Assessment of patient-based outcomes: The case of rotator cuff repair

Despite substantial progress in our understanding of rotator cuff pathophysiology and in our abilities to improve quality of life to patients suffering from rotator cuff pathology, significant controversies persist in this area. Specifically, the evolving role of the arthroscope in the treatment of both partial and full thickness rotator cuff tears and in various other alternative techniques of rotator cuff repair is debated. Furthermore, substantial geographic variation in the rates of rotator cuff repair have been documented, suggesting variations in appropriate indications for use of this procedure. Moreover, although rotator cuff tendon repair is primarily aimed at restoring quality of life of affected individuals, a paucity of literature has explicitly examined quality of life endpoints in this area despite the rapid evolution of techniques to better assess broadly defined patient outcomes. Thus, the application of newly emerging methods of rigorous, patient-based clinical research in this area is clearly needed. This article reviews methods of assessing patient-based outcomes and suggests ways that these emerging methodologies can be applied to improve the understanding of outcome in patients with rotator cuff problems.