Responsiveness of self-report scales in patients recovering from rotator cuff surgery

A consecutive series of patients (n = 149) completed 4 self reporting scales (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire; Simple Shoulder Test [SST]; Western Ontario Rotator Cuff [WORC] questionnaire; and Short Form 36 [SF-36]) during the week before rotator cuff repair and 6 months after surgery. Patients were divided into 3 groups: those who had a positive response on all 3 upper extremity scales (n = 86) were classified as positive responders, those who did not demonstrate a consistent direction of response across scales were labeled as equivocal responders (n = 36), and those with a negative response across all 3 scales were labeled as negative responders (n = 15). Standardized response means (SRMs) were calculated. The WORC questionnaire (SRM, 2.0) and SST (SRM, 1.8) were most responsive to detecting improvement, followed by the DASH questionnaire (SRM, 1.6). The SF-36 was least responsive, with the largest effect on health being noted in the SF-36 subscale on bodily pain (SRM, 1.1). Pearson correlations indicated moderate associations between change scores across upper limb scales (r = 0.68-0.72) and lower associations with SF-36 physical summary scores (r = 0.40-0.50). Mental health scores were lower at baseline and changed more negatively in patients who did not have a positive response to surgery. No best scale can be identified at this time.