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The Single Assessment Numeric Evaluation (SANE) Score

sane

By Rolando (Ro) Rodriguez, PT, DPT, SCS, CSCS & Phil Plisky, PT, DSc, ATC, CSCS

What is the Single Assessment Numeric Evaluation (SANE)?

The Single Assessment Numeric Evaluation (SANE) score is a single-question, patient-reported outcome measure. It is a low-cost, reliable, and efficient tool used in rehabilitation to assess a patient's perceived overall function as a percentage of normal (0% to 100%), with higher scores indicating better function.

As a patient-reported outcome measure, it provides a fast assessment of recovery or functional status and has been used across multiple populations and injuries. It is often employed as a trackable measure to quantify a patient’s confidence in returning to sport or activity, as patients may find it challenging to express their confidence for various reasons. Combined with objective physical performance measures, the SANE score frequently serves as part of a return-to-sport or performance assessment battery. It has low implementation barriers and can be easily administered in person (through verbal questioning), on paper (where the patient marks their score on a form), or digitally (via an app or electronic health record). The simplicity and minimal time investment (< 1 minute) make the SANE score extremely useful in various settings.

One of the most impactful and practical studies using the SANE was conducted by Rhon et al. This study examined 450 individuals who had returned to duty after completing rehabilitation. By testing numerous variables and tracking these individuals for a year, the researchers identified the variables most predictive of future injuries. A SANE score below 92.5% was determined to be a risk factor for subsequent injuries.

What is the Single Assessment Numeric Evaluation (SANE) Score Procedure?

Administration Method Options:

In-Person: Verbal questioning during a consultation.

Paper: The patient marks their score on a form.

Digital: Input via an app and/or electronic health record

SANE Score Administration:

Step 1:

Ask the Patient, “How would you rate your [affected body part] today as a percentage of normal, where 0% is completely abnormal and 100% is normal?”

Step 2:

Patient Response: The patient provides a single number between 0% (worst) and 100% (normal).

Step 3:

Record the Score:

Document the response in percentage value and use it to track progress over time

What is considered passing Single Assessment Numeric Evaluation (SANE) Score?

> 92.5% but likely should be 95%

The mean SANE score of athletes returning to sport after ACL surgery at 9 months was 92.5%, compared to 85.7% for those who did not return by 9 months.
The SANE score was a significant predictor of return to sport at 9 months when adjusted for age, sex, and BRS score (Zhang 2021).
SANE score of <92.5 a risk factor as part of a multiple variable subsequent injury prediction model. The statistical analysis indicated 92.5% but the reporting scale was in 5% increments so 95% is likely the passing score.

What is the reliability of the Single Assessment Numeric Evaluation (SANE) Score?

A systematic review looked at the reliability of the SANE Score and they determined that it has good to excellent reliability (Nazari et al., 2020). This systematic review looked at 9 studies with patients with shoulder pathologies and the studies ranged from “82% to 95% - very good to excellent quality.”

Reliability:

What is the Standard Error of Measurement (SEM) of the SANE Score?

What is the Minimal Detectable Change (MCID) of the Single Assessment Numeric Evaluation (SANE) Score?

27.25-37.05 anchor-based approach
11.80-18.1 distribution-based approach

What is the Validity of the Single Assessment Numeric Evaluation (SANE) Score?

Good correlation with overall rFFI score (Bellas 2019).

r=0.51, P<0.01

High positive correlation between SANE and International Knee Documentation Committee (IKDC) (Alessandra 2019).
Moderate Positive Correlation between SANE and Lower Extremity Functional Scale (LEFS) (Alessandra 2019).

Single Assessment Numeric Evaluation (SANE) Score Normative Data

Effect of Patient Resilience and the Single Assessment Numeric Evaluation (SANE) Score on Return to Sport Outcomes Following ACL Reconstruction Surgery (Zhang et al., 2021)

Patients returning to sport by nine months post-surgery had a mean SANE score of 92.7, compared to 85.7 for those who did not return.
The SANE score significantly predicted return to sport at nine months, adjusted for age, sex, and resilience score.

Are Elite Collegiate Female Athletes PRIME for a Safe Return to Sport After ACLR? An Investigation of Physical Readiness and Integrated Movement Efficiency (Chaaban, et al., 2022)

A SANE score of 90% was identified as the threshold for successful outcomes after ACL reconstruction.
Higher SANE scores indicate better readiness for return to sport.

Single Assessment Numeric Evaluation (SANE) Score as the Critical Outcome Measure After Shoulder Arthroplasty (Hawkins et al., 2024)

Patients reported a SANE score of 76 at care completion and 85 upon return to sport.
Scores indicate significant improvement in perceived function post-treatment.

