Choosing patient-reported outcome measures for shoulder pathology

Abstract

This study was designed to identify the most frequent shoulder patient-reported outcome measures (PROMs) reported in high-quality literature.A systematic review was performed to identify shoulder PROMs, and their diffusion within the scientific literature was tested with a subsequent dedicated search in MEDLINE.506 studies were included in the final data analysis, for a total number of 36,553 patients.The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the American Shoulder, Elbow Surgeons Score (ASES) and the Shoulder Pain and Disability Index (SPADI) were the most frequently reported PROMs in the analysed publications, with disease-specific PROMs being used with increasing frequency.A core set of outcome measures for future studies on patients with shoulder pathologies, based on the international acceptance and diffusion of each PROM, is needed.A combination of the DASH score for shoulder outcome assessment with more specific PROMs, such as the ASES for rotator cuff pathology and osteoarthritis and the SPADI for shoulder stiffness and shoulder pain of unspecified origin, is proposed as a recommended set of PROMs. Cite this article: EFORT Open Rev 2021;6:779-787. DOI: 10.1302/2058-5241.6.200109.

Keywords: outcome measures; patient-reported; shoulder.

Fig. 1

(A) Frequency distribution of the investigated patient-reported outcome measures (PROMs) among the studies considered. (B) Number of patients analysed with the selected PROMs throughout the studies considered. Since more than one PROM can be used in each study, the sum of all percentages is not necessarily 100%. Note. DASH, Disabilities of the Arm, Shoulder and Hand questionnaire; ASES, American Shoulder and Elbow Surgeons Score; SST, Simple Shoulder Test; SPADI, Shoulder Pain and Disability Index; OSS, Oxford Shoulder Score; WOSI, Western Ontario Shoulder Instability Index; WOOS, Western Ontario Osteoarthritis of the Shoulder; WORC, Western Ontario Rotator Cuff Index; SDQ, Shoulder Disability Questionnaire.

Fig. 2

Frequency of the selected patient-reported outcome measures (PROMs) in the studies about rotator cuff and subacromial pathologies. Since more than one PROM can be used in each study, the sum of all percentages is not necessarily 100%. Note. DASH, Disabilities of the Arm, Shoulder and Hand questionnaire; ASES, American Shoulder and Elbow Surgeons Score; SST, Simple Shoulder Test; SPADI, Shoulder Pain and Disability Index; OSS, Oxford Shoulder Score; WOSI, Western Ontario Shoulder Instability Index; WOOS, Western Ontario Osteoarthritis of the Shoulder; WORC, Western Ontario Rotator Cuff Index; SDQ, Shoulder Disability Questionnaire.

Fig. 3

Frequency of the selected patient-reported outcome measures (PROMs) in the studies about proximal humerus fractures. Since more than one PROM can be used in each study, the sum of all percentages is not necessarily 100%. Note. DASH, Disabilities of the Arm, Shoulder and Hand questionnaire; ASES, American Shoulder and Elbow Surgeons Score; SST, Simple Shoulder Test; SPADI, Shoulder Pain and Disability Index; OSS, Oxford Shoulder Score; WOSI, Western Ontario Shoulder Instability Index; WOOS, Western Ontario Osteoarthritis of the Shoulder; WORC, Western Ontario Rotator Cuff Index; SDQ, Shoulder Disability Questionnaire.

Fig. 4

Frequency of the selected patient-reported outcome measures (PROMs) in the studies about rotator shoulder instability. Since more than one PROM can be used in each study, the sum of all percentages is not necessarily 100%. Note. DASH, Disabilities of the Arm, Shoulder and Hand questionnaire; ASES, American Shoulder and Elbow Surgeons Score; SST, Simple Shoulder Test; SPADI, Shoulder Pain and Disability Index; OSS, Oxford Shoulder Score; WOSI, Western Ontario Shoulder Instability Index; WOOS, Western Ontario Osteoarthritis of the Shoulder; WORC, Western Ontario Rotator Cuff Index; SDQ, Shoulder Disability Questionnaire.

Fig. 5

Frequency of the selected patient-reported outcome measures (PROMs) in the studies about glenohumeral osteoarthritis. Since more than one PROM can be used in each study, the sum of all percentages is not necessarily 100%. Note. DASH, Disabilities of the Arm, Shoulder and Hand questionnaire; ASES, American Shoulder and Elbow Surgeons Score; SST, Simple Shoulder Test; SPADI, Shoulder Pain and Disability Index; OSS, Oxford Shoulder Score; WOSI, Western Ontario Shoulder Instability Index; WOOS, Western Ontario Osteoarthritis of the Shoulder; WORC, Western Ontario Rotator Cuff Index; SDQ, Shoulder Disability Questionnaire.

Fig. 6

Frequency of the selected patient-reported outcome measures (PROMs) in the studies about shoulder stiffness. Since more than one PROM can be used in each study, the sum of all percentages is not necessarily 100%. Note. DASH, Disabilities of the Arm, Shoulder and Hand questionnaire; ASES, American Shoulder and Elbow Surgeons Score; SST, Simple Shoulder Test; SPADI, Shoulder Pain and Disability Index; OSS, Oxford Shoulder Score; WOSI, Western Ontario Shoulder Instability Index; WOOS, Western Ontario Osteoarthritis of the Shoulder; WORC, Western Ontario Rotator Cuff Index; SDQ, Shoulder Disability Questionnaire.

Fig. 7

Frequency of the selected patient-reported outcome measures (PROMs) in the studies about calcific tendinitis of the rotator cuff. Since more than one PROM can be used in each study, the sum of all percentages is not necessarily 100%. Note. DASH, Disabilities of the Arm, Shoulder and Hand questionnaire; ASES, American Shoulder and Elbow Surgeons Score; SST, Simple Shoulder Test; SPADI, Shoulder Pain and Disability Index; OSS, Oxford Shoulder Score; WOSI, Western Ontario Shoulder Instability Index; WOOS, Western Ontario Osteoarthritis of the Shoulder; WORC, Western Ontario Rotator Cuff Index; SDQ, Shoulder Disability Questionnaire.

Fig. 8

Frequency of the selected patient-reported outcome measures (PROMs) in the studies about shoulder pain of unspecified origin. Since more than one PROM can be used in each study, the sum of all percentages is not necessarily 100%. Note. DASH, Disabilities of the Arm, Shoulder and Hand questionnaire; ASES, American Shoulder and Elbow Surgeons Score; SST, Simple Shoulder Test; SPADI, Shoulder Pain and Disability Index; OSS, Oxford Shoulder Score; WOSI, Western Ontario Shoulder Instability Index; WOOS, Western Ontario Osteoarthritis of the Shoulder; WORC, Western Ontario Rotator Cuff Index; SDQ, Shoulder Disability Questionnaire.

Fig. 9

Percentage of patient-reported outcome measure diffusion within each pathology category. Note. DASH, Disabilities of the Arm, Shoulder and Hand questionnaire; ASES, American Shoulder and Elbow Surgeons Score; SST, Simple Shoulder Test; SPADI, Shoulder Pain and Disability Index; OSS, Oxford Shoulder Score; WOSI, Western Ontario Shoulder Instability Index; WOOS, Western Ontario Osteoarthritis of the Shoulder.