DEFINING CLINICALLY IMPORTANT IMPROVEMENT FOR THE OXFORD SHOULDER SCORE: DATA FROM THE AUSTRALIAN ORTHOPAEDIC ASSOCIATION NATIONAL JOINT REPLACEMENT REGISTRY PATIENT-REPORTED OUTCOMES MEASURES PROGRAM

Fang Y, Ackerman I, Harris I, et al. DEFINING CLINICALLY IMPORTANT IMPROVEMENT FOR THE OXFORD SHOULDER SCORE: DATA FROM THE AUSTRALIAN ORTHOPAEDIC ASSOCIATION NATIONAL JOINT REPLACEMENT REGISTRY PATIENT-REPORTED OUTCOMES MEASURES PROGRAM. Orthop Procs. 2023;105-B(SUPP_3):113-113. doi:10.1302/1358-992X.2023.3.113

Fang, Y., et al. “DEFINING CLINICALLY IMPORTANT IMPROVEMENT FOR THE OXFORD SHOULDER SCORE: DATA FROM THE AUSTRALIAN ORTHOPAEDIC ASSOCIATION NATIONAL JOINT REPLACEMENT REGISTRY PATIENT-REPORTED OUTCOMES MEASURES PROGRAM.” Orthopaedic Proceedings, vol. 105-B, no. SUPP_3, 2023, pp. 113-113., https://doi.org/10.1302/1358-992X.2023.3.113

Fang, Y., Ackerman, I., Harris, I., Page, R., Cashman, K., Lorimer, M., Heath, E., Graves, S., & Soh, S. (2023). DEFINING CLINICALLY IMPORTANT IMPROVEMENT FOR THE OXFORD SHOULDER SCORE: DATA FROM THE AUSTRALIAN ORTHOPAEDIC ASSOCIATION NATIONAL JOINT REPLACEMENT REGISTRY PATIENT-REPORTED OUTCOMES MEASURES PROGRAM. Orthopaedic Proceedings, 105-B(SUPP_3), 113-113. https://doi.org/10.1302/1358-992X.2023.3.113

Fang, Y., Ackerman, I., Harris, I., Page, R., Cashman, K., Lorimer, M. et al. (2023) “DEFINING CLINICALLY IMPORTANT IMPROVEMENT FOR THE OXFORD SHOULDER SCORE: DATA FROM THE AUSTRALIAN ORTHOPAEDIC ASSOCIATION NATIONAL JOINT REPLACEMENT REGISTRY PATIENT-REPORTED OUTCOMES MEASURES PROGRAM.” Orthopaedic Proceedings, 105-B(SUPP_3), pp. 113-113. Available at: https://doi.org/10.1302/1358-992X.2023.3.113

Fang, Y., I.N. Ackerman, I. Harris, R. Page, K. Cashman, M. Lorimer, E. Heath, S. Graves, and S-E. Soh. “DEFINING CLINICALLY IMPORTANT IMPROVEMENT FOR THE OXFORD SHOULDER SCORE: DATA FROM THE AUSTRALIAN ORTHOPAEDIC ASSOCIATION NATIONAL JOINT REPLACEMENT REGISTRY PATIENT-REPORTED OUTCOMES MEASURES PROGRAM.” Orthopaedic Proceedings 105-B, no. SUPP_3 (2023): 113-113. https://doi.org/10.1302/1358-992X.2023.3.113

Fang Y, Ackerman I, Harris I, Page R, Cashman K, Lorimer M, et al. DEFINING CLINICALLY IMPORTANT IMPROVEMENT FOR THE OXFORD SHOULDER SCORE: DATA FROM THE AUSTRALIAN ORTHOPAEDIC ASSOCIATION NATIONAL JOINT REPLACEMENT REGISTRY PATIENT-REPORTED OUTCOMES MEASURES PROGRAM. Orthop Procs. 2023 Feb 23;105-B(SUPP_3):113-113. https://doi.org/10.1302/1358-992X.2023.3.113

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Abstract

While clinically important improvements in Oxford Shoulder Scores have been defined for patients with general shoulder problems or those undergoing subacromial decompression, no threshold has been reported for classifying improvement after shoulder replacement surgery. This study aimed to establish the minimal clinically important change (MCIC) for the Oxford Shoulder Score in patients undergoing primary total shoulder replacement (TSR).

Patient-reported outcomes data were sourced from the Australian Orthopaedic Association National Joint Replacement Registry Patient-Reported Outcome Measures Program. These included pre- and 6-month post-operative Oxford Shoulder Scores and a rating of patient-perceived change after surgery (5-point scale ranging from ‘much worse’ to ‘much better’). Two anchor-based methods (using patient-perceived improvement as the anchor) were used to calculate the MCIC: 1) mean change method; and 2) predictive modelling, with and without adjustment for the proportion of improved patients.

