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.
Slobogean
Gerard P
GP
Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada.
Noonan
Vanessa K
VK
Famuyide
Akin
A
O'Brien
Peter J
PJ
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