Predicting Subsequent Injury after Being Cleared to Return to Work from Initial Lumbar or Lower Extremity Injury (Rhon et al., 2023)

SANE score of <92.5 a risk factor as part of a multiple variable subsequent injury prediction model.

Single Assessment Numeric Evaluation (SANE) Score References

Bellas N, Cirino C, Cote MP, Sathe V, Geaney L. Validation of the Single Assessment Numeric Evaluation (SANE) Score as an Outcome Measure by Comparison to the Revised Foot Function Index (rFFI). Foot Ankle Orthop. 2019 Aug 15;4(3):2473011419868953. doi: 10.1177/2473011419868953. PMID: 35097335; PMCID: PMC8696912.
Chaaban CR, Hearn D, Goerger B, Padua DA. Are Elite Collegiate Female Athletes PRIME for a Safe Return to Sport after ACLR? An Investigation of Physical Readiness and Integrated Movement Efficiency (PRIME). Int J Sports Phys Ther. 2022 Apr 1;17(3):445-455. doi: 10.26603/001c.32529. PMID: 35391856; PMCID: PMC8975580.
Doxey S, Huyke-Hernandez F, Kleinsmith R, Nelson B, Cunningham B. Poster 338: Minimum Clinically Important Difference (MCID) for Single Assessment Numeric Evaluation (SANE) after Anterior Cruciate Ligament Reconstruction: Determining a Successful Outcome. Orthopaedic Journal of Sports Medicine. 2024;12(7_suppl2). doi:10.1177/2325967124S00304.
Garcia AN, Cook C, Lutz A, Thigpen CA. Concurrent validity of the single assessment numerical evaluation and patient-reported functional measures in patients with musculoskeletal disorders: An observational study. Musculoskelet Sci Pract. 2019 Dec;44:102057. doi: 10.1016/j.msksp.2019.102057. Epub 2019 Sep 12. PMID: 31542682.
Gowd AK, Charles MD, Liu JN, Lalehzarian SP, Cabarcas BC, Manderle BJ, Nicholson GP, Romeo AA, Verma NN. Single Assessment Numeric Evaluation (SANE) is a reliable metric to measure clinically significant improvements following shoulder arthroplasty. J Shoulder Elbow Surg. 2019 Nov;28(11):2238-2246. doi: 10.1016/j.jse.2019.04.041. Epub 2019 Jul 12. PMID: 31307894.
Hawkins RJ, Boes N, Thigpen CA, Shanley E, Pill SG, Kissenberth MJ. Measure what matters: Single Assessment Numeric Evaluation (SANE) score as the critical measure for shoulder outcomes. J Shoulder Elbow Surg. 2024 Jun;33(6):1397-1403. doi: 10.1016/j.jse.2023.12.001. Epub 2024 Feb 1. PMID: 38295936.
Nazari G, MacDermid JC, Bobos P, Furtado R Psychometric properties of the Single Assessment Numeric Evaluation (SANE) in patients with shoulder conditions. A systematic review. Physiotherapy. 2020 Dec;109:33-42. doi: 10.1016/j.physio.2020.02.008. Epub 2020 Mar 4. PMID: 32858378.
Rhon DI, Plisky PJ, Kiesel K, Greenlee TA, Bullock GS, Shaffer SW, Goffar SL, Teyhen DS. Predicting Subsequent Injury after Being Cleared to Return to Work from Initial Lumbar or Lower Extremity Injury. Med Sci Sports Exerc. 2023
Thigpen CA, Shanley E, Momaya AM, Kissenberth MJ, Tolan SJ, Tokish JM, Hawkins RJ. Validity and Responsiveness of the Single Alpha-numeric Evaluation for Shoulder Patients. Am J Sports Med. 2018 Dec;46(14):3480-3485. doi: 10.1177/0363546518807924. Epub 2018 Nov 12. PMID: 30419173
Zhang JK, Barron J, Arvesen J, Israel H, Kim C, Kaar SG. Effect of Patient Resilience and the Single Assessment Numeric Evaluation (SANE) Score on Return to Sport Following Anterior Cruciate Ligament Reconstruction Surgery. Arch Bone Jt Surg. 2021 Sep;9(5):512-518. doi: 10.22038/abjs.2021.48823.2562. PMID: 34692933; PMCID: PMC8503761.

About the Co-Author

Rolando (Ro) Rodriguez, PT, DPT, SCS, CSCS

Ro is a Minor League professional baseball physical therapist with a passion for teaching, mentoring, and helping patients and athletes return to doing what they love. He graduated from Rutgers University’s Physical Therapy program and completed the ProRehab & University of Evansville Sports Residency, as well as the Hospital for Special Surgery & New York Mets Upper Extremity Sports Fellowship.

Are you looking to gain confidence in taking athletes from injury to high level performance? Looking to simplify the process and gain clarity? Wish you had a community to ask questions and bounce ideas off of? Check out the Coaches Club.

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