The analysis included 612 patients undergoing primary TSR who provided pre- and post-operative data (58% female; mean (SD) age 70 (8) years). Most patients (93%) reported improvement after surgery. The MCIC derived from the mean change method was 6.8 points (95%CI 4.7 to 8.9). Predictive modelling produced an MCIC estimate of 11.6 points (95%CI 8.9 to 15.6), which reduced to 8.7 points (95%CI 6.0 to 12.7) after adjustment for the proportion of improved patients.

For patient-reported outcome measures to provide valuable information that can support clinical care, we need to understand the magnitude of change that matters to patients. Using contemporary psychometric methods, this analysis has generated MCIC estimates for the Oxford Shoulder Score. These estimates can be used by clinicians and researchers to interpret important changes in pain and function after TSR from the patient's perspective. We conclude that an increase in Oxford Shoulder Scores of at least 9 points can be considered a meaningful improvement in shoulder-related pain and function after TSR.

Email: sze-ee.soh@monash.edu

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Orthopaedic Proceedings

Volume

105-B No.SUPP_3 | Pages 113 - 113

Section

General Orthopaedics

Published

23 February 2023

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Y. Fang

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

School of Primary and Allied Health Care, Monash University, Melbourne, Australia

South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

Barwon Centre for Orthopaedic Research and Education, Geelong, Australia

Deakin University, Geelong Australia,

Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia

South Australian Health and Medical Research Institute, Adelaide, Australia

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I.N. Ackerman

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

School of Primary and Allied Health Care, Monash University, Melbourne, Australia

South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

Barwon Centre for Orthopaedic Research and Education, Geelong, Australia

Deakin University, Geelong Australia,

Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia

South Australian Health and Medical Research Institute, Adelaide, Australia

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I. Harris

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

School of Primary and Allied Health Care, Monash University, Melbourne, Australia

South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

Barwon Centre for Orthopaedic Research and Education, Geelong, Australia

Deakin University, Geelong Australia,

Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia

South Australian Health and Medical Research Institute, Adelaide, Australia

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R. Page

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

School of Primary and Allied Health Care, Monash University, Melbourne, Australia

South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

Barwon Centre for Orthopaedic Research and Education, Geelong, Australia

Deakin University, Geelong Australia,

Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia

South Australian Health and Medical Research Institute, Adelaide, Australia

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K. Cashman

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

School of Primary and Allied Health Care, Monash University, Melbourne, Australia

South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

Barwon Centre for Orthopaedic Research and Education, Geelong, Australia

Deakin University, Geelong Australia,

Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia

South Australian Health and Medical Research Institute, Adelaide, Australia

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M. Lorimer

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

School of Primary and Allied Health Care, Monash University, Melbourne, Australia

South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

Barwon Centre for Orthopaedic Research and Education, Geelong, Australia

Deakin University, Geelong Australia,

Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia

South Australian Health and Medical Research Institute, Adelaide, Australia

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E. Heath

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

School of Primary and Allied Health Care, Monash University, Melbourne, Australia

South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

Barwon Centre for Orthopaedic Research and Education, Geelong, Australia

Deakin University, Geelong Australia,

Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia

South Australian Health and Medical Research Institute, Adelaide, Australia

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S. Graves

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

School of Primary and Allied Health Care, Monash University, Melbourne, Australia

South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

Barwon Centre for Orthopaedic Research and Education, Geelong, Australia

Deakin University, Geelong Australia,

Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia

South Australian Health and Medical Research Institute, Adelaide, Australia

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S-E. Soh

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

School of Primary and Allied Health Care, Monash University, Melbourne, Australia

South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

Barwon Centre for Orthopaedic Research and Education, Geelong, Australia

Deakin University, Geelong Australia,

Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia

South Australian Health and Medical Research Institute, Adelaide, Australia

sze-ee.soh@monash.edu

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General Orthopaedics

DEFINING CLINICALLY IMPORTANT IMPROVEMENT FOR THE OXFORD SHOULDER SCORE: DATA FROM THE AUSTRALIAN ORTHOPAEDIC ASSOCIATION NATIONAL JOINT REPLACEMENT REGISTRY PATIENT-REPORTED OUTCOMES MEASURES PROGRAM

The New Zealand Orthopaedic Association and the Australian Orthopaedic Association (NZOA AOA) Combined Annual Scientific Meeting, Christchurch, New Zealand, 31 October – 3 November 2022. Part 2 of 2.

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