Is the Simple Shoulder Test a valid outcome instrument for shoulder arthroplasty?

doi:10.1016/j.jse.2017.03.029

Journal of Shoulder and Elbow Surgery

Volume 26, Issue 10, October 2017, Pages 1693-1700

https://doi.org/10.1016/j.jse.2017.03.029 Get rights and content

Background

The Simple Shoulder Test (SST) is a brief, inexpensive, and widely used patient-reported outcome tool, but it has not been rigorously evaluated for patients having shoulder arthroplasty. The goal of this study was to rigorously evaluate the validity of the SST for outcome assessment in shoulder arthroplasty using a systematic review of the literature and an analysis of its properties in a series of 408 surgical cases.

Methods

SST scores, 36-Item Short Form Health Survey scores, and satisfaction scores were collected preoperatively and 2 years postoperatively. Responsiveness was assessed by comparing preoperative and 2-year postoperative scores. Criterion validity was determined by correlating the SST with the 36-Item Short Form Health Survey. Construct validity was tested through 5 clinical hypotheses regarding satisfaction, comorbidities, insurance status, previous failed surgery, and narcotic use.

Results

Scores after arthroplasty improved from 3.9 ± 2.8 to 10.2 ± 2.3 (P < .001). The change in SST correlated strongly with patient satisfaction (P < .001). The SST had large Cohen's d effect sizes and standardized response means. Criterion validity was supported by significant differences between satisfied and unsatisfied patients, those with more severe and less severe comorbidities, those with workers' compensation or Medicaid and other types of insurance, those with and without previous failed shoulder surgery, and those taking and those not taking narcotic pain medication before surgery (P < .005).

Conclusion

These data combined with a systematic review of the literature demonstrate that the SST is a valid and responsive patient-reported outcome measure for assessing the outcomes of shoulder arthroplasty.

Section snippets

Study subjects

Patients in our practice undergoing shoulder arthroplasty between the dates of August 2010 and March 2014 were invited to participate in a prospective outcome study. Those patients with complete baseline characteristics and 2-year outcomes during the time period were included in this analysis. Patients completed the SST and the 36-Item Short Form Health Survey (SF-36) questionnaire preoperatively (within 30 days of surgery) and postoperatively at 2 years. A total of 522 patients were enrolled

Construct validity

Scores after shoulder arthroplasty were improved from a mean of 3.9 ± 2.8 preoperatively to 10.2 ± 2.3 postoperatively (P < .001). Both Cohen's d (2.29) and the SRM (2.05) were large. The effect size and SRM of the SST were larger than that of each SF-36 domain (Table II).

Content validity

The correlation between the SST and SF-36 was moderate for most of the physical domains, including physical function, role physical, and bodily pain (Table III). Correlation was slight or fair for the mental components of the

Discussion

The SST has been used as an outcome measure in many studies evaluating outcomes in patients treated for shoulder arthritis,8, 9, 15, 24, 34 but this instrument has not been rigorously validated for this specific population of patients. This study reports the construct validity, criterion validity, and responsiveness of the SST in a large series of patients undergoing shoulder arthroplasty.

Two prior studies have focused on some of the features of the SST in patients with shoulder arthritis,31, 37

