RESPONSIVENESS OF SELF-REPORT MEASURES IN EVALUATING ROTATOR CUFF REPAIR

Abstract

Forty-nine patients with a repair of their rotator cuff were evaluated at baseline and at six-months after surgery using four self-reports scales (DASH, Western Ontario Rotator Cuff (WORC,) SF-36 and Washington Simple Shoulder (SST) scales. Standardized response means were used to determine responsiveness. The DASH was most responsive (SRM=1.27), the WORC (SRM=1.0) and SST (0.91) were intermediary and the least response was the SF-36 (0.73). These results suggest that the DASH may be preferable to either a disease specific scale or a shoulder scale for detecting clinical progress following cuff repair.

A number of self-report scales exist for shoulder problems, including regional, joint-specific and disease specific scales. Determining the most responsive scale is essential for outcome evaluation and clinical trials.

Forty-nine patients with a repair of their rotator cuff were evaluated at baseline and at six-months after surgery using four self-reports scales (DASH, Western Ontario Rotator Cuff (WORC,) SF-36 and Washington Simple Shoulder (SST) scales. An independent research assistant administered scales. Standardized response means were used to determine responsiveness.

The DASH was most responsive (SRM=1.27), the WORC (SRM=1.0) and SST (0.91) were intermediary and the least response was the SF-36 (0.73). The subscale of the WORC that showed the most change was lifestyle. Physical subscales of the SF-36 showed improvement; whereas, minimal impact on mental health was observed.

The DASH can be used for a variety of upper extremity conditions, whereas the WORC was designed specifically for rotator cuff disease. Unless a disease specific scale is more responsive, there is little reason to adopt a scale than can only be used for one condition. This data supports the ability of the DASH to indicate upper extremity function and the important role of the rotator cuff in function.

The implications of these findings are that the DASH may be preferable to either a disease specific scale for rotator cuff disease or a shoulder scale for detecting clinical progress.