Abstract
BackgroundTo assess responsiveness of five outcome measures at four different follow-ups in patients with SLAP II lesions of the shoulder.Methods119 patients with symptoms and signs, MRI arthrography and arthroscopic findings were included. The Western Ontario Shoulder Instability Index (WOSI), Oxford Instability Shoulder Score (OISS), EuroQol (EQ-5D3L), Rowe Score and Constant-Murley Score (CMS) were assessed at baseline, 3, 6, 12 and 24 months. The analysis contains both anchor-based and distribution-based methods, and hypothesis testing.ResultsConfidence intervals for ROC cut-off values, representing MID, for OISS, CMS and EQ-5D3L crossed zero at 3 months. Cut-off values were stable between 6- and 24-months follow-up. At 24-months ROC cut-off values (95% CI) were: Rowe 18 (13 to 24); WOSI 331 (289 to 442); OISS 9 (5 to 14); CMS 11 (9 to 15) and EQ-5D3L 0.123 (0.035 to 0.222). MID95%limit estimates were substantially higher than ROC cut-off values and MIDMEAN at all follow-ups for all instruments. The reliable change proportion (RCP) values in the improved group were highest for WOSI and the Rowe Score (ranging from 68 to 87%) and significantly lower for CMS. EQ-5D3L had the lowest values (13 to 16%). We found a moderate correlation between mean change scores of the outcome measures and the anchor, except for the EQ-5D3L.ConclusionsIn patients with SLAP II-lesions the patient reported OISS and WOSI and the clinical Rowe score had best responsiveness. Our results suggest that 3 months follow-up is too early for outcome evaluation.
Highlights
To assess responsiveness of five outcome measures at four different follow-ups in patients with SLAP II lesions of the shoulder
The aim of the present study was to compare the responsiveness of these five different outcome measures at four different follow-ups (3, 6, 12 and 24 months) in patients with SLAP II lesions using both anchor- and distribution-based methods
The Constant-Murley Score (CMS) was significantly higher than EQ-5D3L at 12- and 24-months follow-up
Summary
To assess responsiveness of five outcome measures at four different follow-ups in patients with SLAP II lesions of the shoulder. Patient reported outcome measures (PROMS) are recommended for evaluation of treatment effects in patients with shoulder disorders. The patient perspective has been considered increasingly important [1] and shoulder specific and generic health related quality of life outcome measures may replace clinical scores [2]. Generic quality of life questionnaires, like the EuroQol (EQ-5D3L), are often applied as an utility index in cost effectiveness studies [6], despite the fact that its reliability and usefulness in shoulder patients have been questioned [7]. While a possible advantage of questionnaires is that they may be answered online to save time and costs of consultations and travel, the clinical scores provide additional information about range of motion, muscle strength and stability that may be important for the clinician and the patient. Observations are prone to blinding and inter- and intra-rater measurement error
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