The patient acceptable symptom state (PASS) was developed to improve the subjective interpretation of patient reported outcomes (PROs) and the minimum score necessary for the patient to “feel good”. The purpose of this study was to compare individual responses on PROs between patients achieving or failing to meet a PASS after reverse shoulder arthroplasty (RSA).
A retrospective review of multi-center prospectively maintained database of RSAs between 2015 and 2018 was conducted. All primary RSAs with minimum 2 year follow-up were included. Patients undergoing revision arthroplasty or arthroplasty for fracture were excluded. Patients were stratified into two groups by whether they achieved or failed to meet PASS scores at a minimum of two years of 76 for the ASES score or 75.5 for the SANE score. The primary goals of the study were to compare outcomes, range of motion (ROM) and individual ASES and WOOS survey responses for patients above and below the PASS score.
87 patients were included. Using the ASES cutoff for PASS, 23% failed to meet a PASS while 45% failed to meet a PASS defined by the SANE. The most notable difference between patients above and below ASES PASS was a significant difference in VAS pain scores (3.1 vs 0.3; p < 0.001). Overall, ROM was similar between patients above and below the ASES PASS, with slight, but statistically improved rotational motion in those achieving an ASES PASS (ER 14 degrees improved, p = 0.005, IR 10 degrees improved, p = 0.011). Similarly, patients failing to meet the SANE PASS had twice as high VAS pain scores (1.9 vs 0.8; p = 0.017). Patients failing to meet the ASES PASS had almost universally statistically higher rates of reporting “very difficult” or “unable to do” for pain, ADL and work/sports questions on the ASES and globally more symptoms on every domain of questions for the WOOS. Similarly, for the PASS defined by SANE, patients reported higher levels of pain and dysfunction on nearly every question and domain of the ASES and WOOS.
At least one quarter of patients do not achieve a PASS after RSA. Pain appears to be the primary driver for this finding, while ROM is very similar between patients achieving or failing to meet a PASS regardless of PRO used to define the PASS. Patients who fail to achieve PASS after RSA report doing poorly in all domains of their outcome.