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

Document Type : RESEARCH PAPER

Authors

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

Abstract

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

Keywords

References

  1. Broderick JE, Stone AA, Calvanese P, Schwartz JE, Turk DC. Recalled pain ratings: A complex and poorly defined task. J Pain. 2006; 7(2):142-149
  2. Gavaruzzi T, Carnaghi A, Lotto L, Rumiati R, Meggiato T, Polato F, et al. Recalling pain experienced during a colonoscopy: Pain expectation and variability. Br J Health Psychol. 2010; 15:253-264
  3. Singer AJ, Kowalska A, Thode J. Ability of patients to accurately recall the severity of acute painful events. Acad Emerg Med. 2001; 8(3):292-295
  4. Lingard EA, Wright EA, Sledge CB. Pitfalls of using patient recall to derive preoperative status in outcome studies of total knee arthroplasty. J Bone Joint Surg AM. 2001;83(8):1149–1156
  5. Bryant D, Norman G, Stratford P, Marx RG, Walter SD, Guyatt G. Patients undergoing knee surgery provided accurate ratings of preoperative quality of life and function 2 weeks after surgery. J Clin Epidemiol. 2006; 59(9):984-993
  6. Marsh J, Bryant D, MacDonald SJ. Older patients can accurately recall their preoperative health status six weeks following total hip arthroplasty. J Bone Joint Surg AM. 2009;91(12):2827–2837
  7. Mancuso CA, Charlson ME. Does recollection error threaten the validity of cross-sectional studies of effectiveness? Med Care. 1995; 33(4 Suppl):AS77-88
  8. Stepan JG, London DA, Boyer MI, Calfee RP. Accuracy of patient recall of hand and elbow disability on the quickdash questionnaire over a two-year period. J Bone Joint Surg AM. 2013; 95(22):e17
  9. Easton RM, Bendinelli C, Sisak K, Enninghorst N, Regan D, Evans J, et al. Recalled pain scores are not reliable after acute trauma. Injury. 2012; 43(7):1029-1032
  10. Kocher MS, Horan MP, Briggs KK, Richardson TR, O’Holleran J, Hawkins RJ. Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. J Bone Joint Surg AM. 2005; 87(9):2006-2011
  11. Roy JS, Macdermid JC, Woodhouse LJ. Measuring shoulder function: A systematic review of four questionnaires. Arthritis Care Res. 2009; 61(5):623-623
  12. Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587-594
  13. Godfrey J, Hamman R, Lowenstein S, Briggs K, Kocher M. Reliability, validity, and responsiveness of the simple shoulder test: Psychometric properties by age and injury type. J Shoulder Elbow Surg. 2007;16(3):260-267
  14. Williams GN, Gangel TJ, Arciero RA, Uhorchak JM, Taylor DC. Comparison of the single assessment numeric evaluation method and two shoulder rating scales. Outcomes measures after shoulder surgery. Am J Sports Med. 1999; 27(2):214-221.
  15. Wylie JD, Beckmann JT, Granger E, Tashjian RZ. Functional outcomes assessment in shoulder surgery. World J Orthop. 2014; 5(5):623-633
  16. Lindsay GM, Niven KA, Brodie EE, Gaw A, Belcher PR. Accuracy of patient recall of preoperative symptom severity (angina and breathlessness) at one year following aorta-coronary artery bypass grafting. J Clin Nurs. 2009; 18(3):418-425
  17. Wilson J, Baker P, Rangan A. Is retrospective application of the Oxford Shoulder Score valid? J Shoulder Elbow Surg. 2009;18(4):577-580
  18. Howell J, Xu M, Duncan CP, Masri BA, Garbuz DS. A Comparison Between Patient Recall and Concurrent Measurement of Preoperative Quality of Life Outcome in Total Hip Arthroplasty. J Arthroplasty. 2008;23(6):843–849.
  19. Gotlin MJ, Kingery MT, Baron SL, McCafferty J, Jazrawi LM, Meislin RJ. Recall Bias in Retrospective Assessment of Preoperative Patient-Reported American Shoulder and Elbow Surgeons Scores in Arthroscopic Rotator Cuff Repair Surgery. Am J Sports Med. 2020; 48(6):1471-1475
  20. Lowe JT, Li X, Fasulo SM, Testa EJ, Jawa A. Patients recall worse preoperative pain after shoulder arthroplasty than originally reported: a study of recall accuracy using the American Shoulder and Elbow Surgeons score. J Shoulder Elbow Surg. 2017;26(3):506-511
  21. Pellisé F, Vidal X, Hernández A, Cedraschi C, Bagó J, Villanueva C. Reliability of retrospective clinical data to evaluate the effectiveness of lumbar fusion in chronic low back pain. Spine (Phila Pa 1976). 2005; 30(3):365-8.
  22. Erskine A, Morley S, Pearce S. Memory for pain: a review. Pain. 1990;41(3):255-265

 

The Archives of Bone and Joint Surgery
Volume 11, Issue 3
March 2023
Pages 160-165

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History

  • Receive Date: 02 November 2021
  • Accept Date: 19 December 2021
  • First Publish Date: 17 October 2022

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