Psychometric properties of the Single Assessment Numeric Evaluation (SANE) in patients with shoulder conditions. A systematic review

BACKGROUND: Musculoskeletal injuries (i.e. shoulder pain) is the third most commonly reported symptom. The development of the Single Assessment Numeric Evaluation (SANE) scale has presented clinicians and researchers with a more efficient approach in measuring function. Therefore, it is important to establish the reliability, validity and responsiveness properties of this scale, prior to its application in research and clinic. OBJECTIVES: To identify, critically appraise and synthesize the reported psychometric properties of the SANE scale in patients with shoulder related pathologies. DATA SOURCES: Medline, Embase, Scopus and CINAHL databases from inception till February 2019 were searched. Two independent reviewers carried out the systematic electronic searches in each database and screened the retrieved studies and assessed their eligibility. STUDY SELECTION OR ELIGIBILITY CRITERIA: Randomized/prospective studies, that included patients with shoulder joint related pathologies, that reported on the psychometric properties (reliability, validity, responsiveness) of SANE scale. STUDY APPRAISAL AND SYNTHESIS METHODS: The "Quality Appraisal for Clinical Measurement Research Reports Evaluation Form" - a 12-item structured clinical measurement specific appraisal tool was used to assess studies. A qualitative synthesis was performed, and main results summarized based on the shoulder conditions, reported properties and study quality. RESULTS: Nine studies were included. The quality ranged from 82% to 95% - very good to excellent quality. SANE scale reliability measures indicated excellent reliability properties. The Intra-class Correlation Coefficient (ICC) was ≥0.80 and Standard Error of Measurement (SEM) ranged from 4.23 to 7.82 points. Validity measures displayed correlations of 0.50-0.88 (moderate to very strong correlations) between the SANE scale and other patient reported outcomes (American Shoulder and Elbow Surgeons, Rowe score, Simple Shoulder Test, Physical Function Computerized Adaptive Test). Four studies assessed SANE scale responsiveness measures. Effect sizes of 1.5 and 0.83; and minimal clinically important differences that ranged from 27.25 to 37.05 (anchor-based approach) and 11.80 to 18.1 (distribution-based approach) were reported. LIMITATIONS: Caution must be used when interpreting our ICCs values. CONCLUSION IMPLICATIONS OF KEY FINDINGS: Very good to excellent quality evidence indicated that the SANE scale demonstrates evidence of a reliable, valid and responsive tool in patients with shoulder related pathologies. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42018117874.