The Ability of Upper Extremity Surgeons to Assess Patient's Functional Status

Area of Science:

• Orthopedic Surgery
• Patient-Reported Outcomes
• Musculoskeletal Health

Background:

• Accurate assessment of patient functional status is crucial for effective orthopedic care.
• Discrepancies between surgeon and patient perceptions can impact treatment decisions and outcomes.
• Patient-Reported Outcome Measures (PROMs) offer a standardized way to capture patient experiences.

Purpose of the Study:

• To compare surgeon and patient assessments of upper extremity functional status.
• To evaluate agreement on pain scores, functional status, and self-efficacy.
• To test the hypothesis of low agreement between surgeon and patient evaluations.

Main Methods:

• 143 new upper extremity patients were evaluated by fellowship-trained surgeons.
• Patients completed validated PROMs: Numeric Pain Rating Scale, PROMIS Upper Extremity (UE), Pain Interference (PI), and Self-Efficacy (SE).
• Surgeons estimated patient scores on these instruments, blinded to patient results; estimation errors were calculated.

Main Results:

• Surgeons overestimated PROMIS UE and SE scores and underestimated PROMIS PI scores compared to patient reports.
• Mean estimation errors across all PROMIS instruments exceeded 10 points.
• These errors were larger than the standard deviation for these measures in the general population.

Conclusions:

• Upper extremity surgeons exhibit significant difficulty in assessing patient-reported functional status, pain interference, and self-efficacy during initial consultations.
• Increased utilization of formalized PROMs can enhance baseline functional assessments.
• Surgeons should acknowledge the limitations of their subjective assessments when evaluating new patients.