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Does objective shoulder impairment explain patient-reported functional outcome? A study of proximal humerus fractures.
MedLine Citation:
PMID:  20951061     Owner:  NLM     Status:  In-Data-Review    
HYPOTHESIS: Following a healed proximal humerus fracture, patient-reported outcome is predicted by objective physical examination findings. Range of motion and strength thresholds can correctly identify subjects with normal functioning shoulders.
METHODS: Subjects were age ≥55 years with a healed proximal humerus fracture. Impairment was measured with a focused physical examination of the shoulder; patient-reported outcome was assessed using 4 outcome questionnaires. Linear regression was used to determine how well variations in shoulder impairment explain differences in patient-reported outcomes. ROC curves were constructed to determine the physical examination thresholds that would correctly identify normally functioning shoulders.
RESULTS: Thirty-one subjects with a mean age of 70 ± 8 years participated. The mean patient-reported outcome scores were: DASH 21 ± 19, ASES 82 ± 17, SST 8 ± 3, and Oxford 20 ± 8. The linear regression analysis suggests that shoulder impairment explains 38% of the Oxford, 50% of the DASH, 58% of the SST, and 70% of the ASES variance. Abduction strength was a significant predictor for all functional outcomes. Based on ROC analysis, forward flexion had the best discriminatory ability for identifying normally functioning shoulders (area under curve, 0.93). A threshold of 120° forward flexion correctly classified 90% of the shoulders.
CONCLUSION: Range of motion and strength thresholds can identify subjects with normal shoulder function. A discordance between shoulder impairment and patient-reported outcome has been demonstrated and further work to identify patient, injury, or treatment factors to minimize this discrepancy is still needed.
Gerard P Slobogean; Vanessa K Noonan; Akin Famuyide; Peter J O'Brien
Publication Detail:
Type:  Journal Article     Date:  2010-10-15
Journal Detail:
Title:  Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]     Volume:  20     ISSN:  1532-6500     ISO Abbreviation:  J Shoulder Elbow Surg     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-01-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9206499     Medline TA:  J Shoulder Elbow Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  267-72     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.
Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada.
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