Original Article| Volume 39, ISSUE 6, P1405-1414, June 2023

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Minimal Clinically Important Differences for Oxford, Constant, and University of California Los Angeles Shoulder Scores After Reverse Shoulder Arthroplasty to Allow Interpretation of Patient-Reported Outcome Measures and Future Statistical Power Analyses

Published:December 30, 2022DOI:


      To determine the minimal clinically important difference (MCID) for the Constant–Murley Score (CMS), University of California Los Angeles (UCLA) Shoulder Score, and Oxford Shoulder Score (OSS) after reverse shoulder arthroplasty.


      Patients were prospectively followed up between January 2011 and February 2020. Inclusion criteria was that of patients who underwent reverse shoulder arthroplasty for massive irreparable cuff tear, cuff tear arthropathy, and fractures, with and without previous cuff repair, by a fellowship-trained surgeon. Patients were assessed preoperatively and at 3, 6, and 12 months’ postoperatively. Functional outcome was assessed by the CMS, UCLA Shoulder Score, and OSS and the respective MCIDs were determined using simple linear regression in consonance with patient satisfaction and expectation fulfilment.


      A total of 131 patients were followed up for 12 months. The MCIDs at 3 months for CMS, UCLA Shoulder Score, and OSS were 7.2, 3.3, and 6.9, respectively. At 6 months, the MCIDs for CMS, UCLA Shoulder Score, and OSS were 6.6, 2.4, and 4.7, respectively. At 12 months, the MCIDs for CMS, UCLA Shoulder Score, and OSS were 9.3, 2.9, and 6.6, respectively.


      CMS, UCLA Shoulder Score, and OSS are valid scores to calculate MCID after reverse shoulder arthroplasty, and the MCID established in this study can be used for the interpretation of these scores to help in statistical power analysis for future studies.

