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The Influence of Health Perception on Shoulder Outcome Measure Scores
Clin Should Elbow 2019;22:173-182
Published online December 1, 2019;  https://doi.org/10.5397/cise.2019.22.4.173
© 2019 Korean Shoulder and Elbow Society.

Richard E. Hardy , Engin Sungur1, Christopher Butler1, Jefferson C. Brand
Correspondence to: Richard E. Hardy
Department of Sports Medicine, Heartland Orthopedic Specialists, 111 17th Ave E Suite 101, Alexandria, MN 56308, USA
Tel: +1-320-760-2031, Fax: +1-320-589-6428, E-mail: hardyr@morris.umn.edu, ORCID: https://orcid.org/0000-0002-1053-0086
Received August 7, 2019; Revised September 20, 2019; Accepted September 29, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Background: Patient reported outcome measures assess clinical progress from the patient셲 perspective. This study explored the relationship between shoulder outcome measures (The Disability of the Arm, Shoulder and Hand [DASH], American Shoulder and Elbow Surgeons Standard Shoulder Assessment score [ASES], and Constant score) by comparing the best possible scores obtained in an asymptomatic population compared to overall perception of health, as measured by the SF-36 outcome measure.
Methods: Volunteers (age range, 20–69 years) with asymptomatic shoulders and no history of shoulder pain, injury, surgery, imaging, or pathology (bilaterally) were included. The DASH and ASES measures were completed by 111 volunteers (72 female, 39 male), of which 92 completed the Constant score (56 female, 36 male). The SF-36 was completed by all volunteers (level of evidence: IV case series).
Results: The mean (x) score for ASES measure on the right shoulder was higher for the left-hand dominant side (x=100.00 vs. 95.02, p-value<0.001); no other significant differences. Better SF-36 scores were associated with better DASH scores. Our prediction models suggest that perception of overall health affects the DASH scores. Sex affected all three shoulder measures scores.
Conclusions: Comparing scores of shoulder outcome measures to the highest possible score is not the most informative way to interpret patient progress. Variables such as health status, sex, and hand dominance need to be considered. Furthermore, it is possible to use these variables to predict scores of outcome measures, which facilitates the healthcare provider to deliver individualized care to their patients.
Keywords : Disability of the Arm, Shoulder and Hand; American Shoulder and Elbow Surgeons Standard Shoulder Assessment score; Constant score; SF-36; Shoulder