Can Patients Accurately Recall their Preoperative Pain and Functional Scores Following Rotator Cuff Repair and Total Shoulder Arthroplasty?

Document Type : RESEARCH PAPER


1 Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA

2 Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA


Background: Accurate analysis of preoperative shoulder pain and function is important for understanding treatment 
efficacy and producing high-quality research. Oftentimes, preoperative patient-reported outcomes (PROs) are 
missing. Therefore the accuracy of recalled preoperative PROs may be significant. We investigate the ability of 
patients who underwent rotator cuff repair (RCR) or shoulder arthroplasty (TSA) to recall their preoperative PROs.
Methods: We identified 145 patients who underwent either RCR or TSA and had preoperative PROs. All patients 
completed the ASES, SANE, SST, and VAS surveys within 3 months prior to surgery. Patients were contacted 
between one and four years after surgery and asked to recall their baseline pain and shoulder function prior to 
surgery. The mean difference was calculated by determining the difference between the mean recalled score and 
the mean actual score. Intraobserver reliability analysis was performed, comparing recall and actual score for 
each using the 2-way mixed-effects intraclass correlation coefficient (ICC) model. The ICC values > 0.75 were 
considered excellent, values between 0.4 and 0.75 were considered moderate, and values of < 0.4 demonstrated 
a weak agreement. 
Results: For patients who underwent RCR, the mean differences between actual and recalled ASES, SANE, SST 
and VAS pain were 6.3 (P=0.004), 2.0 (P=0.155), -0.04 (P=0.625) and - 1.0 (P<0.001), respectively. In patients 
who underwent TSA, the mean differences between actual and recalled ASES, SANE, SST and VAS pain were 4.5 
(P =0.038), -3.9 (P=0.262), -1.2 (P=0.001) and -1.5 (P<0.001), respectively. ASES, SST, and VAS show moderate 
reliability, and SANE reliability was weak in both RCR and TSA populations. Patients had a tendency to recall higher 
pain scores than actual preoperative pain scores. 
Conclusion: In patients who underwent RCR or TSA, there was too much variability between individual patient’s 
ability to accurately recall preoperative pain and function to reliably use recall data for research purposes. 
Level of evidence: IV