Effects of obesity on clinical and functional outcomes following anatomic and reverse total shoulder arthroplasty.

BACKGROUND: Limited data exist regarding the clinical and functional outcomes following primary total shoulder arthroplasty in obese patients. The purpose of this study is to determine the effects of obesity on the clinical and functional outcomes following primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) in a large patient population with mid-term follow-up. METHODS: Patients in a multi-institutional shoulder registry receiving either primary aTSA (n = 1520) or rTSA (n = 2054) from 2004 to 2018 with a minimum follow-up period of 2 years were studied. All patients received the same single-platform shoulder prosthesis. Study groups were assigned based on implant type (anatomic or reverse), and further stratification was based on patient body mass index (BMI), with obese patients having a BMI ≥ 30 and non-obese patients having a BMI < 30. Patients were evaluated and scored preoperatively and at latest follow-up by use of 5 scoring metrics and range of motion (ROM). RESULTS: The mean follow-up period was 5 years (range, 2-14 years). Obese patients comprised 41% of the aTSA group and 35% of the rTSA group. Significant postoperative improvements in visual analog scale pain scores, ROM, and all 5 scoring metrics occurred in both obese and non-obese patients (P < .05). Obese patients in both groups reported higher preoperative and postoperative visual analog scale pain scores and less preoperative and postoperative ROM compared with non-obese patients. Compared with non-obese patients, obese patients receiving aTSA reported significantly worse postoperative Simple Shoulder Test, Constant-Murley, American Shoulder and Elbow Surgeons, University of California, Los Angeles, and Shoulder Pain and Disability Index scores compared with non-obese patients, and those receiving rTSA reported significantly worse American Shoulder and Elbow Surgeons and Shoulder Pain and Disability Index scores (all P < .05). However, these differences did not exceed the minimal clinically important difference or substantial clinical benefit criteria. Radiographic analysis showed that in the rTSA group, obese patients had significantly less postoperative scapular notching and a lower scapular notching grade compared with non-obese patients (P < .05). DISCUSSION: Both non-obese and obese patients can expect clinically significant improvements in pain, motion, and functional outcome scores following both aTSA and rTSA. Obese patients reported significantly more postoperative pain, lower outcome scores, and less ROM compared with non-obese patients after both aTSA and rTSA at a mean follow-up of 5 years. However, statistically significant differences were not found to be clinically significant with respect to established minimal clinically important difference and substantial clinical benefit criteria. Therefore, obese and non-obese patients experience similar clinical outcomes following total shoulder arthroplasty, regardless of BMI. However, obese patients have more comorbidities, greater intraoperative blood loss, and less scapular notching compared with non-obese patients.

Optimal glenosphere size cannot be determined by patient height.

BACKGROUND: Glenosphere size remains 1 surgeon-controlled variable that can affect patient outcomes following reverse shoulder arthroplasty (RSA). There remains no objective criterion to guide surgeons in choosing glenosphere size. This study's purpose was to evaluate range of motion (ROM) as a function of patient height and glenosphere size to determine the optimal glenosphere size based on patient height. METHODS: We retrospectively reviewed 589 primary RSAs from a multicenter shoulder arthroplasty database of a single RSA system with multiple glenosphere sizes. Shoulders were separated into groups based on glenosphere size (38 or 42 mm). Predictive accuracy was calculated in relation to height and sex for predicting glenosphere size. Improvements in active ROM and patient-reported outcome measures (PROMs) were compared based on glenosphere size as a function of height. RESULTS: Logistic regression analysis demonstrated a strong association of height and sex with surgeon selection of glenosphere size, with shorter heights preferentially treated with 38-mm glenospheres and taller heights with 42-mm glenospheres. There were no statistically significant interaction effects of glenosphere size and height on improvements in ROM or PROMs. These results indicate that for a given glenosphere size, there is not an optimal height range to maximize improvements in postoperative outcome measures. DISCUSSION: Height and sex are highly correlated with a surgeon's choice of glenosphere size. However, on the basis of improvements in ROM and PROMs, no recommendation can be made for surgeons to select a particular glenosphere size based on a patient's height. Surgeons should consider other variables when selecting a glenosphere size.

