Summary

The ability to “map” or translate ASES and PROMIS scores to specific shoulder physical functions would be valuable. This would assist in evaluation of the clinical significance of changes in scores and could help in counseling patients in clinical practice.

Abstract

Introduction

The American Shoulder and Elbow Surgeons (ASES) score is a validated outcome score for a variety of shoulder conditions; the Patient-Reported Outcomes Measurement Information System (PROMIS) score has also been investigated as a valid outcome measure for shoulder conditions. The ability to “map” or translate ASES and PROMIS scores to specific shoulder physical functions would be valuable. This would assist in evaluation of the clinical significance of changes in scores and could help in counseling patients in clinical practice. We sought to to map specific physical functions of the shoulder to ASES and PROMIS scores.

Methods

PROMIS and ASES scores are routinely collected as part of practice at our institution. 3500 completed ASES forms were available for review. 2900 simultaneously collected PROMIS PF (physical function) and 2850 simultaneously collected PROMIS PI (pain interference) scores were also available. The ASES specifically asks about physical functions: putting on a coat, sleeping on the affected side, washing one’s back/doing up bra, managing toileting, combing hair, reaching a high shelf, lifting 10 pounds and throwing a ball. Responses are stratified into unable to do, very difficult to do, somewhat difficult and not difficult. For our investigation, responses were grouped into two categories, a low function response (unable or very difficult) and a high function response (somewhat difficult or not difficult). Receiver operating characteristic (ROC) curves were calculated to determine 90% positive predictive value (PPV) and 90% negative predictive value (NPV) cutoffs for the presence of a high ability to perform a function for ASES, PROMIS PF and PROMIS PI scores. This model was chosen to increase the clinical applicability of the results; for example, the ASES PPV cutoff score for reaching a high shelf would be the score above which at least 90% of people answered “yes” to having high function in reaching a high shelf.

Results

For the ASES, 90% NPV and PPV cutoff scores were 0-7 for toileting, 8-25 for combing one’s hair, 11-31 for putting on a coat, 43-68 for reaching a high shelf, 41-78 for washing one’s back, 41-78 for sleeping on the affected side, 57-84 for lifting 10 pounds and 54-85 for throwing a ball. For example, at least 90% of people would be expected to have high function in reaching for a high shelf if their ASES score was greater than 68, while 90% of people would be expected to not have high fuction (and thus have low function) in reaching for a high shelf if their ASES score was less than 43. For the PROMIS PF, 90% NPV and PPV cutoff scores were x-20 for toileting, x-34 for combing one’s hair, x-37 for putting on a coat, 34-56 for reaching a high shelf, 33-x for washing one’s back, 29-x for sleeping on the affected side, 40-x for lifting 10 pounds and 40-x for throwing a ball (x values were unable to be calculated). For the PROMIS PI, 90% NPV and PPV cutoff scores were x-80 for toileting, x-67 for combing one’s hair, x-65 for putting on a coat, 68-48 for reaching a high shelf, 67-x for washing one’s back, 67-46 for sleeping on the affected side, 63-x for lifting 10 pounds and 63-x for throwing a ball.

Conclusion

Physical function “maps” were created for ASES, PROMIS PF and PROMIS PI scores. There was a greater ability to relate ASES scores than PROMIS scores to specific shoulder physical functions. Based upon this information and the expanding literature based upon patient-reported outcomes, a clinician may be better able answer the question, “Will I be able to reach a shelf after surgery?”