Validity Assessment of the Swiss Orthopaedics Minimal Data Set compared to the subjective shoulder value for rotator cuff repair in relation to Constant score

Daniel Felbar; Vilijam Zdravkovic; Andreas Mueller; Laurent Audigé; Alexandre Lädermann; Claudio Rosso; Bernhard Jost

Abstract

Background: Despite numerous Patient Reported Outcome Measures (PROMs) in shoulder surgery, no standard has been established for subjective measurement of shoulder outcomes.Purpose: This study examines the validity of the Swiss Orthopaedics Minimal Data Set (SOMDS) compared to the subjective shoulder value (SSV) for shoulder pathology in relation to Constant score in patients undergoing arthroscopic rotator cuff reconstruction.Methods: As part of the ARCR_Pred Cohort Study, 973 patients undergoing arthroscopic rotator cuff reconstruction were included from June 2020 to November 2021 across 19 centers. Follow-up examinations at 12 months postoperatively assessed the Constant score, the SOMDS, the subjective shoulder value (SSV), and the EQ-5D-5L index. The validity of both the SOMDS and the SSV was evaluated in comparison to the Constant score, using Cronbach’s alpha for consistency and correlation analyses for validity. Results were visualized with boxplots to assess ceiling effect.Results: The SOMDS has a Cronbach's alpha of α = 0.56. Excluding the level of education sub-item improves internal consistency to α = 0.64. A linear regression model shows a strong correlation between the SOMDS and Constant score (r = 0.657, p < 0.001), superior to the EQ-5D-5L index (r = 0.657 vs. 0.562, p = 0.002) and comparable to the SSV (r = 0.657 vs. 0.644, p = 0.644). Sub-item correlations were also highly significant (p < 0.001). Boxplot analysis reveals a more pronounced ceiling effect for the SOMDS compared to the Constant score and the SSV, particularly affecting the joint-specific satisfaction sub-item.Conclusion: The SOMDS is a time-saving alternative to the Constant score, with a comparable validity to but higher ceiling effect than the SSV. SOMDS and SSV are useful depending on the parameters required to be recorded in everyday clinical practice or for study needs: SSV for patient-perceived functionality and SOMDS for broader assessment of health dimensions. The SOMDS without the level of education sub-item has improved internal consistency.What this study adds: The SOMDS is a valid tool for shoulder outcome assessment.How this study might affect research, practice or policy: Standardizing shoulder outcome measures using the SSV for patient-perceived functionality and the SOMDS for a broader evaluation of health dimensions.Study Design: prospective cohort studyLevel of evidence: Level IIKeywords: Shoulder; Rotator cuff repair; ARCR_Pred Cohort Study, Patient reported outcome measures (PROMs), Complications; Scores; Postoperative evaluation.https://doi.org/10.70885/hmsj.2025.05.002

