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Computerized branching logic systems significantly improve the accuracy of ASES scores for patients with bilateral
Maria Bozoghlian1, Joseph Galvin1, Edward Rojas1
1Departments of Orthopedics & Rehabilitation, The University of Iowa, Iowa City, IA, USA.
Introduction:
The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score is widely used to determine functional outcome following shoulder arthroplasty. There is, however, limited guidance on efficient and accurate collection methods of the ASES score for patients with bilateral shoulder pathology. We developed a branching logic system to improve ASES score collection accuracy. The purpose of this study was to analyze ASES scores for patients who had undergone shoulder arthroplasty and subsequently presented with contralateral shoulder pain within 1 year after surgery, before and after the implementation of a branching logic system.
Methods:
A retrospective review was performed of patients undergoing primary shoulder arthroplasty with a minimum 1-year post-operative follow-up. The cohort was divided into pre- and post-branching logic groups: group A, patients in the pre-branching logic group who subsequently presented with contralateral shoulder pain; group B, patients in the post-branching logic group who subsequently presented with contralateral shoulder pain; group C, patients in the pre-branching logic group who did not present with contralateral shoulder pain post-operatively. ASES scores, visual analog scale (VAS) pain scores, and range of motion were collected at 6 weeks, 3 and 6 months, and 1 year post-operatively.
Results:
A total of 188 patients were included. There were 27 patients in group A, 29 in group B, and 132 in group C. In group A, without any known complications, the mean reported ASES score decreased significantly from 64 at 6 months to 37.2 at 1 year (P = .0007). The mean VAS pain score at 6 months was 3 and increased to 7 at 1 year post-operatively (P < .0001). Conversely, in group B, the mean post-operative ASES score improved during the entire post-operative course, reaching a maximum of 84 by 1 year, whereas the mean VAS pain score decreased at each post-operative time point. Group A showed significantly lower ASES scores at 6 months (P = .01) and 1 year (P < .01) when compared to group B. Patients in group C demonstrated a similar trend in ASES and pain scores as compared to group B, with improvements in both scores at each post-operative time point.
Conclusion:
Branching logic significantly improved the ability to obtain accurate ASES scores for shoulder arthroplasty patients, both from the operated shoulder and the newly symptomatic contralateral shoulder. Implementation of a branching logic system decreases question burden while allowing for accurate collection of ASES and pain scores for patients undergoing shoulder arthroplasty.