Conclusion

This study of the psychometric properties of the SST combined with a systematic review of the literature indicates that this low-cost, brief, and convenient instrument provides a patient-reported measure that is valid in the measurement of shoulder arthroplasty outcomes.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Rotator Cuff Repair With Patch Augmentation Is Associated With Lower Retear Rates for Large Tears: A Systematic Review of Randomized Controlled Trials
2024, Arthroscopy - Journal of Arthroscopic and Related Surgery
To perform a systematic review of randomized controlled trials comparing clinical outcomes of rotator cuff repair with and without patch augmentation.
A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that directly compared outcomes between rotator cuff repair (RCR) with versus without patch augmentation. Patients were evaluated based on retear rate, histological outcomes, radiological outcomes, and patient-reported outcomes (Constant score; American Shoulder and Elbow Surgeons [ASES] score; University of California–Los Angeles shoulder scale; Simple Shoulder Test; EuroQol-visual analog scale; Disabilities of the Arm, Shoulder and Hand score; and PENN shoulder score questionnaire).
Six studies (1 level I, 5 level II) met inclusion criteria, including 188 patients undergoing RCR alone (Control) and 193 patients undergoing RCR with patch augmentation (Patch). Patient age ranged from 56.0 to 68.0 years. The mean follow-up time ranged from 14.0 to 68.4 months. The average body mass index ranged from 24.4 to 29.4, and the overall percentage of males ranged from 32.5% to 82.3%. Three studies found significantly decreased retear rates with patch augmentation. The retear rate ranged from 34.0% to 65.4% in the Control group and 9.1% to 52.9% in the Patch group. One study found a significant difference for the Constant score favoring the Patch group. Two studies found a significant difference for the ASES score favoring the Patch group. One study found significantly better results with patch augmentation in terms of repaired tendon thickness and footprint coverage, based on magnetic resonance imaging.
Patch augmentation of rotator cuff repairs may be associated with lower retear rates for large tears. There is limited evidence to suggest that patch augmentation is associated with improved patient-reported outcomes.
Level II, systematic review of level I and II studies.
Effect of hospital length of stay on functional outcomes and readmission after total shoulder arthroplasty
2024, Seminars in Arthroplasty JSES
Total shoulder arthroplasty (TSA) is a common orthopedic procedure for glenohumeral osteoarthritis, rotator cuff arthropathy, and other degenerative conditions. The current standard hospital length of stay (LOS) commonly accepted following TSA is 1-2 days before discharge to home or a private facility. To evaluate the association between LOS and readmissions, revisions, and outcomes. Additionally, risk factors for increased LOS (> 24 hours) following TSA will be determined.
A retrospective review identified all patients who underwent TSA between 2010 and 2019. Patients were excluded for chronic kidney disease requiring dialysis, preoperative corticosteroid use, revision TSA, undergoing a TSA for a fracture, or having no recorded outcome measures. Demographic information, operative details, medical comorbidities, length of hospital stay, complications, location of discharge, readmissions, revisions, and outcome scores were collected. Patients were categorized into two groups: discharge within 24 hours of TSA and discharge over 24 hours after TSA.
Patients discharged within 24 hours had an average LOS of 0.96 ± 0.19 days, and patients discharged after 24 hours had an average LOS of 2.71 ± 1 day (P < .001). There were no significant differences in the groups with regard to race, sex, and body mass index. Patients discharged within 24 hours were younger at the time of surgery compared to patients discharged after 24 hours (66.7 ± 8.10 years and 70.1 ± 10.4 years, respectively [P = .030]). There was a significant difference in discharge location between the groups with 86.2% of patients in the under-24 hour group being discharged to home compared to only 66.0% in the over-24 hour group (P = .006). There were no significant differences between the groups with regard to postoperative complication rate, 90-day readmission rate, and need for revision procedures. There was a significant difference in the Charlson comorbidity index between the groups with those discharged within 24 hours averaging an index score of 2.78 ± 1.33 and those discharged after 24 hours averaging an index score of 4.02 ± 2.07 (P < .001). No significant differences were found between preoperative and postoperative American Shoulder and Elbow Surgeons Shoulder Survey, Single Assessment Numeric Evaluation, or Simple Shoulder Test scores between the groups.
Patients who had a hospital LOS over 24 hours following TSA were significantly older and discharged to nonhome locations at a higher rate. Patients with Charlson comorbidity index scores over 3 are more likely to have a LOS over 24 hours following TSA. Postoperative outcome measures were not affected by LOS with no significant differences in readmission rate, revision rates, and complications.
