Relationship Between Intensity of Neck Pain and Disability and Shoulder Pain and Disability in Individuals With Subacromial Impingement Symptoms: A Cross-Sectional Study

ObjectiveThis study aimed to verify a possible relationship between shoulder disability and shoulder pain intensity and the variables related to cervical-spine dysfunction, and determine which of these can differentiate moderate to severe shoulder pain (>4 on a numerical rating scale [NRS]) from mild shoulder pain (≤4 on the NRS) in individuals with subacromial impingement symptoms.MethodsOne hundred and forty volunteers with shoulder pain were evaluated. Demographic information and variables related to the shoulder and neck were collected. Self-reported pain and disability of the shoulder and cervical spine were measured using the Shoulder Pain and Disability Index (SPADI) and Neck Disability Index (NDI) questionnaires, respectively. An NRS was used to measure pain in the shoulder and cervical spine. A purposeful modeling strategy was used to determine the best model to predict shoulder disability and shoulder pain (dependent variables). Multiple logistic regression analysis followed by receiver operating curve analysis was used to determine which variables better differentiated moderate to severe shoulder pain from mild shoulder pain.ResultsVariables such as Neck Disability Index (NDI) score (β = 1.09, P = .00) and age (β = −0.19, P = .03) were associated with the total SPADI score. Neck pain was significantly associated with shoulder pain (β = 0.40, P = .00). The combination of variables predicting moderate to severe shoulder pain was total SPADI score (odds ratio [OR] = 1.15, P = .003), neck pain (OR = 3.20, P = .04), and age (OR = 1.01, P = .05).ConclusionOur results demonstrate the important connection between shoulder- and neck-related symptoms in individuals with subacromial impingement symptoms.     

Lumbopelvic sagittal standing posture associations with anthropometry,physical activity levels and trunk muscle endurance in healthy adults

Background:Various factors, inherited and acquired, are associated with habitual spinal postures.Objective:The purpose of this study was to identify the relationships between trunk muscle endurance, anthropometry and physical activity/inactivity and the sagittal standing lumbopelvic posture in pain-free young participants.Methods:In this study, 112 healthy young adults (66 females), with median (IQR) age of 20 years (18.2–22 years), without low back pain, injury or trauma were included. Lumbar curve (LC) and sacral slope (SS) angles were measured in standing with a mobile phone application (iHandy level). Anthropometric, physical activity/inactivity levels (leisure-time sport involvement and sitting hours/day) and abdominal (plank prone bridge test) and paraspinal (Sorensen test) isometric muscle endurance measures were collected.Results:LC and SS angles correlated significantly (r=0.80, p<0.001). Statistically significant differences for both LC (p=0.023) and SS (p=0.013) angles were identified between the male and female participants. A significant negative correlation was identified between the abdominal endurance time and LC (r=−0.27, p=0.004); however, the power of this result (56%) was not sufficiently high. The correlation between abdominal endurance and SS was non-significant (r=−0.17, p=0.08). In addition, no significant associations were identified between either of the sagittal lumbopelvic angles (LC–SS) in standing and the participants’ body mass index (BMI), paraspinal endurance, leisure-time sport involvement or sitting hours/day.Conclusion:The potential role of preventive exercise in controlling lumbar lordosis via enhancement of the abdominal muscle endurance characteristics requires further confirmation. A subsequent study, performed in a larger population of more diverse occupational involvement and leisure-time physical activity levels, is proposed.     

Cross-cultural adaptation of the Pain Catastrophizing Scale in Greek clinical population

Background:Catastrophizing is an important psychological construct in mediating the behavioral response toward pain.Objective:The purpose of this study is to examine the psychometric properties of the Pain Catastrophizing Scale (PCS) in Greek clinical population.Methods:The scale was administered in 376 patients with chronic cervical and lumbar pain. Test–retest reliability, internal consistency (Cronbach α) and concurrent validity were assessed. Exploratory (EFA) and Confirmatory Factor Analysis (CFA) were used to test the factorial validity of the hypothesized three factor structure.Results:The PCS factors suggested high levels of test–retest reliability, whereas Cronbachs’ α values were acceptable. The EFA yielded a three-factor solution and indicated a marginal fit to the data. CFA procedures indicated a rather acceptable fit to the data. The concurrent validity of the instrument was confirmed.Conclusion:PCS seems to be a reliable and valid instrument in Greek patients with chronic cervical and lumbar pain.     

