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

Abstract

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...

Effectiveness of Dextrose Prolotherapy for Rotator Cuff Tendinopathy: A Systematic Review

“…As such, dextrose prolotherapy demonstrates a statistically significant improvement in pain and function when added to standard of care physical therapy, with a mean improvement of 1.6‐3.0, 9.1‐33.4, and 27.9‐point for the pain VAS, SPADI, and WORC, respectively. These all demonstrate both clinically and statistically significant improvements with minimal clinically important difference (or MCID) defined as 1.4‐points, 8‐points, and 14.3 for the VAS, SPADI, and WORC, respectively. The benefit demonstrated with the use of dextrose prolotherapy in addition to physical therapy makes prolotherapy a viable adjunct to maximize the benefit of physical therapy.…”

Previous Rotator Cuff Repair is Associated with Inferior Clinical Outcomes after Reverse Total Shoulder Arthroplasty

“…The minimal clinically important difference (MCID) for the ASES score with regard to shoulder arthroplasty has been addressed by multiple recent publications. 24,25 Unfortunately, these reported MCID values vary notably: One study suggested that a change or difference as low as 9 points may be clinically significant, 25 while another study found 21 points to be clinically significant. 24 The differences we found between previous RCR patients and controls in postoperative ASES score (8.5 points) and improvement in ASES score (7.9 points) are both just below the 9-point threshold reported by Werner et al 25 However, when we controlled for patient-related factors, as indicated by the coefficient B in stepwise regression, the postoperative between-group difference in ASES score was adjusted to 9.5, which may indicate a clinically meaningful difference.…”

How Should We Define Clinically Significant Improvement on Patient-Reported Outcomes Measurement Information System Test for Patients Undergoing Knee Meniscal Surgery?

“…11 Clinically significant outcomes (CSOs) have shifted the paradigm of PROM research toward a valuebased approach focused on translating numerical score change into units of patient-perceived clinical benefit. 12,13 Three patient-perceived outcome metrics commonly reported in CSO research are the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS). The MCID is the minimum change in outcome scoring that a patient perceives as clinically significant.…”

“…[16][17][18] The MCID, SCB, and PASS thresholds are being increasingly defined for a variety of PROMs in specific patient populations. 13,15,[19][20][21] Although the PROMIS PF CAT has shown an acceptable performance relative to legacy PROMs in patients undergoing meniscal surgery, the MCID, SCB, and PASS values have yet to be defined. 9 The purpose of our study was to define the MCID, SCB, and PASS thresholds for the PROMIS PF CAT instrument in patients undergoing arthroscopic meniscal surgery.…”