Glenoid component lucencies are associated with poorer patient-reported outcomes following anatomic shoulder arthroplasty.

BACKGROUND: High rates of radiographic glenoid loosening following anatomic total shoulder arthroplasty (TSA) are documented at midterm follow-up. Small studies remain conflicted on the impact of lucent lines on clinical outcomes. This study assesses the impact of radiolucent lines on function and patient-reported outcomes (PROs) following TSA. METHODS: We retrospectively evaluated 492 primary TSAs performed between February 2005 and April 2016. Radiographs were evaluated for glenoid loosening according to the Lazarus grade at a mean of 5.3 years (range, 2-12 years). Clinical outcome measures included range of motion and American Shoulder and Elbow Surgeons, Constant, University of California-Los Angeles, Simple Shoulder Test, and Shoulder Pain and Disability Index scores. Outcomes were compared between patients with and patients without glenoid lucent lines and in relation to lucency grade. RESULTS: At most recent follow-up, 308 glenoids (63%) showed no radiolucent lines (group 0) and 184 demonstrated peri-glenoid lucencies (group 1). The groups were similar regarding age, sex, body mass index, comorbidities, and prior surgery. At follow-up, group 1 demonstrated significantly lower improvements in forward elevation (P = .02) and all PROs (P ≤ .005). Subgroup analysis by radiolucency grade showed that forward elevation diminished with increasing radiolucent score and exceeded the minimal clinically important difference (MCID) above grade 2 lucencies. A similar decline in PROs was observed with increasing lucency grade. These differences did not exceed the MCID below grade 5 lucencies. DISCUSSION: Peri-implant glenoid lucencies following TSA are associated with lower forward elevation and PROs. Lucencies above grade 2 are associated with clinically important losses in overhead motion. However, differences below the MCID are maintained for PROs below grade 5 glenoid lucencies.

Implications of humeral short-stem diametral sizing on implant stability.

Background: Shoulder arthroplasty humeral stem design has evolved to include various shapes, coatings, lengths, sizes, and fixation methods. While necessary to accommodate patient anatomy characteristics, this creates a surgical paradox of choice. The relationship between the surgeon's selection of short-stem implant size and construct stiffness, resistance to subsidence and micromotion has not been assessed. Methods: Eight paired cadaveric humeri were reconstructed with surgeon-selected (SS) and 2-mm diametrically larger (SS+2) short-stemmed press-fit implants. Each reconstruction was subjected to 2000 cycles of 90° forward flexion loading, and stem subsidence and micromotion were measured using optical tracking. Compressive stiffness of the stem-bone reconstruction was then assessed by applying a load in-line with the stem axis that resulted in 5 mm of stem subsidence. Results: Increasing stem size by 2 mm resulted in the construct stiffness more than doubling compared to SS stems (-741 ± 243 N/mm vs. -334 ± 120 N/mm; P = .003; power = 0.971). These larger stems also subsided significantly less than their SS counterparts (SS: 1.2 ± 0.6 mm; SS+2: 0.5 ± 0.5 mm; P = .029; power = 0.66), though there were no significant changes in micromotion (SS: 169 ± 59 µm; SS+2: 187 ± 52 µm; P = .506; power = 0.094). Conclusions: The results of this study highlight the importance of proper short-stem sizing, as a relatively small 2 mm increase in diametral size was observed to significantly impact construct stiffness, which could increase the risk of stress shielding and implant loosening. Future work should focus on developing tools that objectively quantify bone quality and aid surgeons in selecting the appropriate size short-stem humeral implants for a particular patient.

Regional apparent density correlations within the proximal humerus.