Immediate effect of foam roller on pain and ankle range of motion in patients with plantar fasciitis: A randomized controlled trial

Background:Stretching has been proven to be effective on pain and range of motion (ROM) in patients with plantar fasciitis. Despite recent gain in popularity and the proposed theories of effectiveness of foam roller, there is a lack of literature on the effect of foam rolling on plantar fasciitis.Objective:The objective of this study was to compare the effects of foam rolling and stretching on pain and ankle ROM in patients with plantar fasciitis.Methods:A total of 50 participants were included and randomly allocated to the stretching and foam roller groups. Visual analog scale (VAS), pressure pain thresholds (PPTs) for gastrocnemius, soleus and plantar fascia and weight-bearing lunge test (WBLT) measurements were recorded at baseline and immediately after treatment.Results:Within-group analysis has shown there is a statistically significant difference (p<0.001) in all the outcome measures in both foam roller and self-stretching groups. The between-groups analysis showed no statistical significance difference in VAS, plantar fascia PPT and WBLT parameters (with p-values of 0.171, 0.372 and 0.861, respectively); however, significant differences were found in gastrocnemius PPT (p=0.029) and soleus PPT (p=0.013).Conclusion:It was seen that both stretching and foam rolling techniques helped in reducing pain and increasing the ROM. However, the effectiveness of foam roller was superior to stretching in terms of increase in PPTs at gastrocnemius and soleus.Clinical Trial Registration No:CTRI/2018/01/011398.Name of registry:The Clinical Trials Registry — India (CTRI); https://ctri.nic.in.     

The Chinese (Mandarin) instructions of the 6-minute walk test: A validation study

Background/Objective:To date, a validated Chinese (Mandarin) six-minute walk test (6MWT) translated instruction is not available. Translation of the Chinese 6MWT instruction is done in an ad hoc manner within the Chinese-speaking populations. This study aimed to develop a set of valid and reliable Chinese (Mandarin) instructions of the 6MWT.Methods:Translation was performed from the original English instruction via the recommended “Process of translation and adaptation of instruments” by the World Health Organization to generate the Chinese instructions. The Chinese instructions were tested with 52 healthy adult participants for its validity. Each participant underwent three 6MWTs and a cardiopulmonary exercise test. Randomization allowed participants to undergo the walk test in both the original English and the new Chinese instructions. Face and content validity, intra-rater and inter-rater reliability of the Chinese instructions of the 6MWT were established through the translation process. Criterion validity was established by analyzing the results of the 6MWT and cardiopulmonary exercise test.Results:Intraclass correlation coefficient for inter-rater reliability was excellent (ICC=0.999, 95% confidence interval=0.996–1.000). Similarly, the intra-rater reliability across the three raters was high (R1: ICC=0.996, 95% confidence interval (CI)=0.812–1.000; R2: ICC=1.000, 95% CI=0.994–1.000; R3: ICC=1.000, 95% CI=0.998–1.000). The 6-min walk distances collected from the Chinese and English instructed trials correlated positively with the maximal oxygen consumption (r=0.315, p=0.023; r=0.309, p=0.026).Conclusion:This is the first study to develop and validate the Chinese (Mandarin) instructions of the 6MWT, and the translation is as reliable and valid as the original English instructions.     

Reliability and relationship of the fear-avoidance beliefs questionnaire with the shoulder pain and disability index and numeric pain rating scale in patients with shoulder pain

Purpose: The purpose of this study was to determine: 1) the test–retest reliability of Fear-Avoidance Beliefs Questionnaire (FABQ) Work (FABQW) subscale, FABQ Physical Activity (FABQPA) subscale, Shoulder Pain and Disability Index (SPADI) Pain subscale, SPADI Disability subscale, and Numeric Pain Rating scale (NPRS); and 2) the relationship between the FABQPA, FABQW, SPADI pain, SPADI disability, and NPRS after 4 weeks of pragmatically applied physical therapy (PT) in patients with shoulder pain. Design: Prospective, single-group observational design. Methods: Data were collected at initial evaluation, the first follow-up visit prior to the initiation of treatment, and after 4 weeks of treatment. Results: Statistically significant Intraclass Correlation Coefficient (ICC_2,1) values were reported for the FABQPA, FABQW, SPADI Pain, SPADI Disability, and NPRS. A statistically significant moderate relationship between the FABQPA subscale, SPADI subscale, and NPRS could not be established prior to and after 4 weeks of pragmatically applied PT. Statistically significant differences were observed between the initial evaluation and four-week follow-up for the FABQPA, SPADI Pain, SPADI Disability, and NPRS (p < 0.01). Discussion: Since a meaningful relationship between the FABQ, SPADI, and NPRS did not exist, it suggests that the FABQPA may be measuring a metric other than pain. Conclusions: This study suggests that the FABQW may not be sensitive to change over time.     

