Patient-reported outcome measures (PROMs) for the shoulder generally evaluate a patient’s pain, current satisfaction level with their shoulder, and the joint’s overall functionality.
The majority of reporting tools on the market contain these elements or a variation of them, but some researchers and clinicians feel that none of them adequately assess each measure on its own . The Penn Shoulder Score (PSS) is a PRO measure that was developed in 1999 to try to address these perceived deficiencies.
When considering the pain scale, most shoulder tools on the market today only contain one pain scale. On its own, this may not adequately capture a patients’ true pain status 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 tool asks patients about pain at rest, pain with normal activities, and pain with strenuous activities. These options give full coverage to the spectrum of timing a patient might experience pain which isn’t necessarily captured in other outcome measures.
With regards to patient satisfaction, this dimension is rarely covered by most tools. However, it’s an important metric to consider because patients may achieve a “good” or “excellent” score on an outcome tool, 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” for points on a questionnaire if the patient does not or has never engaged in a particular activity . In the PSS tool, 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.
A higher score means better shoulder function, higher satisfaction, and lower pain levels. 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 and 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 tools, and includes a satisfaction subscale which is missing in many others. Both of these attributes give the clinician better insight into the patients’ pain and attitude with regards to their shoulder.
The questionnaire itself is quick to complete, taking no more than 10 minutes and scores can be quickly calculated. The PSS has excellent test-retest reliability and can be used for a variety of shoulder disorders.
PSS doesn’t appear to have any major weaknesses, although it’s been used less frequently in the literature compared to other outcome scales.
Overall, the PSS is a reliable and valid measure for evaluating outcomes from various shoulder disorders, and is a tool that gives physicians more information regarding a patients’ pain and satisfaction.
- Leggin, B. G., Michener, L. A., Shaffer, M. A., Brenneman, S. K., Iannotti, J. P., & Williams Jr, G. R. (2006). The Penn shoulder score: reliability and validity. Journal of Orthopaedic & Sports Physical Therapy, 36(3), 138-151. http://www.jospt.org/doi/pdf/10.2519/jospt.2006.36.3.138