BACKGROUND: Bone quality influences humeral implant selection for shoulder arthroplasty. However, little is known about how well bone near the humeral resection represents more distal cancellous bone. This investigation aimed to quantify the correlations between the apparent density of sites near the humeral head resection plane and cancellous sites throughout the metaphysis. METHODS: Using computed tomography data from 98 subjects, apparent bone density was quantified in 65 regions throughout the proximal humerus. Pearson's correlation coefficient was determined comparing the density between samples from the humeral resection and all supporting regions beneath the resection. Mean correlation coefficients were compared for (i) each sample region with all support regions, (ii) pooling all sample regions within a slice, and (iii) considering sample regions correlated with only the support regions in the same anatomic section. RESULTS: Stronger correlations existed for bone sampled beneath the resection (0.33 ± 0.10≤ r ≤ 0.88 ± 0.10), instead of from the resected humeral head (0.22 ± 0.10≤ r ≤ 0.66 ± 0.14). None of sample region correlated strongly with all support regions; however, strong correlations existed when sample and support regions both came from the same anatomic section. DISCUSSION: Assessments of cancellous bone quality in the proximal humerus should be made beneath the humeral resection not in the resected humeral head; and each anatomic quadrant should be assessed independently.

Anatomic versus reverse shoulder arthroplasty: a mid-term follow-up comparison.

BACKGROUND: Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. METHODS: Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. RESULTS: At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). DISCUSSION: At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.

The influence of preoperative external rotation weakness or stiffness on reverse total shoulder arthroplasty.

BACKGROUND: Some reverse total shoulder arthroplasty (rTSA) patients may have limited preoperative external rotation (ER) because of stiffness or weakness. Currently it is not known if this affects their clinical outcome or if their ER will improve after surgery. METHODS: A multicenter shoulder arthroplasty database was queried to analyze patients undergoing a primary rTSA using a single prosthesis design featuring a medial glenoid-lateral humerus. Their pre- and postoperative range of motion was evaluated in addition to 5 outcome measures. Patients with limited preoperative ER due to weakness or stiffness were compared to patients with normal preoperative range of motion. The following questions were asked: (1) Does a preoperative ER deficit impact the postoperative outcome? (2) Do patients with preoperative ER deficits due to stiffness or weakness regain ER after rTSA? and (3) Does a preoperative ER lag sign predict a poor outcome? RESULTS: 608 patients were included in this study. Active external rotation (preoperative/postoperative) was as follows for the 3 patient groups: Normal patients (45°/44°), Stiff (-4°/30°), and Weak (16°/32°). Weak patients had a preoperative ER lag of 30°, which improved by 16° after surgery. The clinical outcome scores for all 3 groups improved after rTSA. Stiff patients had significantly greater improvement than Weak and Normal patients. Outcome scores were equivalent for Normal and Stiff patients. Weak patients tended to have slightly lower outcome scores. CONCLUSIONS: Patients with limited preoperative ER can obtain a good clinical result with rTSA using a medial glenoid-lateral humerus prosthesis, ER range of motion can improve after rTSA, and stiff patients have a particularly good prognosis for recovery.

Humeral stem lucencies correlate with clinical outcomes in anatomic total shoulder arthroplasty.

BACKGROUND: Humeral stem lucencies are uncommon after uncemented anatomic total shoulder arthroplasty (aTSA), and their clinical significance is unknown. This study compares clinical outcomes of aTSA with and without humeral stem lucencies. METHODS: Two-hundred eighty aTSAs using an uncemented grit-blasted metaphyseal-fit humeral stem between 2005 and 2013 were retrospectively evaluated for radiographic humeral stem lucencies. All shoulders were evaluated at a minimum 5-year follow-up from a multicenter database. Clinical outcomes included range of motion (ROM) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Constant score, University of California-Los Angeles Shoulder Score (UCLA), Simple Shoulder Test (SST), and Shoulder Pain and Disability Index (SPADI) scores. Postoperative radiographs were evaluated and complications were recorded. RESULTS: Two-hundred forty-three humeral stems showed no radiolucent lines. Among the 37 humeral stems with lucent lines, lines were most common in zones 8, 4, 7, and 3. Preoperative ROM and functional outcomes were similar between groups. Postoperative change in outcomes exceeded the minimal clinically important difference (MCID) for all ROM and outcomes in both groups. Postoperative change between groups showed no significant difference in ROM or outcome scores, but improved mean abduction exceeded the MCID in the patients without humeral lines. The complication rate after omitting patients with humeral loosening was higher in patients with humeral lucencies, as was the revision rate. There was also a higher glenoid-loosening rate in patients with humeral lucencies. CONCLUSION: Humeral lucent lines after uncemented stemmed aTSA have a small negative effect on ROM and functional outcomes compared with patients without lucent humeral lines, which may not be clinically significant. The complication and revision rates were significantly higher in patients with humeral lucencies.

