Mr J. Tyler and Prof B Singh Medway Foundation Trust 2 WEEKS AFTER AN ARTHROSCOPIC SHOULDER PROCEDURE PATIENTS HAVE FORGOTTEN THEIR PRE-OPERATIVE SYMPTOMS. Mr J. Tyler and Prof B Singh Medway Foundation Trust

Declaration This study made up part of an University of Brighton MSc project. No industry funding.

Introduction This study investigates whether arthroscopic shoulder surgery confounds memory of pre-operative symptoms. It is accepted that patients forget their pre-operative symptoms once they undergo a surgical procedure. The authors wished to quantify this using an accepted and validated symptom scoring system.

DASH outcome measure This is a widely used Patient reported outcome measure It well-validated measure of upper limb symptom progression. Upper limb surgery outcome can be evaluated by comparing pre- and post-operative DASH scores.

The hypothesis If patients can remember their pre-operative symptoms after surgery then a ‘recall’ DASH score obtained after surgery would be similar to the DASH score obtained prior to surgery.

Methods Prospective cohort of 25 patients undergoing arthroscopic shoulder surgery DASH outcome measure obtained prior to surgery DASH outcome measure obtained after surgery; patients asked to recall their pre-operative symptoms DASH scores compared using intraclass correlation coefficient (ICC 2,1). 2 way random effects analysis of variance with 2 recorded measures

Results Procedure Number ASAD 7 ASAD + ACJ excision 4 SLAP repair Rotator cuff repair 6 Arthroscopic arthrolysis TOTAL 25

Statistics 2 patients incorrectly filled the pre-operative DASH questionnaire and were excluded DASH outcome scores tested for normality. Normally distributed Paired T test performed to compare the means. Similar means SPSS Normal Q-Q plots, histograms with a normal curve overlaid and a Shapiro-Wilk test

Correlations

Intraclass correlation coefficient

Discussion There was a large discrepancy between the ICC obtained in previous validation experiments: 0.96(1) and the ICC obtained in our study: 0.55. Pearson correlation obtained in the validation experiments: 0.96(1) were also vastly superior to our results: 0.55.

Conclusion This study shows that an arthroscopic shoulder operation confounds patients’ memory of symptoms and confirms the need to score patients symptoms prior to a surgical procedure

Reference: 1. Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001 Mar;14(2):128–46.