• Muriel J Solberg, Arnold B Alqueza, Tyler J Hunt, and Laurence D Higgins.
• Boston Shoulder Institute, Brigham and Women's Hospital, Boston, MA. ldhiggins@bwh.harvard.edu.
• Am J. Orthop. 2017 Nov 1; 46 (6): E358-E365.

AbstractShared decision-making provides patients a measure of autonomy in making choices for their health and their future. Patient-reported outcome measures (PROMs) use clinically sensitive and specific metrics to evaluate a patient's self-reported pain, functional ability, and mental state. We conducted a study to create an evidence-based clinical decision-making tool. We used PROMs to create a predictive model of a patient's outcome to help set patient expectations and facilitate a collaborative decision-making environment for patient and physician. The study used a comprehensive prospective database that stores preoperative and 1-year postoperative patient demographics and total shoulder arthroplasty PROM data. Linear regression models were used to evaluate the predictive ability of each factor and the overall predictive ability of each model. One model predicts 1-year postoperative visual analog scale (VAS) pain scores; the other predicts 1-year postoperative American Shoulder and Elbow Surgeons (ASES) Function scores. The total number of observations was 1004 for modeling 1-year postoperative VAS pain scores and 986 for modeling 1-year postoperative ASES Function scores. Regression coefficients and P and ω2 values are reported. Preoperative VAS pain scores predicted 1-year postoperative VAS pain scores (P < .001) but not 1-year postoperative ASES Function scores (P = .485). Preoperative Veterans RAND 12-Item Health Survey (VR-12) mental health component summary (MCS) scores predicted self-reported pain and function (Ps < .001) 1 year after surgery. In these models, preoperative VR-12 MCS score was the most predictive PROM for 1-year postoperative VAS pain score (ω2 = .023) and 1-year postoperative ASES Function score (ω2 = .029). Together, a patient's preoperative VAS pain score, ASES Function score, VR-12 MCS score, age, sex, and type of arthroplasty can provide significant predictive value that may aid in setting appropriate expectations for pain and function 1 year after surgery.

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