      Level of Evidence

      III, retrospective cohort study.
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        • Ernstbrunner L.
        • Andronic O.
        • Grubhofer F.
        • Camenzind R.S.
        • Wieser K.
        • Gerber C.
        Long-term results of reverse total shoulder arthroplasty for rotator cuff dysfunction: A systematic review of longitudinal outcomes.
        J Shoulder Elbow Surg. 2019; 28: 774-781
        • Fraser A.N.
        • Bjørdal J.
        • Wagle T.M.
        • et al.
        Reverse shoulder arthroplasty is superior to plate fixation at 2 years for displaced proximal humeral fractures in the elderly: A multicenter randomized controlled trial.
        J Bone Joint Surg Am. 2020; 102: 477-485
        • Shukla D.R.
        • McAnany S.
        • Kim J.
        • Overley S.
        • Parsons B.O.
        Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: A meta-analysis.
        J Shoulder Elbow Surg. 2016; 25: 330-340
        • Jaeschke R.
        • Singer J.
        • Guyatt G.H.
        Measurement of health status. Ascertaining the minimal clinically important difference.
        Controlled Clinical Trials. 1989; 10: 407-415
        • Bohannon R.W.
        • Crouch R.
        Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: A systematic review.
        J Eval Clin Pract. 2017; 23: 377-381
        • Clement N.D.
        • Bardgett M.
        • Weir D.
        • Holland J.
        • Gerrand C.
        • Deehan D.J.
        What is the minimum clinically important difference for the WOMAC index after TKA?.
        Clin Orthop Rel Res. 2018; 476: 2005-2014
        • Xu S.
        • Chen J.Y.
        • Lie H.M.E.
        • Hao Y.
        • Lie D.T.T.
        Minimal clinically important difference of Oxford, Constant, and UCLA shoulder score for arthroscopic rotator cuff repair.
        J Orthop. 2020; 19: 21-27
        • Coghlan J.A.
        • Bell S.N.
        • Forbes A.
        • Buchbinder R.
        Comparison of self-administered University of California, Los Angeles, Shoulder Score with traditional University of California, Los Angeles, shoulder score completed by clinicians in assessing the outcome of rotator cuff surgery.
        J Shoulder Elbow Surg. 2008; 17: 564-569
        • Olley L.M.
        • Carr A.J.
        The use of a patient-based questionnaire (the Oxford Shoulder Score) to assess outcome after rotator cuff repair.
        Ann R Coll Surg Eng. 2008; 90: 326-331
        • Placzek J.D.
        • Lukens S.C.
        • Badalanmenti S.
        • et al.
        Shoulder outcome measures: A comparison of 6 functional tests.
        Am J Sports Med. 2004; 32: 1270-1277
        • Constant C.R.
        • Murley A.H.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop Rel Res. 1987; 214: 160-164
        • Hirschmann M.T.
        • Wind B.
        • Amsler F.
        • Gross T.
        Reliability of shoulder abduction strength measure for the Constant-Murley score.
        Clin Orthop Rel Res. 2010; 468: 1565-1571
        • Johansson K.M.
        • Adolfsson L.E.
        Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment.
        J Shoulder Elbow Surg. 2005; 14: 273-278
        • Kemp K.A.
        • Sheps D.M.
        • Beaupre L.A.
        • Styles-Tripp F.
        • Luciak-Corea C.
        • Balyk R.
        An evaluation of the responsiveness and discriminant validity of shoulder questionnaires among patients receiving surgical correction of shoulder instability.
        ScientificWorldJournal. 2012; 2012410125
        • Roy J.S.
        • MacDermid J.C.
        • Woodhouse L.J.
        A systematic review of the psychometric properties of the Constant-Murley score.
        J Shoulder Elbow Surg. 2010; 19: 157-164
        • Amstutz H.C.
        • Sew Hoy A.L.
        • Clarke I.C.
        UCLA anatomic total shoulder arthroplasty.
        Clin Orthop Rel Res. 1981; 155: 7-20
        • Ellman H.
        Arthroscopic subacromial decompression: Analysis of one- to three-year results.
        Arthroscopy. 1987; 3: 173-181
        • Nutton R.W.
        • McBirnie J.M.
        • Phillips C.
        Treatment of chronic rotator-cuff impingement by arthroscopic subacromial decompression.
        J Bone Joint Surg Br. 1997; 79: 73-76
        • Ellman H.
        • Kay S.P.
        • Wirth M.
        Arthroscopic treatment of full-thickness rotator cuff tears: 2- to 7-year follow-up study.
        Arthroscopy. 1993; 9: 195-200
        • Dawson J.
        • Fitzpatrick R.
        • Carr A.
        Questionnaire on the perceptions of patients about shoulder surgery.
        J Bone Joint Surg Br. 1996; 78: 593-600
        • Dawson J.
        • Hill G.
        • Fitzpatrick R.
        • Carr A.
        The benefits of using patient-based methods of assessment. Medium-term results of an observational study of shoulder surgery.
        J Bone Joint Surg Br. 2001; 83: 877-882
        • Wells G.
        • Beaton D.
        • Shea B.
        • et al.
        Minimal clinically important differences: Review of methods.
        J Rheumatol. 2001; 28: 406-412
        • Mouelhi Y.
        • Jouve E.
        • Castelli C.
        • Gentile S.
        How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods.
        Health Qual Life Outcomes. 2020; 18: 136
        • Maredupaka S.
