Single Assessment Numeric Evaluation (SANE) is a reliable metric to measure clinically significant improvements following shoulder arthroplasty

Anirudh K Gowd; Michael D Charles; Joseph N Liu; Simon P Lalehzarian; Brandon C Cabarcas; Brandon J Manderle; Gregory P Nicholson; Anthony A Romeo; Nikhil N Verma

doi:10.1016/j.jse.2019.04.041

Single Assessment Numeric Evaluation (SANE) is a reliable metric to measure clinically significant improvements following shoulder arthroplasty

J Shoulder Elbow Surg. 2019 Nov;28(11):2238-2246. doi: 10.1016/j.jse.2019.04.041. Epub 2019 Jul 12.

Authors

Anirudh K Gowd¹, Michael D Charles², Joseph N Liu³, Simon P Lalehzarian⁴, Brandon C Cabarcas⁵, Brandon J Manderle⁴, Gregory P Nicholson¹, Anthony A Romeo⁶, Nikhil N Verma⁷

Affiliations

¹ Department of Orthopedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
² Department of Orthopaedic Surgery, University of California San Francisco at Fresno, Fresno, CA, USA.
³ Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
⁴ Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
⁵ Department of Orthopaedics and Sports Medicine, University of Southern Florida Health, Tampa, FL, USA.
⁶ Rothman Orthopaedic Institute, New York, NY, USA.
⁷ Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address: Nikhil.Verma@rushortho.com.

PMID: 31307894
DOI: 10.1016/j.jse.2019.04.041

Abstract

Background: Single Assessment Numeric Evaluation (SANE) offers a simple method of evaluating patients' sense of functional improvement after shoulder arthroplasty.

Methods: Patients receiving total shoulder arthroplasties were retrospectively queried between 2014 and 2017. Patients completed questionnaires involving SANE, American Shoulder and Elbow Surgeons (ASES) score, and Constant scores at the 1-year interval. Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were calculated using the anchor-based methodology.

Results: A total of 207 patients with an average age of 66.7 ± 10.3 years and a body mass index of 31.5 ± 7.3 were available for analysis. The SANE score was the only score to have acceptable area under curve (AUC) (70.5%) for achieving MCID with a cutoff of 28.8. In terms of SCB, ASES (88%) and SANE (70.5%) had acceptable AUC with cutoffs of 20.7 and 50.2, respectively. All 3 scores had excellent AUC (>80%) for PASS with cutoffs of 81.9, 75.5, and 24.5 for ASES, SANE, and Constant scores, respectively. Normalized SANE scores were weakly correlated with ASES and Subjective Constant after normalizing for scale (R2 < 0.4). Achieving MCID by SANE was correlated with achieving MCID by Constant (P < .001). Achieving SCB and PASS by SANE was correlated with achieving SCB and PASS by ASES and Constant (ASES: P = .007, P < .001; Constant: P < .001, P < .001).

Conclusion: The present study establishes clinically significant outcomes for SANE. Achievement of clinically significant outcomes in SANE was correlated with achieving meaningful outcomes with legacy measures of ASES and Constant scores. SANE may be used as a simple and efficient measure of patient outcome after total shoulder arthroplasty.

Keywords: Total shoulder arthroplasty; clinical outcomes; minimal clinically important difference; patient acceptable symptomatic state; single assessment numeric evaluation; substantial clinical benefit.

MeSH terms

Aged
Area Under Curve
Arthroplasty, Replacement, Shoulder*
Female
Humans
Male
Middle Aged
Minimal Clinically Important Difference*
Retrospective Studies
Shoulder Joint / physiopathology*
Shoulder Joint / surgery*
Surveys and Questionnaires*
Treatment Outcome