The glenoid in shoulder arthroplasty.

Total shoulder arthroplasty is a common treatment for glenohumeral arthritis. One of the most common failure modes of total shoulder arthroplasty is glenoid loosening, causing postoperative pain, limitation of function, and potentially, the need for revision surgery. The literature has devoted considerable attention to the design of the glenoid component; efforts to better understand the biomechanics of the reconstructed glenohumeral joint and identify factors that contribute to glenoid component loosening are ongoing. This article reviews the current state of knowledge about the glenoid in total shoulder arthroplasty, summarizing the anatomic parameters of the intact glenoid, variations in component design and fixation, the mechanisms of glenoid loosening, the outcomes of revision surgery in the treatment of glenoid component failure, and alternative treatments for younger patients.

An evaluation of the relationships between reverse shoulder design parameters and range of motion, impingement, and stability.

BACKGROUND: The purpose of this study was to evaluate the role of reverse shoulder design parameters on performance. METHODS: A computer analysis was conducted on the Grammont reverse shoulder to quantify the effect of varying design parameters on functional measurements during humeral abduction/adduction. To demonstrate the application of these relationships, a novel prosthesis was designed. RESULTS: The Grammont reverse shoulder impinged inferiorly and superiorly on the glenoid at 31 degrees and 95 degrees of humeral abduction with an average jump distance of 10 mm. Several linear relationships were identified. The proposed 38 mm, 42 mm, and 46 mm reverse shoulder designs impinged inferiorly and superiorly on the glenoid at 7.3 degrees/87.5 degrees, 1 degrees/87.5 degrees, and 0 degrees/89.3 degrees of humeral abduction with an average jump distance of 11.7 mm, 13.5 mm, and 14.1 mm, respectively. CONCLUSIONS: The results of this study demonstrate that subtle changes in design parameters can minimize inferior glenoid impingement and offer potential for dramatic functional improvements in ROM (39%) and jump distance (36%).

Effect of Tuberosity Healing on Clinical Outcomes in Elderly Patients Treated With a Reverse Shoulder Arthroplasty for 3- and 4-Part Proximal Humerus Fractures.

OBJECTIVES: To evaluate tuberosity union rate and clinical outcome after 3- and 4-part proximal humerus fractures in the elderly. DESIGN: Retrospective, multicenter database cohort study. SETTING: Level I and Level II trauma centers. PATIENTS: Fifty-five patients older than 65 years had insertion of reverse shoulder arthroplasty (RTSA) for OTA/AO 11-B and 11-C proximal humerus fractures. INTERVENTION: Treatment with RTSA using a dedicated low profile onlay fracture stem using variable tuberosity fixation. MAIN OUTCOME MEASURES: Constant score, the American Shoulder and Elbow Surgeons score, Shoulder Pain and Disability Index score, University of California at Los Angeles score, Simple Shoulder Test score, visual analog pain score, shoulder function score, active range of motion, external rotation (ER)-specific tasks and position, rate of greater tuberosity healing, effect of tuberosity healing on overall clinical metrics, incidence of humeral lucency, and scapular notching. RESULTS: Eighty-three percent of the greater tuberosities that were repaired united. Greater tuberosity union resulted in greater active ER (P = 0.0415). There was a statistically significant difference in the ability to do ER-type activities between the 2 cohorts reflected in the ability to position one's hand behind their head with the elbow forward (P = 0.002) and comb their hair (P < 0.001). CONCLUSION: The use of a low profile onlay fracture stem in RTSA for acute 3- and 4-part proximal humerus fractures in the elderly can result in a high tuberosity union rate. Greater tuberosity healing significantly influences ER and ER-type activities that are not apparent by analysis of the overall metrics studied. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Preoperative parameters that predict postoperative patient-reported outcome measures and range of motion with anatomic and reverse total shoulder arthroplasty.

