Back

I am a physical therapist in a large hospital setting. Our administrators want us to start testing patients before and after treatment in order to see what value or benefit they are getting. We've each been assigned to find test measures for different problems. Mine is for shoulder surgery. Currently, we are using the DASH for everyone. Do you recommend something else?

Before and after measurements of pain, motion, strength, and function are a good way to track which patients improve with surgery and rate the level of success or failure for each procedure. But as you probably already know, there are over 30 different tests that can be done. You may even recognize the names of some of the most commonly used tests: the American Shoulder and Elbow Surgeons (ASES) shoulder outcome score, the Constant Shoulder Score, Disabilities of the Arm, Shoulder, and Hand (DASH), the Western Ontario Osteoarthritis of the Shoulder Index (WOOS). Here's a little bit about each one. The American Shoulder and Elbow Surgeons (ASES) test has been around for the last 15 years. It was developed by a committee with the hope of using it for research. The ASES can be used with all patients no matter what's wrong with the shoulder. And it can be used for patients treated conservatively (nonoperatively) as well as for those who end up having surgery for their shoulder problem. The ASES assesses pain, instability, and function (activities of daily living or ADLs). The one major disadvantage of this test is the level of difficulty in calculating the score. It is widely used in the U.S. and Europe and can be used for research and for a general idea of how the shoulder is doing. The Constant score is used to measure before and after results from surgery, but it can be used with nonsurgical cases as well. It does measure pain, activities of daily living (ADLs), shoulder motion, and strength. But the Constant score test has not been validated for all different kinds of shoulder problems. And there are problems with examiner bias when it comes to measuring strength and motion. So, for now, this one isn't recommended until some of these issues have been ironed out. Everyone agrees that the Disabilities of the Arm, Shoulder, and Hand (DASH) is a good measure of disability for the arm that can stand alone (i.e., other tests aren't needed along with it). It's a questionnaire patients take answering questions about symptoms and physical function. It can be completed quickly, scored with moderate ease, and used with many different shoulder problems (e.g., arthritis, tendinitis, psoariatic arthritis, rotator cuff problems and repair, shoulder joint replacement). For general assessment and worker's compensation claims, the DASH can't be beat. And finally, the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) is rated the best for assessing results of total shoulder replacement and treatment for arthritis of the shoulder. The patient answers 19 questions about symptoms (including pain), sport, recreation, work, lifestyle, and emotional function. The best thing to do is consider your setting, the type of patients you are seeing most often, and how much detail you need in the information gathered. Once you select the most appropriate tool and use it consistently, you'll have a better idea if that is the one you want to stick with -- or if your patient population should be tested using one of the other tools.

« Back