinically important difference (MCID) of the WORC, the ASES score, and the SANE was reported. 12 , 18 , 22 , 23 These studies suggested the MCID of the WORC was 11.7%, the SANE was 15%, and the MCID of the ASES ranged from 6.4 to 17.…”

“…Prospective collection of preoperative patient-determined outcomes scores on patients undergoing arthroscopic rotator cuff repair by a single surgeon was begun in December 2008. Quality-of-life outcome scores that were collected include the Western Ontario Rotator Cuff Index (WORC) 9 , 10 , 11 (a disease-specific outcome score that has been recommended for assessing the results of rotator cuff repair treatment 12 ), the American Shoulder and Elbow Surgeons (ASES) score, 13 , 14 , 15 the Simple Shoulder Test (SST), 15 , 16 (joint-specific outcome scores), and the Single Assessment Numeric Evaluation (SANE) 17 , 18 (a general health measure). In addition, the Shoulder Activity Level was the primary activity level score outcome examined in this study since it is a validated, patient-determined outcome score that can be used to measure a patient’s activity level.…”

Single Assessment Numeric Evaluation scores correlate positively with American Shoulder and Elbow Surgeons scores postoperatively in patients undergoing rotator cuff repair

“…4,9 One study examined the relationship between these 2 scores at the 3-month postoperative time point. 11 However, the purpose of our study was to use the ASES score (the gold standard for evaluating shoulder function) as a benchmark by which to evaluate the SANE score, with the hope that the SANE score can be used together with clinicianbased and combination scores to assess postoperative shoulder function in patients undergoing RCR or shoulder arthroplasty.…”

“…2 The SANE has been shown to be reliable, responsive, and valid preoperatively and at short-term (3-month) postoperative follow-up in patients undergoing rotator cuff repair (RCR) and shoulder arthroplasty. 11 Our aims were to determine (1) the correlation between ASES and SANE scores preoperatively and 2 years postoperatively in patients undergoing RCR or shoulder arthroplasty and (2) the correlation between the change in ASES scores and change in SANE scores. We hypothesized that ASES and SANE scores would correlate positively before and after surgery in both groups.…”