American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and responsiveness

doi:10.1067/mse.2002.127096

Journal of Shoulder and Elbow Surgery

Volume 11, Issue 6, November–December 2002, Pages 587-594

https://doi.org/10.1067/mse.2002.127096 Get rights and content

Abstract

The purpose of this study was to examine the psychometric properties of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), patient self-report section. Patients with shoulder dysfunction (n = 63) completed the ASES, The University of Pennsylvania Shoulder Score, and the Short Form–36 during the initial evaluation, 24 to 72 hours after the initial visit, and after 3 to 4 weeks of physical therapy. The test-retest reliability (intraclass correlation coefficient[1-way random-effects], 0.84; 95% CI lower limit, 0.75) and internal consistency (Cronbach α, 0.86) values were acceptable. The standard error of the measure was 6.7 ASES points (90% CI, 11.0). Construct and discriminant validity was demonstrated. Responsiveness was demonstrated with a standardized response mean of 1.5 and an effect size of 1.4. The minimal detectable change was 9.7 ASES points (90% CI, 16), and the minimal clinically important difference was 6.4 ASES points. The results indicate that the ASES is a reliable, valid, and responsive outcome tool. (J Shoulder Elbow Surg 2002;11:587-94)

Section snippets

Materials and methods

The patient self-report section of the ASES is a condition-specific scale—that is, it is designed for a specific condition, which is intended to measure functional limitations and pain of the shoulder. The original ASES²¹ consists of 2 portions, a medical professional assessment section and a patient self-report section. The patient self-report section, evaluated in this study, is a patient self-evaluation questionnaire that takes approximately 5 minutes to complete and consists of 2

Reliability

Test-retest reliability was calculated with the use of 1-way ICCs, the results of which are shown in Table III.The internal consistency estimate of Cronbach α was.86.¹⁹

Error estimates

The error associated with a single application (SEM) and multiple applications (MDC/SRD) of the patient self-report section of the ASES was calculated; the results are shown in Table III.

Validity

The correlations (95% CI) for the assessment of convergent validity were significant betweenthe patient self-report section of the ASES and the

Discussion

In the present health care climate, there is an ever-increasing demand to demonstrate the efficacy of therapeutic interventions. Because of this need self-report instruments have been developed to assess the impact of a disease on a patient's functional limitations and disability. However, in order for an outcome measure to be interpreted and used, these instruments must have documented psychometric properties.

To assess reliability, the patient self-report section of the ASES was administered 1

Acknowledgements

We would like to express our sincere appreciation to the clinicians from the following clinics who participated in the data collection process, because without their assistance this project could not have been completed: Penn Therapy and Fitness, University of Pennsylvania Health Systems, Philadelphia, Pa; LifeCare Medical Center, Glassboro, NJ; Rehabilitation and Fitness Services, Philadelphia, Pa; NovaCare, Inc, Cinnamenson, NJ; Healthsouth, Philadelphia and Levittown, Pa; Temple Sports

References (26)

D Beaton et al.
Assessing the reliability and responsiveness of 5 shoulder questionnaires
J Shoulder Elbow Surg
(1998)
RA Deyo et al.
Assessing the responsiveness of functional scales to clinical change: an analogy to diagnostic test performance
J Chronic Dis
(1986)
GH Guyatt et al.
Measuring health status: what are the necessary measurement properties?
J Clin Epidemiol
(1992)
GH Guyatt et al.
Measuring change over time: assessing the usefulness of evaluative instruments
J Chronic Dis
(1987)
R Jaeschke et al.
Measurement of health status. Ascertaining the minimal clinically important difference
Control Clin Trials
(1989)
GR Norman et al.
Methodological problems in the retrospective computation of responsiveness to change: the lesson of Cronbach
J Clin Epidemiol
(1997)
G Stucki et al.
Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis
J Clin Epidemiol
(1995)
DE Beaton
Understanding the relevance of measured change through studies of responsiveness
Spine
(2000)
DE Beaton et al.
Measuring function of the shoulder. A cross-sectional comparison of five questionnaires
J Bone Joint Surg Am
(1996)
JM Fritz et al.
A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale
Phys Ther
(2001)

GH Guyatt et al.

Measuring health-related quality of life

Ann Intern Med

(1993)

SL Heald et al.

The shoulder pain and disability index: the construct validity and responsiveness of a region-specific disability measure

Phys Ther

(1997)

ME Kantz et al.

