Reliability, validity, and responsiveness of a novel subscapularis outcome score: the Baltimore Orthopedic Subscapularis Score

Max Hamaker, MD; Blessing Enobun, MD, MPH; Samir Kaveeshwar, MD; S. Ashfaq Hasan, MD; Brian Shiu, MD; R. Frank Henn, III, MD; Kelly Kilcoyne, MD; Umasuthan Srikumaran, MD; Gregory Gasbarro, MD; Zachary R. Zimmer, MD; Mohit N. Gilotra, MD, MS

JSES International (Nov 2022)

Reliability, validity, and responsiveness of a novel subscapularis outcome score: the Baltimore Orthopedic Subscapularis Score

Max Hamaker, MD,
Blessing Enobun, MD, MPH,
Samir Kaveeshwar, MD,
S. Ashfaq Hasan, MD,
Brian Shiu, MD,
R. Frank Henn, III, MD,
Kelly Kilcoyne, MD,
Umasuthan Srikumaran, MD,
Gregory Gasbarro, MD,
Zachary R. Zimmer, MD,
Mohit N. Gilotra, MD, MS

Affiliations

Max Hamaker, MD: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
Blessing Enobun, MD, MPH: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
Samir Kaveeshwar, MD: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
S. Ashfaq Hasan, MD: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
Brian Shiu, MD: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
R. Frank Henn, III, MD: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
Kelly Kilcoyne, MD: Department of Orthopedics, Walter Reed National Military Medical Center, Bethesda, MD, USA
Umasuthan Srikumaran, MD: Johns Hopkins Medicine, Baltimore, MD, USA
Gregory Gasbarro, MD: Orthopaedic Specialty Hospital Mercy Medical Center, Baltimore, MD, USA
Zachary R. Zimmer, MD: Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
Mohit N. Gilotra, MD, MS: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA; Corresponding author: Mohit N. Gilotra, MD, MS, Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn St, Room 540D Baltimore, MD 21201, USA.

Journal volume & issue: Vol. 6, no. 6
pp. 957 – 962

Abstract

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Background: Available surveys that evaluate shoulder strength and pain often combine rotator cuff muscles making the test unable to differentiate subscapularis tears from other pathology including concomitant supraspinatus, infraspinatus tears. The purpose of this study was to validate a subscapularis-specific shoulder survey (Baltimore Orthopedic Subscapularis Score) as a viable clinical outcome assessment through analysis of psychometric properties. Methods: A 5-question survey was given to a study population of 390 patients, 136 of whom had full thickness rotator cuff tears with a minimum score of 5 (better) and a maximum score of 25 (worse). Surveys were given during the initial consultation, preoperative visit, and postoperative visit. Content validity, construct validity, test-retest reliability, responsiveness to change, internal consistency, and minimal clinically important difference using distribution and anchor-based methods were determined for our subscapularis function survey. Results: A high correlation was reported on test-retest reliability (intraclass correlation coefficient = 0.89). An acceptable internal consistency was reported for all patients surveyed (Cronbach alpha = 0.91). Floor and ceiling effects for patients with rotator cuff pathology were minimized (1% for both). Patients with an isolated subscapularis tear scored worse than supraspinatus/infraspinatus tears and exhibited similar dysfunction as patients with a supraspinatus/infraspinatus/subscapularis tear. An acceptable construct validity was reported with subscapularis-involved tears demonstrating higher scores with significance (P 0.8). The minimal clinically important difference using a distribution and anchor-based method was 4.1 and 4.6, respectively. Among patients with rotator cuff tears in this population, a score of 22 or higher predicts a subscapularis tear 75% of the time, in spite of its low overall prevalence. Conclusion: The subscapularis shoulder score demonstrated acceptable psychometric performance for outcomes assessment in patients with rotator cuff disease. This survey can be used as an effective clinical tool to assess subscapularis function.

Published in JSES International

ISSN: 2666-6383 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://www.journals.elsevier.com/jses-international

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