Reliability, validity, and responsiveness of a novel subscapularis outcome score: the Baltimore Orthopedic Subscapularis Score

Authors

Max Hamaker, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Blessing Enobun, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Samir Kaveeshwar, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
S Ashfaq Hasan, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Brian Shiu, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
R Frank Henn, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Kelly Kilcoyne, Department of Orthopedics, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Umasuthan Srikumaran, Johns Hopkins Medicine, Baltimore, MD, USA.
Gregory Gasbarro, Orthopaedic Specialty Hospital Mercy Medical Center, Baltimore, MD, USA.
Zachary R Zimmer, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Mohit N. Gilotra, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

11-1-2022

Journal

JSES international

Volume

6

Issue

6

DOI

10.1016/j.jseint.2022.08.006

Keywords

Outcomes assessment; Rotator cuff tears; Shoulder score; Subscapularis

Abstract

BACKGROUND: Available surveys that evaluate shoulder strength and pain often combine rotator cuff muscles making the test unable to differentiate subscapularis tears from other pathology including concomitant supraspinatus, infraspinatus tears. The purpose of this study was to validate a subscapularis-specific shoulder survey (Baltimore Orthopedic Subscapularis Score) as a viable clinical outcome assessment through analysis of psychometric properties. METHODS: A 5-question survey was given to a study population of 390 patients, 136 of whom had full thickness rotator cuff tears with a minimum score of 5 (better) and a maximum score of 25 (worse). Surveys were given during the initial consultation, preoperative visit, and postoperative visit. Content validity, construct validity, test-retest reliability, responsiveness to change, internal consistency, and minimal clinically important difference using distribution and anchor-based methods were determined for our subscapularis function survey. RESULTS: A high correlation was reported on test-retest reliability (intraclass correlation coefficient = 0.89). An acceptable internal consistency was reported for all patients surveyed (Cronbach alpha = 0.91). Floor and ceiling effects for patients with rotator cuff pathology were minimized (1% for both). Patients with an isolated subscapularis tear scored worse than supraspinatus/infraspinatus tears and exhibited similar dysfunction as patients with a supraspinatus/infraspinatus/subscapularis tear. An acceptable construct validity was reported with subscapularis-involved tears demonstrating higher scores with significance ( < .05). There was excellent responsiveness to change with a standardized response mean of 1.51 and effect size of 1.27 (large > 0.8). The minimal clinically important difference using a distribution and anchor-based method was 4.1 and 4.6, respectively. Among patients with rotator cuff tears in this population, a score of 22 or higher predicts a subscapularis tear 75% of the time, in spite of its low overall prevalence. CONCLUSION: The subscapularis shoulder score demonstrated acceptable psychometric performance for outcomes assessment in patients with rotator cuff disease. This survey can be used as an effective clinical tool to assess subscapularis function.

APA Citation

Hamaker, Max; Enobun, Blessing; Kaveeshwar, Samir; Hasan, S Ashfaq; Shiu, Brian; Henn, R Frank; Kilcoyne, Kelly; Srikumaran, Umasuthan; Gasbarro, Gregory; R Zimmer, Zachary; and Gilotra, Mohit N., "Reliability, validity, and responsiveness of a novel subscapularis outcome score: the Baltimore Orthopedic Subscapularis Score" (2022). GW Authored Works. Paper 1998.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1998

Department

Orthopaedic Surgery