title: Patients recall worse preoperative pain after shoulder arthroplasty than originally reported: a study of recall accuracy using the American Shoulder and Elbow Surgeons score.
abstract: BACKGROUND
  Patient-reported outcome measures (PROMs) are valuable tools for quantifying outcomes of orthopedic surgery. However, when baseline scores are not obtained, there is considerable controversy about whether PROMs can be administered retrospectively for patients to recall their preoperative state. We investigated the accuracy of patient recall after total shoulder arthroplasty (TSA) using the American Shoulder and Elbow Surgeons (ASES) assessment score.
  
  
  METHODS
  Recalled ASES scores were collected postoperatively at 6 weeks, 3 months, 6 months, and 12 months from 169 patients who previously completed baseline scores before TSA. The ASES total score was divided into its two subcomponents: functional ability and visual analog scale (VAS) for pain. We compared preoperative and recalled scores for each subcomponent and the total ASES score.
  
  
  RESULTS
  Recalled ASES function scores were comparable to corresponding preoperative scores across all time points (analysis of variance, P = .21), but recalled VAS pain was significantly higher at all time points beyond 6 weeks after surgery (P = .0001 at 3 months; P = .005 at 6 months; and P = .001 at 12 months). As a result, the ASES total score was only comparable at 6 weeks after surgery (P = .39) and differed at all time points thereafter.
  
  
  CONCLUSIONS
  Patients are able to recall preoperative function with considerable accuracy for up to 12 months after TSA. However, beyond 6 weeks postoperatively, patients recall having worse pain than they originally reported, and recalled ASES total scores are unreliable as a result.
authors.affiliation: New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA.
authors.forename: Jeremiah T
authors.initials: JT
authors.lastname: Lowe
authors.affiliation: Boston Medical Center, Boston, MA, USA.
authors.forename: Xinning
authors.initials: X
authors.lastname: Li
authors.affiliation: New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA.
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Fasulo
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Testa
authors.affiliation: New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA. Electronic address: andrewjawa@gmail.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder; D005260:Female; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D010147:Pain Measurement; D011184:Postoperative Period; D057234:Preoperative Period; D020069:Shoulder Pain
keywords: American Shoulder and Elbow Surgeons score (ASES); outcomes; patient recall; patient-reported outcome measure (PROM); shoulder arthroplasty; visual analog scale pain (VAS)