Managing rotator cuff tear arthropathy: a role for cuff tear arthropathy hemiarthroplasty as well as reverse total shoulder arthroplasty
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Disabling cuff tear arthropathy (CTA) is commonly managed with reverse shoulder arthroplasty (RSA). However, for patients with CTA having preserved active elevation, cuff tear arthropathy hemiarthroplasty (CTAH) may offer a cost-effective alternative that avoids the complications unique to RSA. We sought to determine the characteristics and outcomes of a series of patients with CTA managed with these procedures.
We retrospectively reviewed 103 patients with CTA treated with shoulder arthroplasty, the type of which was determined by the patient's ability to actively elevate the arm. Outcome measures included the change in the Simple Shoulder Test (SST), the percent maximum improvement in SST (%MPI), and the percentage of patients exceeding the minimal clinically important difference for the change in SST and %MPI. Postoperative x-rays were evaluated to assess the positions of the center of rotation and the greater tuberosity for each implant.
Forty-four percent of the 103 patients were managed with CTAH while 56% were managed with RSA. Both arthroplasties resulted in clinically significant improvement. Patients having RSA improved from a mean preoperative SST score of 1.7 (interquartile range [IQR], 0.0-3.0) to a postoperative score of 6.3 (IQR, 2.3-10.0) (P < .01). Patients having CTAH improved from a preoperative SST score of 3.1 (IQR, 1.0-4.0) to a postoperative score of 7.6 (IQR, 5.0-10.) (P < .001). These improvements exceeded the minimal clinically important difference. Instability accounted for most of the RSA complications; however, it did not account for any CTAH complications. The postoperative position of the center of rotation and greater tuberosity on anteroposterior radiographs did not correlate with the clinical outcomes for either procedure.
For 103 patients with CTA, clinically significant improvement was achieved with appropriately indicated CTAH and RSA. In view of the lower cost of the CTAH implant, it may provide a cost-effective alternative to RSA for patients with retained active elevation.
What activities do patients hope to perform following reverse shoulder arthroplasty but are unable to? Looking beyond patient-reported outcome measures
2023, Seminars in Arthroplasty JSES
Patients return to activities of daily living at a relatively high frequency following reverse shoulder arthroplasty (RSA), based on structured patient-reported outcome measures (PROMs) asking about specific activities. What is unknown, however, is what activities do patients want to be able to perform following RSA but are unable to, beyond what is asked in PROMs.
Patients who underwent primary RSA for glenohumeral osteoarthritis or rotator cuff arthropathy between January 1, 2016, and July 1, 2019, were identified using an institutional clinical registry. A survey was sent to patients at a minimum of two years postoperatively, which included a free-response question in addition to eight selection-based questions assessing patients’ ability to perform various activities.
Of 246 patients solicited, 142 (58%) completed the survey. Among survey participants, the mean age was 70.8 ± 7 years, and the mean duration of follow-up was 4.3 years. A large majority of patients reported little-to-no difficulty with driving a car (90%), managing toileting (84%), putting on a seatbelt (82%), and washing hair (81%). Fifty-nine percent of patients reported reaching shelves at home with minimal difficulty. When asked which activities they wanted to perform, but felt unable to, patients most commonly self-identified tennis (15%), swimming (11%), throwing a ball (11%), golf (10%), and lifting weights or exercising the arm (10%).
Patients can perform many low-demand household activities without difficulty following RSA. There remains a host of other activities, hobbies, and sports, however, that patients wish to perform following RSA that are not captured in the most commonly reported PROMs. This study highlights the need for continued research toward optimizing patients’ ability to perform activities that they want to do but are unable to after RSA.
Quantifying success after anatomic total shoulder arthroplasty: the substantial clinically important percentage of maximal possible improvement
2023, Journal of Shoulder and Elbow Surgery
Percentage maximal possible improvement (%MPI) has been described as a threshold by which to evaluate patient improvement after anatomic total shoulder arthroplasty (aTSA) that has favorable psychometric properties. The primary purpose of this study was to define the percentage maximal possible improvement (%MPI) thresholds associated with substantial clinical improvement following primary anatomic total shoulder arthroplasty (aTSA) and compare the rates of success as defined by those achieving the substantial clinical benefit (SCB) compared with the 30% MPI for different outcome scores.