Methods for assessing condition-specific and generic functional status outcomes after total knee replacement

Med Care

(1992)

Cited by (823)

Clinical and Radiologic Outcomes of Arthroscopic Rotator Cuff Repair in Medial Bursal-Side Fosbury Flop Tears Compared With Tendinous Avulsion Lesions
2024, Arthroscopy, Sports Medicine, and Rehabilitation
To determine the clinical and radiologic outcomes after surgical repair of medial bursal-side Fosbury flop rotator cuff tears compared with traditional avulsion of tendinous attachments lesions.
A retrospective cohort study was performed. All patients who had undergone arthroscopic posterosuperior repair were recruited. Patients with previous shoulder rotator cuff surgery were excluded. Recruited patients were divided into 2 groups: one presenting Fosbury flop tears and the other presenting with standard avulsion lesions. Preoperative demographics such as age, gender, and arm dominance were recorded. Range of motion (ROM), visual analog scale (VAS) for pain and satisfaction, Constant score, Single Alpha-Numeric Evaluation score, and American Shoulder and Elbow Surgeons score were evaluated at 3 points in time: preoperatively, and at 6 months and minimum 1-year postoperatively. The healing of repaired cuffs was evaluated by ultrasound at 6 months.
Two hundred thirty-six patients were recruited, with 27 (11.4%) Fosbury flop tears and 209 (88.6%) tendon avulsions. Although there was no significant difference in gender or arm dominance between the groups, Fosbury flop tears had significantly older patients (P < .05) with a mean age 61.6 years (standard deviation 9.0), compared with tendon avulsions with a mean age of 56.1 years (standard deviation 9.1). There was no significant difference in tendon retraction between the groups. Both groups demonstrated significant improvement in ROM, visual analog scale, American Shoulder and Elbow Surgeons, Single Alpha-Numeric Evaluation, and Constant score postoperatively at 6 months and minimum 1 year. The groups demonstrated no significant difference in the ROM and clinical scores. There was a nonsignificant difference in re-tear rate of 7.4% (2/27) in Fosbury flop tears compared with 2.8% (6/209) in tendon avulsions (P = .361).
Arthroscopic rotator cuff repair of medial bursal side Fosbury Flop rotator cuff tears results in favorable clinical and radiologic outcomes at 4 years after surgery. These outcomes are comparable with surgically repaired avulsion lesions, with an acceptable retear rate after arthroscopic repair.
Level III, retrospective comparative prognostic trial.
Full arthroscopic vs. arthroscopically assisted posterosuperior latissimus dorsi tendon transfer for shoulders with failed and irreparable rotator cuff repair: matched case-control study
2024, Journal of Shoulder and Elbow Surgery
To compare clinical outcomes and complication rates of full arthroscopic latissimus dorsi tendon transfer (LDTT) vs. arthroscopically assisted LDTT, for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs) in shoulders that had failed rotator cuff repair (RCR).
We evaluated a continuous series of 191 patients who underwent LDTT over 4 consecutive years. A total of 107 patients did not have previous shoulder surgery, leaving 84 patients who had prior surgical procedures. All procedures performed over the first 2 years were arthroscopically assisted (n = 48), whereas all procedures performed over the last 2 years were full arthroscopic (n = 36). We noted all complications, as well as clinical scores and range of motion at ≥24 months. To enable direct comparison between the 2 techniques, propensity score matching was used to obtain 2 groups with equivalent age, sex, and follow-up.
Compared with the 48 patients who underwent arthroscopically assisted LDTT, the 36 patients who underwent full arthroscopic LDTT had comparable complications (13% vs. 11%) and conversions to RSA (8.3% vs. 5.6%). Propensity score matching resulted in 2 groups, each comprising 31 patients, which had similar outcomes in terms of clinical scores (except mobility component of Constant score, which was better following fully arthroscopic LDTT; P = .037) and range of motion at a minimum follow-up of 2 years.
At a minimum follow-up of 24 months, for the treatment of irreparable posterosuperior mRCTs in shoulders that had surgical antecedents, full arthroscopic LDTT had significantly better mobility component of the Constant score than arthroscopically assisted LDTT, although there were no significant differences in the other clinical or functional outcomes. Arthroscopically assisted LDTT and full arthroscopic LDTT had comparable rates of complications (8.3% vs. 13%) and conversion to RSA (5.6% vs. 8.3%).
Does glenoid version affect the post-operative clinical outcome after repair of posterior labral tear: A retrospective study
2024, Journal of Orthopaedics
Posterior shoulder instability and consequent labral tear have been predominantly associated with retroversion of the bony glenoid and chondrolabral version. However, literature concerning the degree of glenoid and chondrolabral version and clinical outcomes following labral repair is scarce.
