Patient Reported Outcomes for Rotator Cuff Disease - Which PRO Should You Use?

Abstract

Objectives: Patient reported outcomes (PRO) are important clinical and research tools that are utilized by orthopedic surgeons in order to assess health outcomes following treatment. This is particularly so in the setting of rotator cuff pathology, in which several different validated patient reported outcomes exist. However, multiple recent studies have demonstrated a lack of standardization in the utilization of these scores. Moreover, many of these scores contain numerous components, thereby making them difficult to administer in a busy ambulatory setting. The goal of this study was to quantitatively assess the commonly used PRO for rotator cuff disease in order to identify the most efficient and comprehensive ones available for clinicians. Methods: Fifteen different PROs commonly used for rotator cuff pathology were selected for review. These outcome tools were assessed by the study team and reviewed for comprehensiveness with regards to assessment of pain, strength, activity, motion, and quality of life. The comprehensiveness and efficiency of each tool was evaluated by inclusion of questions addressing each domain. PROs were also evaluated with a focus of pain criteria (night pain, baseline/general pain, pain during activities of daily living, pain during sport, and pain during work). Finally, all PROs were assessed with regards to comprehensiveness in assessing activity scores (motion/stiffness, activities of daily living, sport, and work). Comprehensiveness scores were calculated by dividing the number of domains or subdomains present by the total domains or subdomains possible. Efficiency was calculated by dividing the number of domains present by the number of questions contained in each PRO. Results: The UCLA, Western Ontario Rotator Cuff Index (WORC), Disabilities of the Arm, Shoulder, and Hand (DASH), PENN, Shoulder Rating Questionnaire (SRQ), and Korean Shoulder Score (KSS) had an overall comprehensiveness score of 1.00 indicating all domains were present. The American Shoulder and Elbow Surgeons score (ASES), Constant score, Simple Shoulder Test (SST), 36 item Short Form Health Survey (SF-36), and Shoulder Pain and Disability Index (SPADI) had an overall comprehensiveness score of 0.80. The remaining PROs had a score of 0.60 or less. The highest scoring PROs for efficiency were UCLA, Constant, and Marx with scores of 1.00, 0.50, and 0.43 respectively. The UCLA, DASH, PENN, and SRQ had the highest pain comprehensiveness score of 0.60. The ASES, SST, WORC, DASH, Quick DASH, PENN, and SRQ had the highest activity comprehensiveness score of 1.00. The three highest averages of overall comprehensiveness, overall efficiency, pain comprehensiveness, and activity comprehensiveness were the UCLA, SRQ, and PENN PROs with averages of 0.78, 0.71, and 0.70 respectively. Conclusion: This is the first study to quantitatively assess quality and efficiency of patient reported outcomes for rotator cuff tears. The UCLA shoulder score was determined to be the most comprehensive and efficient when compared to fourteen other shoulder PROs in regards to the domains of pain, strength, activity, motion, and quality of life. Clinicians should consider these metrics when incorporating these tools in everyday clinical practice and research.(Figure Presented).