What patients with proximal humerus fractures really want and what commonly used outcome scores measure.

Abstract

This study aims (1) to identify patient-reported questionnaire items, independent of age or gender, that reflect healthy shoulder function and treatment satisfaction in patients with proximal humerus fracture (PHF), and (2) to compare these items and their weighted importance with items measured by the most frequently used outcome measures. Patients who sustained a PHF from June 2016 to September 2021 were surveyed with a 29-item questionnaire on their perceptions of item importance as a measure of shoulder function and treatment outcome. Items were generated from the following outcome measures: American Shoulder and Elbow Surgeons score, Constant Score, Neer Score, Oxford shoulder Score (OSS), QuickDASH, and the University of California, Los Angeles shoulder rating score. A mean difference of at least 10% between gender and age groups (<60 vs. ≥60 years) was defined as clinically significant. Items that were rated as at least 90% important without a clinically and statistically significant mean difference between the groups were defined as essential items. One hundred forty-six patients with mean age 60.8 years (range 20-92 years) completed the questionnaires. Only 6 out of 29 items were identified as essential items. These include: being pain-free, being able to sleep/having no pain in bed at night, using a knife and a fork at the same time, putting on a coat/to dress, managing toileting, washing under both arms. None of the scoring systems covered all these items with appropriate weighting of scoring points. The OSS most closely covered patient interest with the most appropriate weighting of points. We identified 6 items from daily life that are of essential importance for patient-reported healthy shoulder function and treatment satisfaction regardless of age and gender. Until a reliable and valid scoring system for PHF is developed that includes these items, we recommend using the OSS, as it most closely reflects patient-reported interests.