2015 ISAKOS Biennial Congress ePoster #2419

Correlation of Promis Physical Function Cat with Constant Shoulder, Ases and Reaching Task Kinematic Analysis in Patients Who Have Undergone Rotator Cuff Repair Surgery

Mark O. Papuga, PhD, Seneca Falls, NY UNITED STATES
Karen Meess, BS, Rochester, NY UNITED STATES
Brian Giordano, MD, Rochester, NY UNITED STATES
John Elfar, MD, Rochester, NY UNITED STATES
Ilya Voloshin, MD, Rochester, NY UNITED STATES
Stephen Kates, MD, Rochester, NY UNITED STATES
Ralf Thiele, MD, Rochester, NY UNITED STATES
Edward Schwarz, PhD, Rochester, NY UNITED STATES
Michael D. Maloney, MD, Rochester, NY UNITED STATES

University of Rochester Medical Center, Rochester, NY, USA

FDA Status Not Applicable

Summary: PROMIS upper extremity function CAT and kinematic analysis of reach are high throughput outcome measures that show correlation with CSS and ASES




Surgical treatment of rotator cuff tear results in impaired healing in 20-50% of cases suggesting an incomplete understanding of the tendon-bone healing process post operatively for the supraspinatus tendon regardless of the surgical technique used (1). High throughput outcome measures are needed for clinical practice, both creating a low subject burden that can be easily administered during the routine post-operative examinations. We propose the Patient-Reported Outcomes Measurement Information System (PROMIS), and a simple reaching task to correlate patient reported clinical outcomes with objective kinematic results. Methods: IRB approved protocols were used to assess 32 (22 males, 10 females) skeletally mature patients 58.3 ±8.86 (mean ±SD) years who were scheduled to undergo rotator cuff repair surgery. All measurements were collected at a routine pre-surgical clinical visit and post-operatively at 1 month, 3 months, and 4-6 months after surgery. The Constant Shoulder Score (CSS) and the American Shoulder and Elbow Surgeons (ASES) assessments were used as “gold standard” comparisons for patient reported and clinician reported shoulder outcomes. The quantitative kinematic measures of physical function during an overhead reaching task were collected via Microsoft Kinect™ and custom software. The reaching task involved lifting a 2lb weight from a shelf at approximately hip height onto the “highest reachable shelf”. Results: Baseline evaluation of the enrolled cohort (n=32) revealed impaired function with CSS=42.4 ±18.6; ASES = 48.5 ±19.9; PROMIS 30.1 ±6.5 (mean ±SD). Longitudinal patient and clinician reported outcomes data showed decreased function associated with surgical recovery at 1 month, with marked improvement above baseline at 3 months and with scores of CSS=64.74±19.2; ASES = 81.5 ±21.7; PROMIS 45.6 ±10.9 at 4-6 months for each of the questionnaires. Correlation between PROMIS scores and CSS and ASES scores resulted R2 values of .671 and .653 respectively. Kinematic analysis illustrates functional differences between the injured and uninjured limb at baseline in reach distance (.83m vs .96m), reach speed(.58m/s vs .63m/s), and shoulder elevation angle (115deg vs 138deg) . Significant increases (p<0.01)over baseline are seen in both reach distance and shoulder elevation at 3 months for the repaired shoulder. At 4- 6 months, reach distance(.97m), reach speed (.65m/s) and maximum shoulder elevation angle(137deg) all significantly increased (p<0.01) compared to baseline. No significant changes were found for elbow extension angle. Discussion: High throughput physical function outcome measures in clinical practice offer the ability to inform and improve patient care through enhanced insight into the recovery process. Here we have shown PROMIS and a functional reach task can be a low burden means by which to evaluate the utility of such surgical techniques and/or adjuvant healing therapies during routine clinical visits. Acknowledgements: This work was supported by research grants from the National Institutes of Health (P30 AR061307 and P50 AR054041). We would also like to thank Kaili Pecorella, Meghan Lissow, and Scott Roides for the effort they gave in technical support of this research. References: (1) Jost B, et al. 2006, J Bone Joint Surg Am 88:472. (2) Fealy S et al. 2006, Am J Sports Med 34:120-127.