PMID- 37245623
OWN - NLM
STAT- Publisher
LR  - 20231015
IS  - 1532-6500 (Electronic)
IS  - 1058-2746 (Linking)
VI  - 32
IP  - 11
DP  - 2023 Nov
TI  - Quantifying success after reverse total shoulder arthroplasty: the minimal 
      clinically important percentage of maximal possible improvement.
PG  - 2296-2302
LID - S1058-2746(23)00388-9 [pii]
LID - 10.1016/j.jse.2023.04.011 [doi]
AB  - BACKGROUND: In high functioning patients, the ceiling effect associated with many 
      patient-reported outcome measures (PROMs) limits the ability to appropriately 
      stratify success. The percentage maximal possible improvement (%MPI) was 
      introduced as another evaluation tool, with a proposed threshold of success at 
      30%. It remains unclear if this threshold correlates with perceived patient 
      success following shoulder arthroplasty. The purpose of this study was to compare 
      the proportion of patients that achieved the minimal clinically important 
      difference (MCID) and %MPI for different outcome scores and to define the %MPI 
      thresholds associated with patient satisfaction following primary reverse total 
      shoulder arthroplasty (rTSA). METHODS: A retrospective review was performed of an 
      international shoulder arthroplasty database between 2003 and 2020. All primary 
      rTSAs performed using a single implant system with minimum 2-year follow-up were 
      reviewed. Pre- and postoperative outcome scores were evaluated for all patients 
      to determine the raw improvement and %MPI. The proportion of patients achieving 
      the MCID and 30% MPI were determined for each outcome score. Thresholds for the 
      minimal clinically important %MPI (MCI-%MPI) were calculated using an 
      anchor-based method for each outcome score and stratified by age and sex. 
      RESULTS: A total of 2573 shoulders with a mean follow-up of 47 months were 
      included. Outcome scores with known ceiling effects (Simple Shoulder Test [SST], 
      Shoulder Pain and Disability Index [SPADI], University of California-Los Angeles 
      shoulder score [UCLA]) had higher rates of patients achieving the 30% MPI but not 
      the previously reported MCID. Inversely, outcome scores without significant 
      ceiling effects (Constant and Shoulder Arthroplasty Smart [SAS] scores) had 
      higher rates of patients achieving the MCID, but not the 30% MPI. The MCI-%MPI 
      differed among outcome scores and mean values were as follows: 33% for the SST, 
      27% for the Constant score, 35% for the American Shoulder and Elbow Surgeons 
      Standardized Shoulder Assessment Form (ASES) score, 43% for the UCLA score, 34% 
      for the SPADI score, and 30% for the SAS score. The MCI-%MPI increased with 
      greater age for SPADI (P < .04) and SAS (P < .01) scores, meaning that patients 
      with higher thresholds required a greater fraction of the possible improvement 
      for a given score to be satisfied but did not reach statistical significance for 
      other scores. Females had a greater MCI-%MPI for the SAS and ASES scores and a 
      lower MCI-MPI% for the SPADI score. CONCLUSION: The %MPI offers a simple method 
      to quickly assess improvements across patient outcome scores. However, the %MPI 
      that represents patient improvement after surgery is not uniformly the previously 
      established 30% threshold. Surgeons should use score-specific estimates of the 
      MCI-%MPI to gauge success when evaluating patients undergoing primary rTSA.
CI  - Copyright (c) 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. 
      Published by Elsevier Inc. All rights reserved.
FAU - Nieboer, Micah J
AU  - Nieboer MJ
AD  - Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
FAU - Hao, Kevin A
AU  - Hao KA
AD  - College of Medicine, University of Florida, Gainesville, FL, USA.
FAU - Tams, Carl
AU  - Tams C
AD  - Exactech Inc., Gainesville, FL, USA.
FAU - King, Joseph J
AU  - King JJ
AD  - Department of Orthopaedic Surgery and Rehabilitation, University of Florida, 
      Gainesville, FL, USA.
FAU - Wright, Thomas W
AU  - Wright TW
AD  - Department of Orthopaedic Surgery and Rehabilitation, University of Florida, 
      Gainesville, FL, USA.
FAU - Simovitch, Ryan W
AU  - Simovitch RW
AD  - Department of Orthopedic Surgery, Hospital Special Surgery, West Palm Beach, FL, 
      USA.
FAU - Parsons, Moby
AU  - Parsons M
AD  - The Knee, Hip and Shoulder Center, Portsmouth, NH, USA.
FAU - Schoch, Bradley S
AU  - Schoch BS
AD  - Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA. Electronic 
      address: Schoch.bradley@mayo.edu.
LA  - eng
PT  - Journal Article
DEP - 20230526
PL  - United States
TA  - J Shoulder Elbow Surg
JT  - Journal of shoulder and elbow surgery
JID - 9206499
SB  - IM
OTO - NOTNLM
OT  - American Shoulder and Elbow Surgeons score
OT  - Shoulder Arthroplasty Smart score
OT  - Shoulder replacement
OT  - Simple Shoulder Test
OT  - clinical outcome
OT  - maximal outcome improvement
OT  - patient satisfaction
EDAT- 2023/05/29 00:42
MHDA- 2023/05/29 00:42
CRDT- 2023/05/28 19:24
PHST- 2022/12/15 00:00 [received]
PHST- 2023/03/27 00:00 [revised]
PHST- 2023/04/05 00:00 [accepted]
PHST- 2023/05/29 00:42 [pubmed]
PHST- 2023/05/29 00:42 [medline]
PHST- 2023/05/28 19:24 [entrez]
AID - S1058-2746(23)00388-9 [pii]
AID - 10.1016/j.jse.2023.04.011 [doi]
PST - ppublish
SO  - J Shoulder Elbow Surg. 2023 Nov;32(11):2296-2302. doi: 10.1016/j.jse.2023.04.011. 
      Epub 2023 May 26.