        • Meshram P.
        • Chatte M.
        • Kim W.H.
        • Kim T.K.
        Minimal clinically important difference of commonly used patient-reported outcome measures in total knee arthroplasty: Review of terminologies, methods and proposed values.
        Knee Surg Rel Res. 2020; 32: 19
        • Khow Y.A.-O.
        • Liow M.A.-O.
        • Goh G.A.-O.
        • Chen J.A.-O.
        • Lo N.N.
        • Yeo S.J.
        Defining the minimal clinically important difference for the Knee Society Score following revision total knee arthroplasty.
        Knee Surg Sports Traumatol Arthrosc. 2022; 30: 2744-2752
        • Lee W.C.
        • Kwan Y.H.
        • Chong H.C.
        • Yeo S.J.
        The minimal clinically important difference for Knee Society Clinical Rating System after total knee arthroplasty for primary osteoarthritis.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 3354-3359
        • Nyring M.R.K.
        • Olsen B.S.
        • Amundsen A.
        • Rasmussen J.V.
        Minimal Clinically Important Differences (MCID) for the Western Ontario Osteoarthritis of the Shoulder Index (WOOS) and the Oxford Shoulder Score (OSS).
        Patient Rel Outcome Meas. 2021; 12: 299-306
        • Grammont P.
        • Trouilloud P.
        • Laffay J.P.
        • Deries X.J.R.
        Etude et réalisation d'une nouvelle prothèse d'épaule.
        Rhumatologie. 1987; 39 ([in French]): 407-418
        • Schrumpf M.A.
        • Jones K.J.
        • Dines D.M.
        Reverse total shoulder arthroplasty: Restoring function.
        Semin Arthroplasty. 2012; 23: 83-89
        • Frankle M.
        • Siegal S.
        • Pupello D.
        • Saleem A.
        • Mighell M.
        • Vasey M.
        The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients.
        J Bone Joint Surg Am. 2005; 87: 1697-1705
        • Sirveaux F.
        • Favard L.
        • Oudet D.
        • Huquet D.
        • Walch G.
        • Molé D.
        Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders.
        J Bone Joint Surg Br. 2004; 86: 388-395
        • Wall B.
        • Nové-Josserand L.
        • O'Connor D.P.
        • Edwards T.B.
        • Walch G.
        Reverse total shoulder arthroplasty: A review of results according to etiology.
        J Bone Joint Surg Am. 2007; 89: 1476-1485
        • Revicki D.
        • Hays R.D.
        • Cella D.
        • Sloan J.
        Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes.
        J Clin Epidemiol. 2008; 61: 102-109
        • Randsborg P.H.
        • Adamec D.
        • Cepeda N.A.
        • Ling D.I.
        Two-year recall bias after ACL reconstruction is affected by clinical result.
        JB JS Open Access. 2021; 6
        • Tashjian R.Z.
        • Deloach J.
        • Green A.
        • Porucznik C.A.
        • Powell A.P.
        Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease.
        J Bone Joint Surg Am. 2010; 92: 296-303
        • Kukkonen J.
        • Kauko T.
        • Vahlberg T.
        • Joukainen A.
        • Aärimaa V.
        Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery.
        J Shoulder Elbow Surg. 2013; 22: 1650-1655
        • Nasca R.J.
        Patient-reported outcomes unbiased by length of follow-up after lumbar degenerative spine surgery: Do we need 2 years of follow-up?.
        Spine J. 2019; 19: 1597
        • Torrens C.
        • Guirro P.
        • Santana F.
        The minimal clinically important difference for function and strength in patients undergoing reverse shoulder arthroplasty.
        J Shoulder Elbow Surg. 2016; 25: 262-268
        • Park I.
        • Lee J.H.
        • Hyun H.S.
        • Lee T.K.
        • Shin S.J.
        Minimal clinically important differences in Rowe and Western Ontario Shoulder Instability Index scores after arthroscopic repair of anterior shoulder instability.
        J Shoulder Elbow Surg. 2018; 27: 579-584
        • Grundshtein A.
        • Kazum E.
        • Chechik O.
        • et al.
        Arthroscopic repair of humeral avulsion of glenohumeral ligament lesions: Outcomes at 2-year follow-up.
        Orthop J Sports Med. 2021; 923259671211004968
        • Simovitch R.
        • Flurin P.H.
        • Wright T.
        • Zuckerman J.D.
        • Roche C.P.
        Quantifying success after total shoulder arthroplasty: the minimal clinically important difference.
        J Shoulder Elbow Surg. 2018; 27: 298-305
        • Uppstrom T.J.
        • Sullivan S.W.
        • Burger J.A.
        • Ranawat A.S.
        • Kelly B.T.
        • Nwachukwu B.U.
        Defining minimal clinically important difference after open hip abductor repair.
        Orthop J Sports Med. 2021; 923259671211007740
        • Kim M.S.
        • Koh I.J.
        • Choi K.Y.
        • et al.
        The minimal clinically important difference (MCID) for the WOMAC and factors related to achievement of the MCID after medial opening wedge high tibial osteotomy for knee osteoarthritis.
        Am J Sports Med. 2021; 49: 2406-2415
        • Werner B.C.
        • Chang B.
        • Nguyen J.T.
        • Dines D.M.
        • Gulotta L.V.
        What change in American Shoulder and Elbow Surgeons score represents a clinically important change after shoulder arthroplasty?.
        Clin Orthop Rel Res. 2016; 474: 2672-2681