Penn Shoulder Score (PSS)
Patient outcome-reporting measures for the shoulder generally evaluate patient pain, their current satisfaction level with their shoulder and the joint’s overall functionality.
The majority of reporting measures on the market contain these elements or a variation of them, but some researchers and clinicians believe that none of them adequately assess each measure on its own. The Penn Shoulder Score (PSS) is a PRO measure developed in 1999 to try to address these perceived deficiencies.
When considering the pain scale, most shoulder measures on the market today only contain one pain scale, which on its own may not adequately capture a patient’s true pain status. This is because shoulder pain is often intermittent and its presence is dependent on what activities are being carried out. The pain subscale of the Penn Shoulder Score measure asks patients about pain at rest, pain with normal activities and pain with strenuous activities. These options give full coverage to the spectrum of timings a patient might experience pain, which is not necessarily captured in other outcome measures.
With regards to patient satisfaction, this dimension is rarely covered by most measures. However, it is an important metric to consider because patients may achieve a ‘‘good’’ or ‘‘excellent’’ score on an outcome measure, but actually remain unsatisfied with their ability to use the shoulder. Although function and disability items are included in many shoulder reporting measures, the items included in this dimension differ in each scale. In addition, the available response options and scoring in many scales does not consider whether the patient performed the activity prior to their injury or surgery. Therefore, a patient will be ‘‘penalized’’ points on a questionnaire if the patient does not or has never engaged in a particular activity. In the PSS measure, maximum points are awarded if all activities can be performed without difficulty.
Additionally, if applicants do not find questions applicable to them, an option of ‘‘did not do before injury’’ is available. This solves the problem of penalizing points that is inherent in other questionnaires.
Higher scores on the Penn Shoulder Score measure indicate better shoulder function, lower pain and higher satisfaction. Additionally, the sub-scales can also be used in aggregate or looked at independently.
The individual subscales and the PSS total score are considered reliable, valid measures that can be used confidently to assess the outcome of both individuals and groups of patients with shoulder disorders.
The Penn Shoulder Score pays more attention to the pain subscale than comparable outcome measures and includes a satisfaction subscale which is missing in many others. Both of these attributes give the clinician better insight into the patient’s pain and attitude with regards to their shoulder.
The questionnaire itself can be completed in less than ten (10) minutes and the scores calculated quickly. The PSS has excellent test-retest reliability and can be used for a variety of shoulder disorders.
The Penn Shoulder Score does not appear to have any major considerations, although it has been used less frequently in the literature compared to other outcome scales.
Overall, PSS is a reliable and valid measure for evaluating outcomes from various shoulder disorders and is a measure that gives physicians more information regarding a patient’s pain and satisfaction.
The Penn Shoulder Score does not require a license. To learn more about the Penn Shoulder Score and view the tool, please see their validation publication: www.jospt.org/doi/pdf/10.2519/jospt.2006.36.3.138.
The Penn Shoulder Score: Reliability and Validity