Cross-cultural adaption,reliability and validity of an Indian (Tamil) version for the Shoulder Pain and Disability Index

The objective of the study was to cross-culturally adapt the Shoulder Pain and Disability Index (SPADI) into a regional Indian language (Tamil) and to test the reliability and linguistic validity of the index in Tamil-speaking Indian participants. Cross-cultural adaptation and psychometric testing of SPADI was undertaken at the Outpatient Physiotherapy Department of the Sri Ramachandra University Hospital in Chennai, India. The Test-retest reliability was quantified using the interclass correlation coefficient (ICC) and Cronbach alpha was calculated to assess internal consistency of the Tamil questionnaire. The construct validity was assessed using Spearman rank correlation coefficients. The reliability of the total Tamil SPADI and its subsets (Intraclass correlation coefficient >0.90) were found to be higher than that of the English SPADI and the German SPADI in this population. The internal consistency of the Tamil SPADI (Cronbach's alpha >0.95) was slightly higher than the English and the German versions. Thus, the cross-culturally adapted version of the English SPADI into a regional Indian language (Tamil) is easy to use and is a reliable and valid measure of shoulder pain and disability in the Tamil speaking population.     

Does additional weekend and holiday physiotherapy benefit geriatric patients with hip fracture? — A case-historical control study

Objective:To evaluate the new service model of additional weekend and holiday physiotherapy (PT) by comparing functional outcomes and hospital length of stay between a group of geriatric patients with hip fracture receiving daily PT training and a group of geriatric patients with hip fracture receiving weekdays PT training.Methods:A retrospective case-historical control chart review was conducted and a total of 355 patients were identified. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), Modified Barthel Index (MBI) and process outcome in terms of length of stay (LOS) in hospitals.Results:With similar characteristics, patients who received weekend and holiday PT training had a significant higher percentage of MFAC Category III and a significant lower percentage of MFAC Category II (p=0.015) and significant higher MBI scores (mean±standard deviation, median; Study group: 47.4±19.6 points, 51 points; Control group: 43.0±20.0 points, 43 points; p=0.042) upon admission to rehabilitation hospital. A similar trend in EMS scores (Study group: 8.2±5.5 points, 7 points; Control group: 8.4±6.1 points, 6 points; p=0.998) and MBI scores (Study group: 63.0±23.4 points, 68 points; Control group: 61.2±26.1 points, 64 points; p=0.743) were observed upon discharge from the rehabilitation hospital. The average LOS in acute hospitals remained static (Study group: 7.7±3.9 days, 7 days; Control group: 7.4±5.0 days, 6 days; p=0.192). The average LOS in rehabilitation hospital (Study group: 20.0±5.5 days, 20 days; Control group: 24.3±9.9 days, 23 days; p<0.001) and total in-patient LOS (Study group: 26.7±6.4 days, 26 days; Control group: 30.7±11.2 days, 28 days; p<0.001) were significantly reduced. A higher percentage of days having PT training during hospitalization in rehabilitation hospital was shown with the implementation of new service (Study group: 89.1%; Control group: 65.9%, p<0.001).Conclusion:Additional weekend and holiday PT training in post-operative acute and rehabilitation hospitalization benefits geriatric patients with hip fracture in terms of improved training efficiency, where hospital LOS was shortened with more PT sessions, without any significant impacts on functional outcome.     

Physical Therapy (97)

