American Shoulder and Elbow Surgeons Shoulder Score (ASES)
The American Shoulder and Elbow Surgeons Shoulder Score (ASES) was created by the Society of the American Shoulder and Elbow Surgeons in 1994 as a tool that is applicable to all shoulder diagnosis.
At the time of its development, the goal of the ASES measure was to create a standardized form for the assessment of shoulder function and to encourage multi-center trials in shoulder and elbow surgery. The ASES has been validated for use in patients with osteoarthritis, shoulder instability, rotator cuff injuries and shoulder arthroplasty.
The ASES is a mixed-outcome reporting tool, meaning it consists of a physician-rated and patient-rated questionnaire. The patient-rated questionnaire focuses on joint pain, instability and activities of daily living. However, only the VAS and 10 functional questions on the patient-rated questionnaire are used to calculate the ASES score; the physician-rated section is not scored.
Calculation of the ASES score is itself a complicated process. The total score is weighted 50% for pain and 50% for function. The pain score is calculated by subtracting the VAS from 10 and multiplying it by 5. The 10 functional questions are scored on a 4-point scale (0-3) with a maximum functional score of 30. The raw functional score is then multiplied by 5/3 to make the maximum functional score out of 50 possible points. The pain and function scores are then added together to obtain the final ASES score (out of 100). Higher scores correlate to better outcomes. This scoring methodology is somewhat arduous and can be time-consuming. It is made even more difficult if patients fail to respond to an appropriate number of questions.
Strengths
The psychometric properties of the ASES have been well established and its validity, reliability and responsiveness have been assessed in a variety of shoulder problems including rotator cuff disease, glenohumeral arthritis, shoulder instability and shoulder arthroplasty.
The ASES score has been shown to be valid, reliable and responsive to non-operative treatments and correlation with other shoulder measures is high for the ASES score.
Considerations
The ASES has a number of disadvantages that can make it slightly difficult to use on a consistent basis. Most physicians will probably find the physician-reported section time consuming to complete. Additionally, the scoring system is complicated and can be time consuming.
Another limitation of the measure is that higher functioning patients may experience ceiling effects due to the response structure.
Overall, the ASES Shoulder Score is a good measure for use in many different shoulder and arm conditions. It compares favorably to many other popular shoulder outcome measures. However, its scoring methodology is complicated and use in clinical trials may lead to poor responsiveness and validity.
Licensing and Cost
The ASES PRO Measure does not require a license and is free to use.
Sources
Upper extremity-specific measures of disability and outcomes in orthopaedic surgery | Functional outcomes assessment in shoulder surgery | Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI) | Scoring systems for the functional assessment of the shoulder
