The assessment of shoulder function is the cornerstone of clinical research regarding the natural history and treatment outcomes for shoulder disorders. Current approaches to this assessment include patient-reported measures, which are often referred to as “subjective,” and provider-reported measures, which are often referred to as “objective.” Relatively little is known about the relationship between these 2 types of measures in patients with shoulder arthritis. Such an analysis is complicated by the observation that provider-reported measures are subject to intraobserver and interobserver variability6,9-20,23,24,48. The importance of this study lies in its analysis of the relationship between subjective patient-reported assessment of shoulder function and observer-independent objective measurement of active shoulder motion in patients with glenohumeral arthritis presenting for consideration of shoulder arthroplasty. The results indicate a highly variable relationship between the patients’ reported ability to perform the functions of the SST and the range of active abduction measured by the Kinect motion sensor system, particularly for osteoarthritic shoulders.
Whereas there were some differences in active abduction between the shoulders that did and did not allow performance of the different SST functions, these differences were less apparent for the osteoarthritic shoulders than for the contralateral shoulders; this suggests that factors other than the active range of motion had a substantial effect on the patients’ self-assessed ability to perform each function.
Some authors have suggested threshold values for the range of motion of the shoulder required to perform specific daily activities; for example, one study of 40 normal shoulders of 20 volunteers showed that 128° ± 8° of abduction was required to perform 10 functional tasks; the small standard deviation is noteworthy27. However, our study of patients with shoulder arthritis indicates that the range of active motion associated with different shoulder functions varied widely from patient to patient, with standard deviations in the range of 30° to 40°. A set threshold of 128° of abduction would not have been useful in predicting which shoulders would or would not allow the patient to perform each of the 12 SST functions.
While the osteoarthritic shoulders of the women were less functional overall than those of the men, the high degree of interpatient variability led to a lack of significant differences between the sexes in terms of the active ranges of abduction associated with the different shoulder functions.
The results of this study need to be viewed in light of certain limitations. First, we considered only the relationship between active abduction assessed by the Kinect and patient self-assessed shoulder function documented with the SST; analysis of other measures of motion and other methods of functional assessment might have led to different results. Second, we only studied patients with osteoarthritis who presented to a single expert surgeon for shoulder arthroplasty; different findings might have been obtained with different patient populations with different pathological conditions seen in different practices. Third, we selected active abduction as the motion with which patient self-assessed function was compared; it is possible that other active motions would have had a different relationship with self-assessed shoulder function. Fourth, we compared the shoulder that was to undergo surgery for osteoarthritis with the contralateral shoulder; we did not assess the type or degree of pathological involvement or its effect on the contralateral shoulder. Fifth, we did not attempt to assess other factors that might have affected patient self-assessed function, such as pain, motivation, strength, relationship of the shoulder condition to the patient’s work, or radiographic findings. Finally, most “objective” measurements of range of motion are made using some form of handheld goniometer, and the problem of intraobserver and interobserver variability in such “objective” measurements remains unresolved9-20.
We found highly variable relationships between subjective patient-assessed shoulder function and objectively measured active range of motion, particularly for the osteoarthritic shoulders. These relationships did not differ significantly between the shoulders of men and women. Both subjective and objective measurements are important in characterizing the clinical status of shoulders. Studies of natural history and treatment outcomes should include separate assessments of these 2 complementary aspects of shoulder function.
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