Comparison of the University of California (Los Angeles) shoulder scale and the simple shulder test with shoulder pain and disability index: Single‐administration reliability and validity. (Texas Woman's University, Houston, TX) Phys Ther. 2000;80:759–768. This study compared 2 shoulder measures—the University of California‐Los Angeles (UCLA) Shoulder Scale and the Simple Shoulder Test (SST)—with the Shoulder Pain and Disability Index (SPADI). One hundred ninety‐two patients with shoulder disorders were recruited from one physician's office to complete the self‐report sections of the 3 scales. Cronbach alpha values and standard errors of measurements (SEM) were calculated for each of the multi‐item subscales. Validity was examined through calculation of correlation coefficients among the 3 scales. Factor analysis was completed to assess the underlying constructs of the SPADI and SST. Cronbach alpha values ranged from 0.85 to 0.95. The SEM values for the multi‐item scales ranged from 4.75 to 11.65. Evidence for validity to reflect function was indicated by the correlation between the SST and the SPADI disability subscale. The factor analysis of the SPADI revealed loading on 1 factor, whereas the SST loaded on 2 factors. Conclude that all scales demonstrated good internal consistency, suggesting that all items for each scale measure the same constract. However, SEMS for all scales were high. Factor loading was consistent, suggesting that patients may not distinguish between pain and function. Comment by Philip S. Sizer Jr., MED, PT. Clinical practitioners are leaning toward evaluating functional status versus a pure‐impairment‐based approach to appraising shoulder limitations. Several scales have been developed for the evaluation of shoulder function, including the University of California Los Angeles Shoulder Scale (UCLA), the Simple Shoulder Test (SST), and the Shoulder Pain and Disability Index (SPADI). Investigations demonstrating the psychometric properties of these scales are limited in number. These investigators attempted to assess those properties, including internal consistency, reliability, and validity for all 3 scales. The analyses demonstrated internal consistency and construct homogeneity for the SPADI. However, all 3 scales demonstrated rather large standard errors of measure, which questions the reliability of the scales for measurement of an individual's progress. Regarding construct validity, the SPADI does not appear to distinguish between pain and dysfunction, disqualifying its use as a gold standard for comparison with other scales. While the SST purports to measure a single construct, the data suggests that it appears to measure 2 different constructs namely function and comfort. Additionally, the analyses appear to demonstrate that, while the scales may attempt to measure the same constructs, they apparently do not. Finally, the authors suggest that the precision of the UCLA scale is inferior to the other 2 scales and insufficient for following the progress of individual patients in the clinical setting.     

Poster 7: Shoulder impingement syndrome: clinical indicators and short-term predictors of disability

Objective: To identify the best indicators of the current disability of patients with shoulder impingement syndrome (SIS) and the strongest predictors of 3-month SIS-related disability. Design: Prospective cohort study. Setting: Movement analysis laboratory. Participants: 41 subjects with SIS. Interventions: Evaluations at baseline and at 3 months. Main Outcome Measures: Personal, occupational, and impairment variables and the Shoulder Pain and Disability Index (SPADI). Cross-sectional explicative and 3-month predictive regression models of the level of disability (SPADI score) were developed using multivariate analyses. Results: Strength deficits in shoulder abduction-lateral rotation, pain during muscle strength testing, painful arc in abduction, scapular anterior tilting asymmetry, gender, and age explained 91% of the variance of the SPADI at baseline. The SPADI score at baseline, perceived work capacity, acromiohumeral distance at 90° of abduction, acromiohumeral distance difference between shoulders at 110° of flexion, difference between active and passive range of motion in abduction, and the presence of SIS on the dominant side predicted 86% of the variance of the SPADI at 3 months. Conclusions: Variables that best explain the current disability level and predictors of short-term level of disability should be considered in SIS treatment planning as well as for establishing prognosis.     

The influence of low-intensity resistance training combined with neuromuscular electrical stimulation on autonomic activity in healthy adults: A randomized controlled cross-over trial

Background:Low-intensity resistance training (RT) combined with neuromuscular electrical stimulation (NMES) is one method of exercise to improve the deterioration of physical function. However, it is unclear whether low-intensity RT combined with NMES (RT + NMES) can be safely implemented.Objective:This study aimed to examine the influence of low-intensity RT + NMES on autonomic activity and cardiovascular responses in healthy adults.Methods:This study was an open-label, randomized controlled cross-over trial. The exercise intensity of isometric knee extension RT was set to 40% of the maximum voluntary contraction (peak torque). NMES was adjusted to a biphasic asymmetrical waveform with the frequency maintained at 50 Hz and a phase duration of 300 μs. The difference in the change in autonomic activity and cardiovascular responses was compared by assessing heart rate variability, blood pressure, and heart rate during RT and RT+NMES.Results:Twenty healthy male college students (mean age 21.0±0.6 years) participated in this study. The ratio of low- and high-frequency components of heart rate variability, systolic blood pressure, and heart rate increased during exercise in the RT and RT+NMES sessions (P<0.05). There were no significant differences in autonomic activity and cardiovascular responses throughout the sessions during RT and RT+NMES.Conclusion:In conclusion, our results demonstrated that low-intensity RT+NMES was safe and did not induce excessive autonomic and cardiovascular responses in healthy adults.     

