Session IX - Upper Extremity

*Assessment of Elbow Function: Discrepancy between Physician and Patient Perspectives

David Ring, MD; Leah Fourt, MD; Jesse B. Jupiter, MD, Massachusetts General Hospital, Boston, MA (all authors ­ a-AO Foundation)

Introduction: Current elbow rating systems combine subjective factors such as pain with objective factors like motion, making it difficult to evaluate discrepancies between patient and physician assessments of elbow function.

Methods: A total of 125 patients with post-traumatic elbow problems were evaluated with standard objective measures and with the DASH, SF-36, and ASES outcome instruments. The correspondence between different scoring systems, objective measures of elbow function, and the overall clinical impression of the surgeon was evaluated statistically. Stepwise multiple linear regression was used to measure the proportion of disability measured by the DASH and SF-36 that was due to various subjective and objective measures.

Results: Rating systems containing both subjective and objective measures correlated well with one another, but only moderately with specific objective measures, outcome instruments, or the surgeon's impression; most of the discrepancies were related to complaints of pain. Stepwise multiple linear regression revealed that complaints of pain account for 34% of variation in the DASH and SF-36. Forearm rotation (13%) and flexion-extension (8%) were far less important.

Discussion: Complaints of pain have a substantial influence on measures of health status, are weighted highly in current elbow scoring systems, and account for most of the discrepancies between patient and physician assessment of elbow function. Pain is a very subjective factor that is strongly influenced by personality traits, psychological makeup, and secondary gain. It may be necessary to develop rating systems based entirely on objectively measurable factors to better study discrepancies between physician and patient assessments of elbow function.