BACKGROUND: Preoperative factors that most influence postoperative outcomes of both anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are unknown. The purpose of this study was to identify the preoperative parameters that significantly influence postoperative outcomes of aTSA and rTSA. METHODS: The outcomes of 1089 aTSA patients and 1332 rTSA patients (mean follow-up period, 49 months) from an international registry with a single platform system were analyzed. A multiple linear regression model with backward stepwise selection identified the preoperative parameters that were significant predictors of postoperative clinical outcome metric scores and motion measures for both rTSA and aTSA. RESULTS: For both aTSA and rTSA patients, numerous preoperative parameters that influence postoperative outcomes were identified. Greater postoperative range of motion (ROM) was significantly influenced by greater preoperative ROM. For aTSA, greater postoperative American Shoulder and Elbow Surgeons (ASES) scores were significantly influenced by greater preoperative ASES scores, no history of shoulder surgery, and the presence of greater preoperative active external rotation. For rTSA, greater postoperative ASES scores were significantly influenced by greater preoperative ASES scores, no history of shoulder surgery, no history of tobacco use, less preoperative passive external rotation, and greater preoperative active external rotation. CONCLUSIONS: This study quantified the preoperative predictors of postoperative clinical outcome metric scores and ROM for both aTSA and rTSA. Numerous significant associations were identified, including demographic and comorbidity risk factors. These associations may be helpful for surgeons to consider when counseling patients regarding aTSA versus rTSA and to establish more accurate expectations prior to surgery.

The effect of radial mismatch on radiographic glenoid loosening.

BACKGROUND: The ideal glenohumeral radial mismatch following anatomic total shoulder arthroplasty (TSA) remains ill defined, with biomechanical and clinical studies recommending a range between 4 and 10 mm. This study evaluates the effect of radial mismatch on the formation of radiolucent lines after TSA. METHODS: We evaluated 451 TSAs at a mean follow-up of 5.4 years. All TSAs were performed using a single implant system that allows radial mismatch between 3.4 and 7.7 mm. Shoulders were retrospectively evaluated for radiographic glenoid loosening according to the Lazarus score. Shoulders were evaluated according to radial mismatch: 3.4 mm in 23, 4.3 mm in 154, 5.1 mm in 72, 5.9 mm in 81, 6.7 mm in 103, and 7.7 mm in 18. Clinical outcome measures included range of motion and American Shoulder and Elbow Surgeons, University of California, Los Angeles, and Shoulder Pain and Disability Index scores. RESULTS: At similar follow-up times, all groups demonstrated a similar incidence of glenoid radiolucencies and similar mean Lazarus scores. Shoulders in female patients were more commonly treated with implant combinations resulting in 4.3, 5.9, and 7.7 mm of radial mismatch (P < .001). Improvements in range of motion and American Shoulder and Elbow Surgeons, University of California, Los Angeles, and Shoulder Pain and Disability Index scores were similar among all groups. Rates of reoperation secondary to glenoid loosening were similar among groups (P = .57). Moreover, the incidence of radiographic loosening (Lazarus grade 4 or 5) was similar among the groups (P = .22). DISCUSSION: Variation in mismatch between 3.4 and 7.7 mm did not affect the incidence of glenoid lucent lines or Lazarus score. This finding suggests that optimal radial mismatch may extend below 5.5 mm, as previously recommended by Walch et al, without affecting the incidence and grade of glenoid lucencies.

Effect of reverse shoulder design philosophy on muscle moment arms.

This study analyzes the muscle moment arms of three different reverse shoulder design philosophies using a previously published method. Digital bone models of the shoulder were imported into a 3D modeling software and markers placed for the origin and insertion of relevant muscles. The anatomic model was used as a baseline for moment arm calculations. Subsequently, three different reverse shoulder designs were virtually implanted and moment arms were analyzed in abduction and external rotation. The results indicate that the lateral offset between the joint center and the axis of the humerus specific to one reverse shoulder design increased the external rotation moment arms of the posterior deltoid relative to the other reverse shoulder designs. The other muscles analyzed demonstrated differences in the moment arms, but none of the differences reached statistical significance. This study demonstrated how the combination of variables making up different reverse shoulder designs can affect the moment arms of the muscles in different and statistically significant ways. The role of humeral offset in reverse shoulder design has not been previously reported and could have an impact on external rotation and stability achieved post-operatively.

