Scientific Articles   |    
The Impact of Response Shift on Perceived Disability Two Years Following Rotator Cuff Surgery
Helen Razmjou, MSc, PT, PhD1; Carolyn E. Schwartz, ScD2; Richard Holtby, MB, BS, FRCSC1
1 Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 43 Wellesley Street East, Toronto, ON M4Y 1H1, Canada. E-mail address for H. Razmjou: Helen.razmjou@Sunnybrook.ca
2 DeltaQuest Foundation, Inc., Concord, MA 01742
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Sep 15;92(12):2178-2186. doi: 10.2106/JBJS.I.00990
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case



Understanding how patients appraise their health-related problems is important for an accurate assessment of recovery over time. It has been proposed that the response shift phenomenon has an impact on self-report measures, and this may subsequently affect measurement of true treatment effects. The objective of the present study was to explore the impact of response shift on the subjective perception of disability following rotator cuff surgery.


We conducted a repeated-measures study of the outcome following surgical decompression or repair of the rotator cuff. The American Shoulder and Elbow Surgeons (ASES) questionnaire was used in a thentest design to measure recalibration response shift two years following surgery. Disability was measured with a disease-specific measure. Objective findings consisting of the range of motion and strength were recorded preoperatively and postoperatively. Parametric and nonparametric univariate and multivariate analyses were performed. The contribution of recall bias was estimated by assessing agreement between pretest and thentest scores on the basis of the percentage of agreement and the Spearman correlation coefficient.


One hundred and seven patients (forty-one women and sixty-six men; mean age, fifty-seven years) participated in the study. Seventy-two patients had decompression surgery and forty-four underwent a rotator cuff repair; nine patients had both procedures. A significant response shift was observed in the pain domain (p < 0.0001) and not in the functional ability domain of the ASES (p = 0.58). Three distinct patterns of response shift were observed. Univariate analyses showed that satisfaction with the result of the surgery, the range of motion, strength, age, and response shift were associated with disability. The final multivariate analysis showed that disability at two years following the surgery was affected by the range of motion (p < 0.0001), satisfaction (p = 0.006), age (p = 0.02), and response shift (p = 0.03).


The response shift phenomenon exists in patients who have undergone surgery for rotator cuff disorders and has different patterns related to overrating or underrating of preoperative pain. A recalibration response shift characterized by overrating of preoperative pain was associated with lower levels of residual disability at two years following the surgery.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    OH - University Hospitals Case Medical Center
    WY - Memorial Hospital of Sweetwater County
    OR - The Center - Orthopedic and Neurosurgical Care and Research