Trends in shoulder surgery patient-reported outcome measures

Abstract

Patient-reported outcome measures (PROMs) are a vital part of the toolkit for the current practice of orthopedic surgery. We are witnessing the expansion of the use of PROMs in clinical practice and in research; the ultimate direction of this expansion is unclear. The purpose of this systematic review was to identify the trends in the use of PROMs in major upper limb publications over a 7-year period. We retrospectively reviewed all articles published in 6 of the most influential upper limb orthopedic journals based on impact factor from January 2013 to January 2020. PubMed, Medline, and Embase were used to access the abstracts for all articles published for this period. We included all articles related to shoulder arthroplasty, shoulder instability, rotator cuff surgery, and involving the use of PROMs. There were 4175 articles identified from the selected journals over the chosen time period, of which 607 were eligible for inclusion in the study. The number of articles reporting PROMs increased from 57 in 2013 to 115 in 2019, which was a 102% increase. The total number of PROM usages recorded was 1593 which was comprised of 63 different scoring systems, with each article using a median of 3 different PROMs. The most commonly used score in articles originating from North America was the American Shoulder and Elbow Surgeons score (216 uses in 273 articles; 78.1%), from Europe it was the Constant-Murley Score (129 uses in 183 articles; 70.4%), and from Asia it was the American Shoulder and Elbow Surgeons score (80 uses in 126 articles; 63.4%). The use of PROMs is evolving with an increasing prevalence of and diversity of PROMs being used in upper limb surgery. There is geographical variation in the use of PROMs, and a variety of systems used, with only 3 of the top 10 most used PROMs reporting on patient satisfaction or wellbeing. Given that a diverse range of PROMs study a diverse range of conditions and procedures, there may not be a need for a consensus on the best overall use of PROMs, but there may be ideal PROMs suited to answer specific questions.

Keywords: Arthroplasty; Instability; PROMs; Patient reported outcome measures; Rotator cuff; Shoulder surgery.

Figure 1

This PRISMA flowchart outlines the literature search process undertaken for the study. JSES, Journal of Shoulder and Elbow surgery; JBJS, Journal of Bone and Joint Surgery; AJSM, American Journal of Sports Medicine: BJJ, Bone and Joint Journal; CORR, Clinical Orthopaedics and Related Research; PROMs, patient reported outcome measures.

Figure 2

The blue columns in this bar graph represent the number of articles with PROMs published per year in the journals that we assessed. PROMs, patient reported outcome measures.

Figure 3

The blue columns in this bar graph represent the number of PROMs used per article in the articles that we assessed. PROMs, patient reported outcome measures.

Figure 4

The blue columns in this bar graph represent the number of times each PROM system was used in a different article. ASES, American Shoulder and Elbow Surgeons; VAS, visual analog scale; SST, simple shoulder test; UCLA, University of California Los Angeles score; SSV, subjective shoulder value; SANE, single assessment numeric evaluation; WOSI, Western Ontario Shoulder Instability index; DASH, disabilities of the arm shoulder and hand score; OSS, Oxford Shoulder Score; WORC, Western Ontario Rotator Cuff index; SPADI, shoulder pain and disability index; PROM, patient reported outcome measures.

Figure 5

Each colored line in this line graph represents one of the Top 4 most commonly used PROMs and the number of times they were used in articles each year. PROMs, patient reported outcome measures; ASES, American Shoulder and Elbow Surgeons; SST, simple shoulder test; VAS, visual analog scale.

Figure 6

Each column in this bar graph represents a geographical region of origin for the published articles. The color code for each bar represents different PROMs. PROMs, patient reported outcome measures; ASES, American Shoulder and Elbow Surgeons; SST, simple shoulder test; SSV, subjective shoulder value; UCLA, University of California Los Angeles score; VAS, visual analog scale.

Figure 7

Each column in this bar graph represents one of the Top 10 most used PROMs. The color code for each bar represents the domains that constitute each PROM scoring system. ROMs, patient reported outcome measures; UCLA, University of California Los Angeles score; WOSI, Western Ontario Shoulder Instability index; DASH, disabilities of the arm shoulder and hand score; SST, simple shoulder test; ASES, American Shoulder and Elbow Surgeons; SANE, single assessment numeric evaluation; SSV, subjective shoulder value; VAS, visual analog scale.