# Utilization of patient-reported outcome measures in shoulder and elbow surgery: a survey-based study

## TL;DR

This study explores how often doctors in Germany, Austria, and Switzerland use patient-reported outcome measures in shoulder and elbow surgery and identifies barriers to their use.

## Contribution

The study provides insights into the current utilization and perceived barriers of PROMs in shoulder and elbow surgery in the D-A-CH region.

## Key findings

- Only 46% of physicians incorporate PROMs into daily practice, with significant variation in specific measures used.
- Paper questionnaires remain the primary method for collecting PROMs, with limited use of digital tools.
- PROMs are valued for research and treatment quality but hindered by subjective patient input and workload.

## Abstract

Patient-reported outcome measures (PROMs) are widely established in shoulder and elbow surgery, as they are able to reflect the functional outcome after a respective treatment. However, various challenges exist to add PROMs into in the daily clinical practice. The aim of the presented study was to analyze the utilization of PROMs among shoulder and elbow physicians in Germany, Austria, and Switzerland.

An online questionnaire (SurveyMonkey) assessed the use of shoulder- and elbow-specific PROMs in orthopedic and trauma surgery clinics across the D-A-CH region. Distributed via the D-A-CH Society for Shoulder and Elbow Surgery email list, surveys were enlisted from April to December 2024. Participation was voluntary, anonymous, and implied consent. Due to anonymity, European data protection regulations were not applicable. Ethical approval was obtained.

Among 124 participants, 82% were male and 17% female. While 54% did not use PROMs, 46% incorporated them into daily practice. For shoulders, Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH)/quick Disabilities of the Arm, Shoulder and Hand Questionnaire (73%), Simple Shoulder Test (29%), and ROWE Score (21%) were most frequently used. Regarding elbows, 54% did not use PROMs, DASH (29%) and Mayo Elbow Performance Score (25%) were most common among users. PROMs were primarily collected via paper questionnaires (58%) or not with digital tools (23%). PROMs were valued for scientific research (73%), therapy monitoring (71%), and treatment quality improvement (56%). Key disadvantages included subjective patient perception (71%), needed patient collaboration (67%), and additional workload (63%).

PROMs are still rarely used in daily clinical practice but are valued for enhancing research and treatment quality by integrating patients' subjective experiences. Key barriers include the lack of affordable, user-friendly digital solutions. Future efforts may focus on professional society recommendations for suitable PROMs and the establishment of their digital measuring.