A retrospective cohort study was undertaken among patients with posterior shoulder instability who had undergone arthroscopic isolated posterior labral repair. The MRI was used to assess the bony and labral variations of the glenoid using the Friedman method and further categorized as either anteverted or retroverted glenoid. American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score (OSS), and Single Assessment Numeric Evaluation (SANE) scores were used to evaluate pre- and postoperative clinical outcomes at a minimum follow-up of one year.
33 shoulder MRIs performed at our institution were available for radiographic analysis. Among the 33 shoulders that underwent posterior shoulder capsulolabral repair, 23 were available for clinical follow-up for at least one year (range, 12–108 months). The mean (±SD) labral version and bony version were −3.98 (±5.68) and −2.83 (±5.20), respectively. The mean (±SD) postoperative ASES, Oxford score, and SANE scores for all participants were 84.04 (±14.14), 43.38 (±3.81), and 78.57 (±17.40), respectively. However, the difference in clinical outcomes in patients with anteverted or retroverted glenoid versions was not statistically significant.
Our study concludes a strong correlation between posterior glenohumeral instability and higher degree of glenoid retroversion. Nevertheless, variations in the glenoid version appear to have no significant impact on clinical outcomes.
Level IV, retrospective cohort.
Quantifying success after first revision reverse total shoulder arthroplasty: the minimal and substantial clinically important percentage of maximal possible improvement
2024, Journal of Shoulder and Elbow Surgery
When patients require reoperation after primary shoulder arthroplasty, revision reverse total shoulder arthroplasty (rTSA) is most commonly performed. However, defining clinically important improvement in these patients is challenging because benchmarks have not been previously defined. Furthermore, although the minimal clinically important difference and substantial clinical benefit are commonly used to assess clinically relevant success, these metrics are limited by ceiling effects that may cause inaccurate estimates of patient success. Our purpose was to define the minimal and substantial clinically important percentage of maximal possible improvement (MCI-%MPI and SCI-%MPI) for commonly used pain and functional outcome scores after revision rTSA and to quantify the proportion of patients achieving clinically relevant success.
This retrospective cohort study used a prospectively collected single-institution database of patients who underwent first revision rTSA between August 2015 and December 2019. Patients with a diagnosis of periprosthetic fracture or infection were excluded. Outcome scores included the American Shoulder and Elbow Surgeons (ASES), raw and normalized Constant, Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), and University of California, Los Angeles (UCLA) scores. We used an anchor-based method to calculate the MCI-%MPI and SCI-%MPI. In addition, we calculated the MCI-%MPI using a distribution-based method for historical comparison. The proportions of patients achieving each threshold were assessed. The influence of sex, type of primary shoulder arthroplasty, and reason for revision rTSA were also assessed by calculating cohort-specific thresholds.
Ninety-three revision rTSAs with minimum 2-year follow-up were evaluated. The mean age of the patients was 67 years; 56% were female, and the average follow-up was 54 months. Revision rTSA was performed most commonly for failed anatomic TSA (n = 47), followed by hemiarthroplasty (n = 21), rTSA (n = 15), and humeral head resurfacing (n = 10). The indication for revision rTSA was most commonly glenoid loosening (n = 24), followed by rotator cuff failure (n = 23) and subluxation and unexplained pain (n = 11 for both). The anchor-based MCI-%MPI thresholds (% of patients achieving) were ASES = 33% (49%), raw Constant = 23% (64%), normalized Constant = 30% (61%), UCLA = 51% (53%), SST = 26% (68%), and SPADI = 29% (58%). The anchor-based SCI-%MPI thresholds (% of patients achieving) were ASES = 55% (31%), raw Constant = 41% (27%), normalized Constant = 52% (22%), UCLA = 66% (37%), SST = 74% (25%), and SPADI = 49% (34%).
This study is the first to establish thresholds for the MCI-%MPI and SCI-%MPI at minimum 2 years after revision rTSA, providing physicians an evidence-based method to assess patient outcomes postoperatively.
Improved joint function when reaching behind the back is associated with patient reported outcomes in individuals with rotator cuff tears following exercise therapy
2024, Clinical Biomechanics
Reaching behind the back is painful for individuals with rotator cuff tears. The objectives of the study were to determine changes in glenohumeral kinematics when reaching behind the back, passive range of motion (RoM), patient reported outcomes and the relationships between kinematics and patient reported outcomes following exercise therapy.
