Does objective shoulder impairment explain patient-reported functional outcome? A study of proximal humerus fractures.
OBJECTIVE
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.


CONCLUSIONS
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.
Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada.
Gerard P
GP
Slobogean
Vanessa K
VK
Noonan
Akin
A
Famuyide
Peter J
PJ
O'Brien
D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012647:Self-Assessment; D012782:Shoulder; D012784:Shoulder Fractures / Q000534:rehabilitation*; D016896:Treatment Outcome