PMID- 31335605 OWN - NLM STAT- MEDLINE DCOM- 20200608 LR - 20240214 IS - 1528-1132 (Electronic) IS - 0009-921X (Print) IS - 0009-921X (Linking) VI - 477 IP - 8 DP - 2019 Aug TI - Which Is the Best Outcome Measure for Rotator Cuff Tears? PG - 1869-1878 LID - 10.1097/CORR.0000000000000800 [doi] AB - BACKGROUND: The American Shoulder and Elbow Surgeons Standardized Shoulder Form (ASES), the Shoulder Pain and Disability Index (SPADI), and the shortened Disability of the Arm, Shoulder, and Hand (quickDASH) are patient-reported upper extremity-specific outcome scales currently used to evaluate patients with rotator cuff tears. This heterogeneity does not allow for a uniform metric for research and patient care. QUESTIONS/PURPOSES: Our objective was to determine psychometric properties (reliability, convergent and discriminant validity, and responsiveness) of five commonly used outcome instruments (the ASES, the SPADI, the quickDASH, the SF-12, and the EuroQol-5D) in a longitudinal study of patients undergoing treatment for rotator cuff tears. METHODS: From February 2011 through June 2015, 120 patients completed a standardized history, the five outcome scales under study, a physical examination, and an MRI. Of these, 47 (39%) were lost to followup before 18 months, and another 24 (20%) were accounted for at 18 months but had missing data at one or more of the earlier prespecified followup intervals (3, 6, or 12 months). Reliability (the reproducibility of an outcome instrument between subjects; tested by Cronbach's alpha), convergent and discriminant validity (determining which outcome measures correlate most strongly with others; tested by Spearman's correlation coefficients), and responsiveness (the change in outcome scales over time based on percent improvement in shoulder functionality using the minimal clinically important difference [MCID] and the subjective shoulder value) were calculated. RESULTS: All outcomes measures had a Cronbach's alpha above 0.70 (range, 0.74-0.94) and therefore were considered reliable. Convergent validity was demonstrated as the upper extremity-specific measures (SPADI, ASES, and quickDASH) were more strongly correlated with each other (rho = 0.74-0.81; p < 0.001) than with any of the other measures. Discriminant validity was demonstrated because the Spearman's correlation coefficients were stronger for the relationships between upper extremity measures compared with the correlations between upper extremity measures and general health measures for 53 of the 54 correlations that were compared. Both internal and external responsiveness of the measures was supported. Patients who achieved the MCID and at least a 30% change on the subjective shoulder value had more positive change in scores over time compared with those who did not. Mixed model linear regressions revealed that all three upper extremity-specific measures had a group by time interaction for the MCID, indicating that patients who achieved the MCID had greater change over time compared with those who did not achieve the MCID. Results showed that the measure with the best discrimination between groups, or best internal responsiveness, was the ASES (beta = -8.26, 95% confidence interval [CI], -11.39 to -5.14; p < 0.001; eta = 0.089) followed by the SPADI (beta = 6.88, 95% CI, 3.78-9.97; p < 0.001; eta = 0.088) then the quickDASH (beta = 3.43, 95% CI, 0.86-6.01; p = 0.009, eta = 0.027). Measures with the best external responsiveness followed the same pattern of results. CONCLUSIONS: All the upper extremity-specific scales had acceptable psychometric properties. Correlations were high and thus only one upper extremity-specific instrument is needed for outcome assessment. Given the overall psychometric assessment, we recommend SPADI be the shoulder-specific instrument used to assess outcomes in patients with rotator cuff tears. LEVEL OF EVIDENCE: Level III, diagnostic study. FAU - Dabija, Dominique I AU - Dabija DI AD - D. I. Dabija, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA J. S. Pennings, K. R. Archer, J. E. Kuhn, N. B. Jain, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA K. R. Archer, N. B. Jain, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA G. D. Ayers, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA L. D. Higgins, E. Matzkin, Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA K. M. Baumgarten, Orthopedic Institute, Sioux Falls, SD, USA. FAU - Pennings, Jacquelyn S AU - Pennings JS FAU - Archer, Kristin R AU - Archer KR FAU - Ayers, Gregory D AU - Ayers GD FAU - Higgins, Laurence D AU - Higgins LD FAU - Kuhn, John E AU - Kuhn JE FAU - Baumgarten, Keith M AU - Baumgarten KM FAU - Matzkin, Elizabeth AU - Matzkin E FAU - Jain, Nitin B AU - Jain NB LA - eng GR - K23 AR059199/AR/NIAMS NIH HHS/United States GR - U34 AR069201/AR/NIAMS NIH HHS/United States GR - UL1 TR000445/TR/NCATS NIH HHS/United States PT - Comparative Study PT - Journal Article PL - United States TA - Clin Orthop Relat Res JT - Clinical orthopaedics and related research JID - 0075674 SB - IM MH - Aged MH - Biomechanical Phenomena MH - *Disability Evaluation MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Pain Measurement MH - *Patient Reported Outcome Measures MH - Predictive Value of Tests MH - Psychometrics MH - Recovery of Function MH - Reproducibility of Results MH - Rotator Cuff/*physiopathology/surgery MH - Rotator Cuff Injuries/*diagnosis/physiopathology/therapy MH - Shoulder Pain/*diagnosis/physiopathology/therapy MH - Treatment Outcome PMC - PMC7000030 COIS- All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research(R) editors and board members are on file with the publication and can be viewed on request. EDAT- 2019/07/25 06:00 MHDA- 2020/06/09 06:00 PMCR- 2020/08/01 CRDT- 2019/07/24 06:00 PHST- 2019/07/24 06:00 [entrez] PHST- 2019/07/25 06:00 [pubmed] PHST- 2020/06/09 06:00 [medline] PHST- 2020/08/01 00:00 [pmc-release] AID - 00003086-201908000-00021 [pii] AID - CORR-D-18-01289 [pii] AID - 10.1097/CORR.0000000000000800 [doi] PST - ppublish SO - Clin Orthop Relat Res. 2019 Aug;477(8):1869-1878. doi: 10.1097/CORR.0000000000000800.