References

  1. Mosher, Zachary A., et al. "Usage trends of patient-reported outcome measures in shoulder literature." JAAOS-Journal of the American Academy of Orthopaedic Surgeons 28.17 (2020): e774-e781. DOI: 10.5435/JAAOS-D-19-00455
  2. Lädermann, A., Eurin, R., Alibert, A., Bensouda, M., Bothorel, H. (2021). Measuring patient value after total shoulder arthroplasty. Journal of Clinical Medicine, 10(23), 5700. DOI: 10.3390/jcm10235700
  3. Meadows, Keith A. "Patient-reported outcome measures: an overview." British journal of community nursing 16.3 (2011): 146-151. DOI: 10.12968/bjcn.2011.16.3.146
  4. Jentzsch, Thorsten, et al. "Swiss Orthopaedics Minimal Dataset: First Pilot Report of Reliability and Validity." Advances in Orthopedics 2020 (2020): 1-4. DOI: 10.1155/2020/6673175
  5. Cunningham, G., Zanchi, D., Emmert, K., Kopel, R., Van De Ville, D., Lädermann, A., &; Hoffmeyer, P. (2015). Neural correlates of clinical scores in patients with anterior shoulder apprehension. Med Sci Sports Exerc, 47(12), 2612-2620. DOI: 10.1249/MSS.0000000000000726
  6. Gagnier, Joel J., and Bradley C. Johnston. "Poor quality patient reported outcome measures bias effect estimates in orthopaedic randomized studies." Journal of Clinical Epidemiology 116 (2019): 36-38. DOI: 10.1016/j.jclinepi.2019.07.012
  7. Zini, Michela Luciana Luisa, and Giuseppe Banfi. "A narrative literature review of bias in collecting patient reported outcomes measures (PROMs)." International journal of environmental research and public health 18.23 (2021): 12445. DOI: 10.3390/ijerph182312445
  8. Audigé, Laurent, et al. "Protocol: Swiss-wide multicentre evaluation and prediction of core outcomes in arthroscopic rotator cuff repair: protocol for the ARCR_Pred cohort study." BMJ Open 11.4 (2021). DOI: 10.1136/bmjopen-2020-042604
  9. Harris, Paul A., et al. "Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support." Journal of biomedical informatics 42.2 (2009): 377-381. DOI: 10.1016/j.jbi.2008.08.010
  10. Constant, C. R., & Murley, A. G. (1987). A clinical method of functional assessment of the shoulder. Clinical Orthopaedics and Related Research®, 214, 160-164. DOI: 10.1097/00003086-198701000-00023
  11. Lillkrona, U. (2008). How should we use the Constant Score?—A commentary. Journal of shoulder and elbow surgery, 17(2), 362-363. DOI: 10.1016/j.jse.2007.12.016
  12. Herdman, Michael, et al. "Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)." Quality of life research 20 (2011): 1727-1736. DOI: 10.1007/s11136-011-9903-x
  13. Jentzsch, T., Dora, C., Müller, U., & Farshad, M. (2020). Swiss orthopaedics minimal dataset: first pilot report of reliability and validity. Advances in Orthopedics, 2020(1), 6673175. DOI: 10.1155/2020/6673175
  14. Gilbart, M. K., & Gerber, C. (2007). Comparison of the subjective shoulder value and the Constant score. Journal of shoulder and elbow surgery, 16(6), 717-721. DOI: 10.1016/j.jse.2007.02.123
  15. Pichonnaz C. et al. The subjective shoulder value: a valid and simple measurement tool for routine measure of shoulder function Introduction Methods. Retrieved from https://www.chuv.ch/fileadmin/sites/dso/documents/dso_2019_WCPT_Congress_Geneve_C.Pichonnaz_2.pdf
  16. Lädermann, A., Denard, P. J., Collin, P., Ibrahim, M., Bothorel, H., &; Chiu, J. C. H. (2021). Single Assessment Numeric Evaluation for instability as an alternative to the Rowe score. Journal of Shoulder and Elbow Surgery, 30(5), 1167-1173. DOI: 10.1016/j.jse.2020.08.013
  17. R: A language and environment for statistical computing: R Foundation for Statistical Computing, Vienna, Austria - URL http://www.R-project.org/)
  18. Cunningham, G., Lädermann, A., Denard, P. J., Kherad, O., & Burkhart, S. S. (2015). Correlation between American shoulder and elbow surgeons and single assessment numerical evaluation score after rotator cuff or SLAP repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 31(9), 1688-1692. DOI: 10.1016/j.arthro.2015.03.010
  19. Varghese, M., Lamb, J., Rambani, R., & Venkateswaran, B. (2014). The use of shoulder scoring systems and outcome measures in the UK. The Annals of The Royal College of Surgeons of England, 96(8), 590-592. DOI: 10.1308/003588414X14055925058157
  20. Narulla, R., Song, M., Karunaratne, S., Smithers, C., & Petchell, J. (2023). Trends in shoulder surgery patient-reported outcome measures. JSES international, 7(4), 653-661. DOI: 10.1016/j.jseint.2023.03.010
  21. Vrotsou, K., Ávila, M., Machón, M., Mateo-Abad, M., Pardo, Y., Garin, O., & Cuéllar, R. (2018). Constant–Murley Score: systematic review and standardized evaluation in different shoulder pathologies. Quality of life research, 27, 2217-2226. DOI: 10.1007/s11136-018-1875-7
  22. Kim, H. M., Caldwell, J. M. E., Buza, J. A., Fink, L. A., Ahmad, C. S., Bigliani, L. U., & Levine, W. N. (2014). Factors affecting satisfaction and shoulder function in patients with a recurrent rotator cuff tear. JBJS, 96(2), 106-112. DOI: 10.2106/JBJS.L.01649

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