Interferential laser therapy in the treatment of shoulder pain and disability from musculoskeletal pathologies: a randomised comparative study

BackgroundInterference is an important feature of the waves. When two or more in phase light waves meet, a new and reinforced wave is generated. Shoulder pain is a common clinical problem and laser is one of the treatments frequently used to relieve it.ObjectiveTo test the safety of interferential laser therapy generated by two independent low level lasers and compare its effectiveness with conventional single laser therapy in the reduction of shoulder musculoskeletal pain and associated disability.DesignRandomised and single-blind controlled clinical trial.SettingPhysiotherapy Unit and Rehabilitation Department of Ramon y Cajal University Hospital (Madrid).Participants200 patients with shoulder musculoskeletal pain were randomly assigned in two groups, 100 people each.InterventionsGroup I, experimental (n=100) received interferential laser, placing two probes opposite each other over the shoulder joint. Group II, control (n=100) received conventional laser therapy, using a single probe along with a second inactive dummy probe. Lasers used were GaAlAs diode (810 nm, 100 mW), in continuous emission. Laser was applied in contact mode through ten sessions, on 5 shoulder points (7 Joules/point) per session.Main Outcome MeasuresVisual Analogue Scale (VAS) score and Shoulder Pain Disability index (SPADI), recorded before and after laser treatment.ResultsThere were no differences between both groups in the reduction of pain, either assessed by VAS scale (median difference=0, 95% CI of the difference =-.6 to .5, p=0.81) or SPADI index (median difference = .4, 95% CI of the difference =-2.9 to 3.8, p=0.80), using the Mann-Whitney U-test. Comparison between the scores recorded before and after the treatment, within each group, showed significant differences for VAS during movement (median difference=3, 95% CI of the difference =2.07 to 4, p<0.001) and SPADI index (median difference=3.5, 95% CI of the difference =2.67 to 3.85, Wilcoxon test, p<0.001), for both groups.ConclusionsIn this study, the application of two low level lasers in order to generate interference inside the irradiated tissue showed to be a safe therapy. Both interferential and conventional laser therapy reduced shoulder pain and disability. Nevertheless, differences between them were not detected. Future research in this field could include applying this technique with other laser parameters or application forms.     

Validity of an Alternate Hand Behind Back Shoulder Range of Motion Measurement in Patients With Shoulder Pain and Movement Dysfunction

Objectives

The purpose of this study was to determine the criterion-related validity of a novel method of measuring hand behind back (HBB) shoulder range of motion (ROM) for evaluating pain and disability in people with shoulder pain and movement impairment.

Ambulatory chest physiotherapy in mild-to-moderate acute bronchiolitis in children under two years of age — A randomized control trial

Objective:The aim of this study was to compare the role of a chest physiotherapy (CP) intervention to no intervention on the respiratory status of children under two years of age, with mild-to-moderate bronchiolitis.Methods:Out of 80 eligible children observed in the Emergency Room, 45 children completed the study with 28 randomized to the intervention group and 17 to the control group. The intervention protocol, applied in an ambulatory setting, consisted of combined techniques of passive prolonged slow expiration, rhinopharyngeal clearance and provoked cough. The control group was assessed with no chest physiotherapy intervention. The efficacy of chest physiotherapy was assessed using the Kristjansson Respiratory Score at the admission and discharge of the visit to the Emergency Room and during clinical visits at day 7 and day 15.Results:There was a significant improvement in the Kristjansson Respiratory Score in the intervention group compared to the control group at day 15 [1.2 (1.5) versus 0.3 (0.5); p-value=0.005, in the control and intervention groups, respectively], with a mean difference (95% CI) of −0.9 (−1.6 to −0.3).Conclusion:Chest physiotherapy had a positive impact on the respiratory status of children with mild-to-moderate bronchiolitis.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT04260919","term_id":"NCT04260919"}}NCT04260919.     

