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Usage Trends of Patient-reported Outcome Measures in Shoulder Literature
Zachary A Mosher1, Michael A Ewing, Christine S Collins
1From the Department of Orthopaedic Surgery, University of Alabama at Birmingham, School of Medicine, Birmingham, AL (Dr. Mosher, Dr. Ewing, Ms. Collins, Dr. Brabston, Dr. Momaya, and Dr. Ponce), the Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN (Dr. Mosher), the Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO (Dr. Ewing), the University of South Alabama College of Medicine, Mobile, AL (Mr. Young), and the Department of Orthopaedic Surgery, University of Utah, School of Medicine, Salt Lake City, UT (Dr. Tashjian).
Introduction:
Quantifying patient outcomes is integral in orthopaedic practice, and patient-reported outcome measures (PROMs) assist with this goal and assist clinicians in assessing subjective outcomes (pain, satisfaction, etc.). This study seeks to identify the most highly used PROMs in the shoulder literature and analyze their usage trends.
Methods:
PubMed was queried for all shoulder-based articles published in eight selected journals from 2007 to 2017. Articles were assessed for PROM usage, surgical approach, surgical procedure, and disease pathology. Frequency analyses identified the most used PROMs overall, and for each approach, procedure, and pathology. Last, usage trends, question number, validation, and clinician dependence of PROMs with ≥20 uses were analyzed.
Results:
In total, 1,740 of 2,462 articles (71%) used 105 unique PROMs 4,394 times during the study. PROM usage increased 18%, and the use of multiple PROMs increased by 20%. PROMs with a clinician component increased 21% slower than the baseline. Twenty-two PROMs (17%) had >20 uses, with the most used PROMs being the Constant-Murley Score (783), American Shoulder and Elbow Surgeons Shoulder Score (731), Visual Analog Scale (685), Simple Shoulder Test (372), and the University of California, Los Angeles, Shoulder Rating Scale (274). PROMs demonstrating the greatest usage increase were the EuroQol 5-Dimensions Questionnaire (1,282%), Shoulder Pain and Disability Index (638%), Western Ontario Rotator Cuff Index (632%), Western Ontario Osteoarthritis of the Shoulder Index (582%), and Oxford Shoulder Score (462%)-all without a clinician component.
Discussion:
PROM usage is increasing, often with multiple PROMs being used to evaluate patient outcomes. PROMs without a clinician component are growing at higher rates than their clinician-dependent counterparts, highlighting an emphasis on patient reporting of outcomes. This study suggests that the American Shoulder and Elbow Surgeons Shoulder Score, Oxford Shoulder Score, Visual Analog Scales-all without a mandatory clinician component and high levels of use-will be the most highly used PROMs moving forward to assess shoulder function.