Combinatorial delivery of immunosuppressive factors to dendritic cells using dual-sized microspheres.

Microparticulate systems are beginning to show promise for delivery of modulatory agents for immunotherapeutic applications which modulate dendritic cell (DC) functions. Co-administration of multiple factors is an emerging theme in immune modulation which may prove beneficial in this setting. Herein, we demonstrate that localized, controlled delivery of multiple factors can be accomplished through poly (lactic-co-glycolic acid) (PLGA) microparticle systems fabricated in two size classes of phagocytosable and unphagocytosable microparticles (MPs). The immunosuppressive ability of combinatorial multi-factor dual MP systems was evaluated by investigating effects on DC maturation, DC resistance to LPS-mediated maturation and proliferation of allogeneic T cells in a mixed lymphocyte reaction. Phagocytosable MPs (~2 µm) were fabricated encapsulating either rapamycin (RAPA) or all-trans retinoic acid (RA), and unphagocytosable MPs (~30 µm) were fabricated encapsulating either transforming growth factor beta-1 (TGF-ß1) or interleukin-10 (IL-10). Combinations of these MP classes reduced expression of stimulatory/costimulatory molecules (MHC-II, CD80 and CD86) in comparison to iDC and soluble controls, but not necessarily to single factor MPs. Dual MP-treated DCs resisted LPS-mediated activation, in a manner driven by the single factor phagocytosable MPs used. Dendritic cells treated with dual MP systems suppressed allogeneic T cell proliferation, generally demonstrating greater suppression by combination MPs than single factor formulations, particularly for the RA/IL-10 MPs. This work demonstrates feasibility of simultaneous targeted delivery of immunomodulatory factors to cell surface receptors and intracellular locations, and indicates that a combinatorial approach can boost immunoregulatory responses for therapeutic application in autoimmunity and transplantation.

Reconstructing proximal humeral fractures using the bicipital groove as a landmark.

Controversy persists in the literature regarding the use of the bicipital groove as an anatomic landmark to restore humeral head retroversion when treating complex proximal humeral fractures with arthroplasty. We quantified the three-dimensional geometry of the bicipital groove in 49 dried humeri relative to the intramedullary axis, quantified the reliability of using the bicipital groove as an anatomic landmark, and compared this reliability with that of the conventional technique that uses a fixed, average angle relative to the epicondylar axis to establish humeral head retroversion. The data show the anterior offset of the bicipital groove is nearly constant from proximal (7.3 mm +/- 2.8 mm) to distal (7.2 mm +/- 1.5 mm) relative to the intramedullary axis. Given the consistency, the distal bicipital groove (at the level of the surgical neck) is a reasonable landmark to establish humeral head retroversion after complex proximal humeral fractures having reliability (angular error of 7.9 degrees +/- 5.8 degrees) as good as or better than the conventional fixed-angle technique.

Avaliação de impactos dos trabalhos de ONGs: aprendendo a valorizar as mudanças / Impact evaluation of the works ONGs: to value the change learning

É o resultado de uma prática de pesquisa-ação realizada conjuntamente por uma série de organizações não-governamentais (ONGs) internacionais e locais sediadas em quatro países. A pesquisa foi iniciada pela Oxfam da Grã-Bretanha e pela Novib da Holanda. Tenta partilhar com outros as lições aprendidas a partir desta experiência, bem como alguns dos desafios que surgem ao se pensar e realizar uma avaliação de impacto. Está dirigido particularmente aos "executores", e os especialistas em avaliação. A pesquisa mostra que há necessidade de desmistificar o tema. O objetivo é tornar a avaliação de impacto acessível sem ser simplista. Explora também aqueles elementos da avaliação de impacto que estão além do âmbito do projeto, como são os processos organizacionais