Eighty-four individuals with symptomatic isolated supraspinatus tears were recruited for this prospective observational study. Glenohumeral kinematics were measured using biplane radiography during a reaching behind the back movement. Passive glenohumeral internal rotation and patient reported outcome measures were collected. Depending on data normality, appropriate tests were utilized to determine changes in variables. Spearman's correlations were utilized for associations, and Stuart-Maxwell tests for changes in distributions.
Maximum active glenohumeral internal rotation increased by 3.2° (P = 0.001), contact path length decreased by 5.5% glenoid size (P = 0.022), passive glenohumeral internal rotation RoM increased by 4.9° (P = 0.001), and Western Ontario Rotator Cuff Index and American Shoulder and Elbow Surgeons scores increased by 29.8 and 21.1 (P = 0.001), respectively. Changes in Western Ontario Rotator Cuff Index scores positively associated with changes in maximum active glenohumeral internal rotation and negatively associated with changes in contact path lengths (P = 0.008 and P = 0.006, respectively).
The reaching behind the back movement was useful in elucidating in-vivo mechanistic changes associated with patient reported outcomes. Glenohumeral joint function and patient reported outcomes improved, where changes in Western Ontario Rotator Cuff Index scores were associated with kinematics. These findings inform clinicians of functional changes following exercise therapy and new targetable treatment factors.
Patients With Intact Shoulder Superior Capsular Reconstruction Grafts on Ultrasound Show Significant Improvement in Functional Outcomes at Minimum 2-Year Follow-up
2024, Arthroscopy, Sports Medicine, and Rehabilitation
To assess the utility of using dynamic ultrasound for postoperative evaluation after superior capsular reconstruction (SCR) by evaluating graft integrity and its correlation with clinical outcomes at a minimum 2-year follow-up.
A retrospective chart review was conducted to identify patients who underwent SCR between July 2015 and July 2020 with a minimum 2-year clinical and ultrasound follow-up. Clinical outcome measures included Simple Shoulder (SS) and American Shoulder and Elbow Surgeon (ASES) scores. Integrity of the SCR graft was evaluated by dynamic ultrasound.
We evaluated 22 shoulders in 21 patients with a mean follow-up of 44.8 months (range, 24-71 months). The graft was found to be intact by ultrasound evaluation in 82% (18/22). Patients with intact grafts had higher mean SS (11.6 vs 7.8, P = .00079) and ASES (91.2 vs 64.1, P = .0296) scores at latest follow-up compared to those with failed grafts. Those with intact grafts also had significant improvement in SS (3.7 vs 11.6, P < .00001) and ASES (23.2 vs 91.2, P < .00001) scores at latest follow-up compared to their preoperative scores. In contrast, patients with graft failure had no significant improvement in SS (6.3 vs 9.0, P = .123) and ASES (40.4 vs 58.3, P = .05469) scores at latest follow-up compared to their preoperative scores. There was no difference between clinical outcomes at 6 to 12 months vs latest follow-up for both SS (P = .11, P = .5) and ASES (P = .27, P = .21) scores.
SCR grafts were found by ultrasound to be intact in 82% of cases. Patients with intact grafts on ultrasound had significant improvement in functional outcome scores while those with graft failure did not. Functional outcome scores suggest that maximal recovery from this procedure occurs by 6 to 12 months.
Level IV, therapeutic case series.

View all citing articles on Scopus

^*: Partially supported by a grant from the Foundation for Physical Therapy and the National Athletic Trainers Association Research and Education Foundation.

^**: Reprint requests: Lori A. Michener, PhD, PT, ATC, Assistant Professor, Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia Campus, PO Box 980224; Richmond, VA 23298 (E-mail: [email protected]).

View full text

Original articleAmerican Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and responsiveness*,**

Abstract

Section snippets

Materials and methods

Reliability

Error estimates

Validity

Discussion

Acknowledgements

J Shoulder Elbow Surg

J Chronic Dis

J Clin Epidemiol

J Chronic Dis

Control Clin Trials

J Clin Epidemiol

J Clin Epidemiol

Understanding the relevance of measured change through studies of responsiveness

Spine

Measuring function of the shoulder. A cross-sectional comparison of five questionnaires

J Bone Joint Surg Am

A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale

Phys Ther

Measuring health-related quality of life

Ann Intern Med

The shoulder pain and disability index: the construct validity and responsiveness of a region-specific disability measure

Phys Ther

Methods for assessing condition-specific and generic functional status outcomes after total knee replacement

Med Care

Original article
American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and responsiveness*,**