Abstract
PurposeReverse total shoulder arthroplasty (rTSA) is effective and increasingly utilized for the management of proximal humerus fracture (PHF). However, the optimal patient-reported outcome metrics (PROMs) for the evaluation of patient outcomes after this surgery are unclear. We investigated the correlation among global, upper extremity-specific, and shoulder-specific PROMs in patients undergoing rTSA for PHF as well as the responsiveness of these PROMs as assessed by floor and ceiling effects. We hypothesized that patients’ post-operative outcome would be best reflected by a combination of these metrics.MethodsThirty patients with a history of rTSA for ipsilateral PHF filled out the following outcomes questionnaires at a minimum of 3 years post-op: EQ-5D, EQ-5D VAS, PROMIS physical function, DASH, SSV, SPADI, and ASES. Correlation between metrics was assessed using the Spearman correlation coefficient. Responsiveness was assessed by comparing the proportion of patients reaching floor or ceiling values using McNemar’s test.ResultsGlobal health metrics (EQ-5D and PROMIS physical function) were strongly correlated with the upper extremity-specific metric (DASH). Shoulder-specific outcomes (SPADI, ASES, and ASES) were moderately correlated with both the global metrics and DASH. There was no significant difference between PROMs with regards to floor and ceiling effects.ConclusionsThe DASH score has been shown to be valid and responsive for shoulder interventions, and our data demonstrate that it correlates strongly with overall quality of life. Shoulder-specific metrics are valid and responsive for shoulder interventions but correlate less with global quality of life. An optimal PROM strategy in rTSA for PHF might involve both DASH and a shoulder-specific score. Based on our assessment of floor and ceiling effects, none of these metrics should be excluded for poor responsiveness.
Highlights
Fractures of the proximal humerus account for nearly 6 % of fractures in the adult population and the frequency of this injury is expected to increase with aging of the US population [1]
There was no significant difference between Patient-reported outcome metrics (PROMs) with regards to floor and ceiling effects
Based on our assessment of floor and ceiling effects, none of these metrics should be excluded for poor responsiveness
Summary
Fractures of the proximal humerus account for nearly 6 % of fractures in the adult population and the frequency of this injury is expected to increase with aging of the US population [1]. Patient-reported outcome metrics (PROMs) attempt to capture the biopsychosocial impact of disease on patients’ lives [15] and are becoming more important than ever in orthopaedic surgery with the shift in healthcare from fee-for-service to value-based care [16]. They allow the patient’s subjective experience of their injury and its treatment to be formally assessed, in addition to traditional objective and clinicianreported measures, which tend to underestimate patient symptoms and functional limitations [17, 18]. Understanding associations between global health, upper extremityspecific, and shoulder-specific outcomes after rTSA for fracture will help surgeons to better measure the results of this treatment on patients’ lives
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