title: Agreement between patient self-assessment and physician assessment of shoulder range of motion.
abstract: BACKGROUND
  Shoulder outcome scores that include range of motion (ROM) and apprehension signs are limited by the need for direct involvement of the physician. Patient-reported outcome measures are patient centered and self-administered, and they can help physicians track the patient's progress between office visits and for long-term follow-up once the patient has been discharged.
  
  
  METHODS
  Thirty consecutive patients completed a form before their 6-month follow-up after surgery on the labrum or capsule as a result of instability or pain related to instability. The form included bilateral ROM, apprehension, and instability episodes. The same parameters were measured by the physician during the visit. The patient's and physician's responses were compared. The primary outcome was the percentage agreement with exact and approximate agreement.
  
  
  RESULTS
  Exact agreement was moderate for forward elevation at 56.6%; fair for abduction and external rotation at 90° at 24.5% and 34%, respectively; and poor for internal rotation at 90° and external rotation with the arm at the side at 2.6% and 12%, respectively. Approximate agreement within a range of positive or negative 20° range was very good for forward elevation (94%), abduction (92%), and external rotation at 90° (87%); moderate for external rotation with the arm at the side; and fair for internal rotation at 90°. There was 70% agreement regarding apprehension, 93% regarding subluxation events, and 100% regarding redislocation events.
  
  
  CONCLUSIONS
  Some measures of shoulder ROM showed a moderate to high level of agreement between patient-reported measurements and the physician's measurements. This method for short- and long-term follow-up could potentially replace routine clinic visits.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
authors.forename: Bastian
authors.initials: B
authors.lastname: Uribe
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
authors.forename: Youssef
authors.initials: Y
authors.lastname: El Bitar
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wolf
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bollier
authors.affiliation: Vanderbilt Sports Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Kuhn
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA. Electronic address: carolyn-hettrich@uiowa.edu.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Hettrich
mesh_terms: D000293:Adolescent; D000328:Adult; D000072228:Arthroplasty, Replacement, Shoulder; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D063868:Patient Outcome Assessment; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012647:Self-Assessment; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Shoulder physical examination; agreement study; apprehension sign; patient-reported outcome; range of motion; self-assessment