Outcomes research in orthopedics: History, perspectives, concepts, and future

Patient-reported outcomes are, by definition, subjective, and there is consensus that individual patient expectations have a significant effect on the postoperative outcome after shoulder arthroscopy. Most of the outcomes in orthopaedic surgery are measured either in terms of functional scores assessing only one joint or as disease or condition-specific outcomes. As such, there exists a growing interest developing better tools to measure quality-of-life outcome scores as an assessment of overall patient health and satisfaction. Recent research shows that quality-of-life outcome measures correlate with joint-specific and functional outcomes after arthroscopic Bankart repair. We also personally believe that quality-of-life scores should become a standard outcome assessment measurement in orthopaedic surgery because while we perform surgery on the joint, we take care of the whole patient.

We evaluated the responsiveness of patient-derived questionnaires and physical findings in evaluating recovery after treatment of ulnocarpal abutment syndrome.

Patients were assessed at their initial visit to our clinic and again 3 months after the treatment. At each visit, patients completed a Short Form-36, the Japanese Society for Surgery of the Hand version of Disability of the Arm, Shoulder, and Hand questionnaire (DASH-JSSH), and the Japanese version of patient-rated wrist evaluation (PRWE-J). Grip strength, range of motion, and visual analogue scale for wrist pain were also examined at each visit. Satisfaction with treatment was questioned after 3 months using a Likert scale. Standardized response means (SRM) and effect sizes were calculated to evaluate the responsiveness.

The PRWE-J (SRM, 1.35) was the most responsive questionnaire, followed by the DASH-JSSH (SRM, 0.81) and the Short Form-36 (SRM, −0.38 to −1.19). Of the physical tests, grip strength (SRM, 0.81) was more responsive than range of motion (SRM, 0.01 to −0.29). The visual analogue pain scale (SRM, 1.56) was highly responsive. Changes in the PRWE score were correlated with the satisfaction rating for the treatment.

Responsive patient-derived scales can assist in the outcome evaluation of patients with ulnocarpal abutment syndrome.