What Are We Measuring? A Systematic Review of Outcome Measurements Used in Shoulder Surgery

Abstract

Purpose: The purpose of this study was to identify the most commonly used outcome measurements following shoulder surgery and to investigate demographic variables related to their use. Methods: PubMed and Embase were searched to identify studies in which at least 1 shoulder-specific outcome measurement was used. Exclusion criteria included duplicate studies, review articles, lack of surgical arm, written in a language other than English, or not adult-specific. Additionally, surgeries were subcategorized based on the type of pathology leading to surgery. Results: Of the 589 articles identified in the search, 180 met the inclusion criteria. A total of 35 shoulder-specific outcome measurements were reported. The Constant-Murley score (CMS), American Shoulder and Elbow Surgeons Shoulder Score (ASES), Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), and University of California Los Angeles Score (UCLA) were used in more than 10% of the articles. The CMS and SSV were used more commonly together than individually (P = .0074). Additionally, the ASES (P < .00001) and CMS (P = .0109) were associated with the country of origin of the article. The SST was used more frequently in randomized control trials (P = .0287). The ASES and DASH were associated with surgeries categorized under the degenerative indication (P = .001 and P = .0146). Finally, the SSV, ASES and DASH were all found to be significantly paired with surgeries that indicated traumatic pathology (P = .0061, P = .0077 and P = .0069, respectively). Conclusions: There is great variability among the outcome measurements currently being used for assessing function following orthopaedic shoulder surgery; however, 5 scoring systems are used more frequently than others. There remains a large discrepancy between the ideal reporting, as noted in the recent literature review, and the current state of outcomes reported at this time. Clinical Relevance: By identifying and evaluating the heterogeneity of the reporting and the usage of the performance indicators, these results can guide the standardization of outcome measurements in shoulder surgery and allow for better comparability when assessing outcomes between patients and studies.