The American Shoulder and Elbow Surgeons Shoulder Score (ASES) is a mixed outcome reporting tool, applicable for use in all patients with shoulder pathology regardless of their specific diagnosis.

At the time of its development, the goal of ASES was to create a standardized form for the assessment of shoulder function, and to encourage multi-center trials in shoulder and elbow surgery [2,3].

ASES has also been validated for use in patients with osteoarthritis, shoulder instability, rotator cuff injuries and shoulder arthroplasty [5].

The ASES questionnaire is composed of both a physician-rated component and a patient-reported component. The patient questions focus on joint pain, instability and activities of daily living. Only these functional questions and the pain visual analog scale (VAS) are used to tabulate scores. The physician-rated component is usually not reported.

Calculation of the ASES score is a complicated process. The final pain score is calculated via an independent formula, while the raw score from the functional questions is multiplied by a coefficient to get the final score for the functional questions. The pain and functional portions are then summed to obtain the final ASES score [2] with higher scores indicating better outcomes [1]. This scoring methodology is somewhat arduous and can be time-consuming. It is made even more difficult if patients fail to respond to an appropriate number of questions.

The ASES has been found to be comparable to the Shoulder Pain and Disability Index (SPADI) and the Constant Murley Score in terms of responsiveness [3]. A modified version of the ASES questionnaire, the m-ASES also compares favorably to other shoulder rating scales [6].

What PRO Tools are available for Shoulder patients?

Find out in our Upper Extremity and Shoulder PRO Tools Guide.

Strengths

The psychometric properties of the ASES have been well established and its validity, reliability, and responsiveness have been assessed in a variety of shoulder problems including: rotator cuff disease, glenohumeral arthritis, shoulder instability, and shoulder arthroplasty [2].

The ASES score has also been shown to be valid, reliable, and responsive to non-operative treatments [2], and its correlation with other shoulder measures is high for the ASES score [2].

 

Weaknesses

Most physicians will probably find the physician-reported section time consuming,  and the scoring methodology very cumbersome [3]. Although the physician-reported component of the tool was ultimately removed from the scoring system because it was not found to add any value, the scoring may still present a problem.

Another limitation of the tool is that higher functioning patients may experience ceiling effects due to the response structure [2].

Overall, the ASES shoulder score is a good tool for many different shoulder and arm conditions. It compares favorably to many other popular shoulder outcome tools. However, its scoring methodology is complicated and use in clinical trials may lead to poor responsiveness and validity.

 

License

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References

  1. Smith, M. V., Calfee, R. P., Baumgarten, K. M., Brophy, R. H., & Wright, R. W. (2012). Upper Extremity-Specific Measures of Disability and Outcomes in Orthopaedic Surgery. The Journal of Bone and Joint Surgery. American Volume., 94(3), 277–285. http://doi.org/10.2106/JBJS.J.01744 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262183/
  2. Wylie JD, Beckmann JT, Granger E, Tashjian RZ. Functional outcomes assessment in shoulder surgery. World J Orthop 2014; 5(5): 623-633 http://www.wjgnet.com/2218-5836/full/v5/i5/623.htm
  3. Angst, F., Schwyzer, H. K., Aeschlimann, A., Simmen, B. R., & Goldhahn, J. (2011). Measures of adult shoulder function: disabilities of the arm, shoulder, and hand questionnaire (DASH) and its short version (QuickDASH), shoulder pain and disability index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) score (CS), simple shoulder test (SST), Oxford shoulder score (OSS), shoulder disability questionnaire (SDQ), and Western Ontario shoulder instability index (WOSI). Arthritis care & research, 63(S11), S174-S188. http://onlinelibrary.wiley.com/doi/10.1002/acr.20630/full
  4. Kirkley, A., Griffin, S., & Dainty, K. (2003). Scoring systems for the functional assessment of the shoulder. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 19(10), 1109-1120. http://www.arthroscopyjournal.org/article/S0749-8063(03)00973-3/fulltext?refuid=S0749-8063(11)01372-7&refissn=0749-8063
  5. http://freecontent.lww.com/wp-content/uploads/2014/12/Ianotti-Ch36-Measurement-of-Shoulder-Outcomes.pdf
  6. Ellenbecker, T. S., Elmore, E., & Bailie, D. S. (2006). Descriptive report of shoulder range of motion and rotational strength 6 and 12 weeks following rotator cuff repair using a mini-open deltoid splitting technique. Journal of Orthopaedic & Sports Physical Therapy, 36(5), 326-335. http://www.jospt.org/doi/pdfplus/10.2519/jospt.2006.2191