A retrospective review was performed of an international shoulder arthroplasty database between 2003 and 2020. All primary aTSAs 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 calculate improvement. Six outcome scores were assessed: the Simple Shoulder Test (SST), Constant, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), University of California–Los Angeles shoulder score (UCLA), Shoulder Pain and Disability Index (SPADI), and Shoulder Arthroplasty Smart (SAS) scores. The proportion of patients achieving the SCB and 30% MPI were determined for each outcome score. Thresholds for the substantial clinically important %MPI (SCI-%MPI) were calculated using an anchor-based method for each outcome score and stratified by age and sex.
A total of 1593 shoulders with a mean follow-up of 59.3 months were included. Outcome scores with known ceiling effects (SST, ASES, UCLA) had higher rates of patients achieving the 30% MPI but not the previously reported SCB compared to scores without ceiling effects (Constant, SAS). The SCI-%MPI differed among outcome scores, and mean values were as follows: 48% for the SST, 39% for the Constant score, 53% for the ASES score, 55% for the UCLA score, 50% for the SPADI score, and 42% for the SAS score. The SCI-%MPI increased in patients older than 60 years (P ≤ .006 for all) and was greater in females for all scores assessed except the Constant score (P < .001 for all), meaning that patients with higher thresholds required a greater fraction of the maximum possible improvement for a given score to have substantial improvement.
The %MPI judged relative to patient-reported substantial clinical improvement offers a new method to assess improvements across patient outcome scores. Given considerable variation in the %MPI corresponding to substantial clinical improvement, we recommend utilizing score-specific estimates of the SCI-%MPI to gauge success when evaluating patients undergoing primary aTSA.
Factors associated with success of ream-and-run arthroplasty at a minimum of 5 years
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Ream-and-run arthroplasty offers improvements in shoulder pain and function for patients with primary glenohumeral arthritis who wish to avoid limitations associated with a polyethylene glenoid component. Longer-term clinical outcome assessments of the ream-and-run procedure are sparse in the literature. This study aimed to present minimum 5-year functional outcomes in a large cohort following ream-and-run arthroplasty to determine factors associated with clinical success and reoperation.
Patients who underwent ream-and-run surgery with a minimum of 5 years of follow-up were identified through a retrospective review of a prospectively maintained database from a single academic institution. To assess clinical outcomes, the Simple Shoulder Test (SST) was administered and assessed to determine achievement of the minimal clinically important difference, as well as the necessity for open revision surgery. Factors associated with P < .1 on univariate analysis were included in multivariate analysis.
Of 228 patients who consented to undergo long-term follow-up, 201 (88%) were included in our analysis (mean follow-up period, 7.6 ± 2.1 years). The average age was 59.4 ± 8.8 years, and 93% of patients were men. The majority of patients had a diagnosis of osteoarthritis (79%) or capsulorrhaphy arthropathy (10%). SST scores improved from a mean of 4.9 ± 2.5 preoperatively to a mean of 10.2 ± 2.6 at latest follow-up. The minimal clinically important difference in the SST score of 2.6 was reached by 165 patients (82%). Male sex (P = .020), nondiabetic status (P = .080), and lower preoperative SST score (P < .001) were included in a multivariate analysis. Male sex (P = .010) and lower preoperative SST score (P < .001) were associated with clinically important improvements in SST scores on multivariate analysis. Open revision surgery was required in 22 patients (11%). Younger age (P < .001), female sex (P = .055), and higher preoperative pain score (P = .023) were included in a multivariate analysis. Only younger age was predictive of open revision surgery (P = .003).
Ream-and-run arthroplasty can provide significant and clinically important improvements in clinical outcomes at minimum 5-year follow-up. Successful clinical outcomes were significantly associated with male sex and lower preoperative SST scores. Reoperation was more common in younger patients.

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: This study was approved by the Institutional Review Board of the University of Washington: No. 38897.

View full text

Basic ScienceIs the Simple Shoulder Test a valid outcome instrument for shoulder arthroplasty?

Background

Methods

Results

Conclusion

Section snippets

Study subjects

Construct validity

Content validity

Discussion

Conclusion

Disclaimer

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Osteoarthritis Cartilage

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Electromyogr Kinesiol

J Shoulder Elbow Surg

Arthritis Care Res (Hoboken)

Translation, cultural adaptation and validation of the simple shoulder test to Spanish

Orthop J Sports Med

Turkish version of the Simple Shoulder Test: a reliability and validity study

Fizyoter Rehabil

Do outcomes differ after rotator cuff repair for patients receiving workers' compensation?

Clin Orthop Relat Res

Measuring function of the shoulder: a cross-sectional comparison of five questionnaires

J Bone Joint Surg Am

Basic Science
Is the Simple Shoulder Test a valid outcome instrument for shoulder arthroplasty?