Journal of Shoulder and Elbow Surgery

Characterization of ASES score pain and functional improvement after anatomic total shoulder arthroplasty: a patient centered perspective

Published:November 19, 2021DOI:
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      Interpretation of anchor-based clinical differences in the context of pain and functional change remains undefined. The purpose of this study was to characterize ASES scores for patients after anatomic total shoulder arthroplasty with minimum 1 year follow-up in terms of pain and change in each functional element on the ASES.


      We performed a retrospective study of a prospective institutional patient database of primary anatomic total shoulder arthroplasties from 2017-2020 with baseline and 1-year postoperative ASES scores. Three clinical outcome groups were established using an anchor-based global rating of change assessment: minimal clinically important difference (MCID), moderate clinical benefit (MCB) and, substantial clinical benefit (SCB). Pain and functional outcomes in each group where then characterized and compared.


      A total of 67 patients were analyzed in terms of demographics and clinical outcomes. Two-thirds (65%) of patients achieved the SCB, 24% achieved the MCB, and 10% achieved the MCID. Washing, reaching for a shelf, and throwing were the most common functional deficits experienced preoperatively and accounted for the largest improvement in function postoperatively. Patients in the MCID group had higher preoperative VAS pain scores (7.1 ± 3.0) than MCB (5.8 ± 2.5) or SCB (5.8 ± 2.2) groups (p=0.0612). The MCID group had the least amount of preoperative functional deficits when compared to the MCB and SCB groups (p=0.041). Postoperative VAS pain scores improved by 5.1 in the SCB, 3.6 in the MCB, and 3.7 in the MCID groups. Functional change in each element of the ASES improved by 1.4/4 in the SCB, followed by 0.9/4 in the MCB group, and 0.05/4 in the MCID group (p<0.001).


      The MCID group had higher preoperative pain scores and the least amount of preoperative functional deficits when compared to the MCB and SCB groups. The MCID was realized through pain improvement only while the MCB and SCB consisted of meaningful improvements in pain and function.


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