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Total shoulder arthroplasty outcomes may be predicted by preoperative PROMIS scores
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Results showed postoperative achievement of a minimal clinically important difference may be predicted by preoperative Patient-Reported Outcomes Measurement Information System physical function, depression and pain interference scores in patients undergoing total shoulder arthroplasty.
Ilya Voloshin, MD, and colleagues reviewed preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores among 62 patients who underwent primary total shoulder arthroplasty and compared PROMIS physical function, pain interference and depression scores. Researchers also collected preoperative and postoperative shoulder forward flexion and external rotation. Researchers determined whether preoperative PROMIS scores from each domain could predict postoperative achievement of the minimal clinically important difference (MCID) in the same domain using accuracy analyses.
Results showed PROMIS physical function, pain interference and depression scores had significant improvements postoperatively. Researchers also noted significant postoperative improvements with forward flexion and external rotation. Postoperative achievement of the MCID was predicted by preoperative PROMIS physical function, pain interference and depression, as demonstrated by a multivariate model. Researchers found patients were more likely to achieve the MCID if they had a preoperative physical function score lower than 31.7, a pain interference score greater than 66.9 and a depression score greater than 55.5.
“This study demonstrated that generalizable [patient-reported outcomes] PROs, like PROMIS physical function (PF) correlated with range of motion of the shoulder after total shoulder arthroplasty (TSA). The study also showed that preoperative PROMIS PF, PROMIS pain interference and PROMIS depression correlated with achieving minimal clinically important difference after TSA,” Voloshin told Healio.com/Orthopedics. “The findings of this study can assist clinicians in counseling their patients in their decision-making process prior to TSA and help them set more realistic expectations regarding postoperative outcome.” – by Casey Tingle
Disclosures: Voloshin reports he receives consultation fees from Arthrex, Zimmer Biomet, Arthrosurface and Smith & Nephew, and received royalties from Innomed and Smith & Nephew. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Nady Hamid , MD
In the current and future health care climate, emphasis on the patient’s perspective of “success” is of utmost importance. The PROMIS can quantify a patient’s level of health and allow for comparison before and after a surgical procedure — and this change in patients’ perceptions of their health is a major determinant if a surgery if felt to be “successful.”
This study specifically investigated the ability of preoperative PROMIS scores to predict postoperative PROMIS scores in patients undergoing shoulder arthroplasty. This investigation found, not surprisingly, that a clinician can predict postoperative PROMIS scores based on a patient’s preoperative level of health. This can allow for more informed and meaningful preoperative discussions with patients with a particular focus on realistic patient expectations regarding improvement after surgery. As health care continues to emphasize quality and value, this information can also allow payers and other stakeholders in the health care system to determine if a patient has had a “successful” procedure.
OrthoCarolina
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