Agreement between patient selfassessment and physician assessment of shoulder range of motion

作者：Uribe Bastian; El Bitar Youssef; Wolf Brian R; Bollier Matthew; Kuhn John E; Hettrich Carolyn M^*

来源：Journal of Shoulder and Elbow Surgery, 2016, 25(10): 1649-1654.

DOI：10.1016/j.jse.2016.02.010

• Shoulder physical examination
• range of motion
• patient-reported outcome
• self-assessment
• apprehension sign
• agreement study

Background: Shoulder outcome scores that include range of motion (ROM) and apprehension signs are limited by the need for direct involvement of the physician. Patient-reported outcome measures are patient centered and self-administered, and they can help physicians track the patient's progress between office visits and for long-term follow-up once the patient has been discharged.
Methods: Thirty consecutive patients completed a form before their 6-month follow-up after surgery on the labrum or capsule as a result of instability or pain related to instability. The form included bilateral ROM, apprehension, and instability episodes. The same parameters were measured by the physician during the visit. The patient's and physician's responses were compared. The primary outcome was the percentage agreement with exact and approximate agreement.
Results: Exact agreement was moderate for forward elevation at 56.6%; fair for abduction and external rotation at 90 degrees at 24.5% and 34%, respectively; and poor for internal rotation at 90 degrees and external rotation with the arm at the side at 2.6% and 12%, respectively. Approximate agreement within a range of positive or negative 20 degrees range was very good for forward elevation (94%), abduction (92%), and external rotation at 90 degrees (87%); moderate for external rotation with the arm at the side; and fair for internal rotation at 90 degrees. There was 70% agreement regarding apprehension, 93% regarding subluxation events, and 100% regarding redislocation events.
Conclusion: Some measures of shoulder ROM showed a moderate to high level of agreement between patient-reported measurements and the physician's measurements. This method for short-and long-term follow-up could potentially replace routine clinic visits.

• 出版日期2016-10