Abstract
Purpose:
The purpose of this study was to examine whether improvements in the Pediatric and Adolescent Shoulder Survey (PASS) are seen at 3 months following surgical treatment for shoulder instability and whether the PASS can discriminate between patients with differing outcomes based on clinical exam and the single assessment numeric evaluation (SANE). Performance of the PASS was contrasted with an adult validated tool, the quickDASH.
Methods:
Patients who underwent surgical treatment for shoulder instability with completed PASS forms available at pre-operative and 3 months post-operative (range 2.5-4.5mos) were included in this review. The PASS consists of 13 questions that assess (in child friendly language) symptoms, limitations, need for compensatory mechanisms, and emotional distress related to shoulder dysfunction. Responses are on a 0-5 or 0-10 scale with a score calculation based on percentage of total possible points (100% indicates no/minimal impact on quality of life from shoulder dysfunction). Patients were grouped based on range of motion or strength (within 10 degrees to contralateral extremity or no discrepancy in strength score was considered no deficit) and SANE score (=80% vs <80%) at the 3-month visit. Alpha was set at p<0.05 to declare significance.
Results:
50 patients with a mean age of 16 years (range 13.5-18 yrs) were identified in this review with a mean post-operative follow-up of 3.2 ± 0.5 months. Scores on the PASS improved significantly from pre-operative (57 ± 16%) to post-operative (74 ± 16%, p<0.001). The quickDASH similarly showed improvement (27 ± 16 pre vs 18 ± 16 post, p=0.003) although the magnitude of the effect for the PASS was larger (f=0.84 for PASS vs f=0.48 for quickDASH). Ceiling effect (>15% reporting the highest score) was observed at 3 months with the quickDASH (16% with top score), but not with the PASS (4%, p=0.03). While both tools were able to discriminate between patients with SANE score =80% vs <80%, the difference in quickDASH score between patients with/without diminished motion did not reach significance (p=0.07, Table).
Conclusion:
The PASS shows anticipated improvements in shoulder function following surgical intervention for instability without ceiling effects. The PASS is able to discriminate between patients with differing post-operative outcomes at 3 months following surgery.
| PASS | QuickDASH | ||
|---|---|---|---|
|
|
|||
| no | 80 ± 14% | 14 ± 15 | |
| yes | 68 ±15% | 22 ± 15 | |
| p |
|
0.07 | |
| effect size f | 0.44 | 0.28 | |
|
|
|||
| ≥80% | 82 ± 16% | 12 ± 17 | |
| <80% | 65 ± 11% | 25 ± 14 | |
| p |
|
|
|
| effect size f | 0.63 | 0.42 |
*effect size f index; small=0.10, medium =0.25, large =0.40