Patient-Reported and Objectively Measured Function Before and After Reverse Shoulder Arthroplasty
Wendy J. Hurd, PT, PhD,a Melissa M. Morrow, PhD,a Emily J. Miller, MS,a Robert A. Adams, OPA-C,a John W. Sperling, MD,a and Kenton R. Kaufman, PhDaShoulder
Background and Purpose
Documenting functional outcomes after reverse shoulder arthroplasty (RSA) is critical to advancing patient care. The interplay been self-reported and objectively measured outcome measures has not been widely described. The utilization of wearable devices to document upper extremity limb activity is a new approach for objectively measuring outcomes. Therefore the purpose of this study was to evaluate changes in pain, and self-reported function and objectively measured limb activity after RSA. We also assessed the influence of pain on self-reported function and objectively measured limb activity to determine the impact of pain on outcomes after RSA.
Materials
This study implemented a prospective, repeated measures design. Fourteen patients undergoing RSA underwent testing before surgery, and 2 and 12 months after surgery. Patient-report instruments included pain, DASH, and physical component summary (PCS) of the SF-36. Objective limb activity (mean activity value (m/s2/minute epoch), inactive time (%), low activity (%) and high activity (%)) was captured with tri-axial accelerometers worn on the upper and lower arm. A repeated measures ANOVA tested for differences across time. Spearman’s rank-order correlation was calculated to evaluate the influence of pain on DASH, PCS scores, and mean limb activity.
Results
Patient-reported measures improved after surgery (Pain, P < 0.01; DASH, P < 0.01; PCS, P = 0.01). There was no change in limb activity at one year compared to pre-operative values for mean (Forearm, P=1.00; Arm, P=0.36), inactivity (Forearm, P = 0.33; Arm, P = 0.22) low (Forearm, P = 0.77; Arm, P=0.11) or high (Forearm, P = 1.00; Arm, P = 0.20) activity. There was a relationship between pain and DASH scores one year after surgery (P = 0.04) but not before surgery (P = 0.16), or 2 months after surgery (P=0.30). There was no relationship between pain and PCS scores at any time point (pre-operative, P=0.97; 2 months, P=0.21; one year, P=0.08) nor pain and limb activity (Forearm: pre-operative, P = 0.36; 2 months, P = 0.67; one year, P=0.16; Arm: pre-operative, P = 0.97; 2 months, P=0.59; one year, P = 0.51).
Conclusions
RSA reduced pain and enhanced patient perceived function. Objectively measured upper extremity limb activity is not different one year after surgery compared to pre-operative levels.
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