Thoracic Manual Therapy Improves Pain and Disability in Individuals With Shoulder Impingement Syndrome Compared With Placebo: A Randomized Controlled Trial With 1-Year Follow-up

ObjectiveTo investigate whether muscle energy technique (MET) to the thoracic spine decreases the pain and disability associated with shoulder impingement syndrome (SIS).DesignSingle-center, 3-arm, randomized controlled trial, single-blind, placebo control with concealed allocation and a 12-month follow-up.SettingPrivate osteopathic practice.ParticipantsThree groups of 25 participants (N=75) 40 years or older with SIS received allocated intervention once a week for 15 minutes, 4 consecutive weeks.InterventionsParticipants were randomly allocated to MET to the thoracic spine (MET-only), MET plus soft tissue massage (MET+STM), or placebo.Main Outcome MeasuresPrimary outcome measure: Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Secondary outcome measures: Shoulder Pain and Disability Index (SPADI) questionnaire; visual analog scale (VAS) (mm/100): current, 7-day average, and 4-week average; Patient-Specific Functional Scale (PSFS); and Global Rating of Change (GROC). Measures recorded at baseline, discharge, 4-week follow-up, 6 months, and 12 months. Also baseline and discharge thoracic posture and range of motion (ROM) measured using an inclinometer. Statistical analysis included mixed-effects linear regression model for DASH, SPADI, VAS, PSFS, GROC, and thoracic posture and ROM.ResultsMET-only group demonstrated significantly greater improvement in pain and disability (DASH, SPADI, VAS 7-day average) than placebo at discharge (mean difference, DASH=?8.4; 95% CI, ?14.0 to ?2.8; SPADI=?14.7; 95% CI, ?23.0 to ?6.3; VAS=?15.5; 95% CI, ?24.5 to ?6.5), 6 months (?11.1; 95% CI, ?18.6 to ?3.7; ?14.9; 95% CI, ?26.3 to ?3.5; ?14.1; 95% CI, ?26.0 to ?2.2), and 12 months (?13.4; 95% CI, ?23.9 to?2.9; ?19.0; 95% CI, ?32.4 to ?5.7; ?17.3; 95% CI, ?30.9 to ?3.8). MET+STM group also demonstrated greater improvement in disability but not pain compared with placebo at discharge (DASH=?8.2; 95% CI, ?14.0 to ?2.3; SPADI=?13.5; 95% CI, ?22.3 to ?4.8) and 6 months (?9.0; 95% CI, ?16.9 to ?1.2; ?12.4; 95% CI, ?24.3 to ?0.5). For the PSFS, MET-only group improved compared with placebo at discharge (1.3; 95% CI, 0.1-2.5) and 12 months (1.8; 95% CI, 0.5-3.2); MET+STM at 12 months (1.7; 95% CI, 0.3-3.0). GROC: MET-only group improved compared with placebo at discharge (1.5; 95% CI, 0.9-2.2) and 4 weeks (1.0; 95% CI, 0.1-1.9); MET+STM at discharge (1.2; 95% CI, 0.5-1.9) and 6 months (1.2; 95% CI, 0.1-1.3). There were no differences between MET-only group and MET+STM, and no between-group differences in thoracic posture or ROM.ConclusionsMET of the thoracic spine with or without STM improved the pain and disability in individuals 40 years or older with SIS and may be recommended as a treatment approach for SIS.     

Responsiveness of two Persian-versions of shoulder outcome measures following physiotherapy intervention in patients with shoulder disorders

Abstract

Purpose: To identify the ability of the Persian-version of the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) to detect changes in shoulder function following physiotherapy intervention (i.e. responsiveness) and to determine the change score that indicates a meaningful change in functional ability of the patient (i.e. Minimally Clinically Important Difference (MCID)). Method: A convenient sample of 200 Persian-speaking patients with shoulder disorders completed the SPADI and the DASH at baseline and then again 4 weeks after physiotherapy intervention. Furthermore, patients were asked to rate their global rating of shoulder function at follow-up. The responsiveness was evaluated using two methods: the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics extracted from the ROC method are the area under curve (AUC) and the optimal cutoff point called as MCID. Results: Both the SPADI and the DASH showed the AUC of greater than 0.70 (AUC ranges?=?0.77–0.82). The best cutoff points (or change scores) for the SPADI-total, SPADI-pain, SPADI-disability and the DASH were 14.88, 26.36, 23.86, and 25.41, respectively. Additionally, moderate to good correlations (Gamma?=??0.51 to ?0.58) were found between the changes in SPADI/DASH and changes in global rating scale. Conclusions: The Persian SPADI and DASH have adequate responsiveness to clinical changes in patients with shoulder disorders. Moreover, the MCIDs obtained in this study will help the clinicians and researchers to determine if a Persian-speaking patient with shoulder disorder has experienced a true change following a physiotherapy intervention.

• Implications for Rehabilitation

• Responsiveness was evaluated using two methods; the receiver operating characteristics (ROC) method and the correlation analysis.

• The Persian SPADI and DASH can be used as two responsive instruments in both clinical practice and research settings.

• The MCIDs of 14.88 and 25.41 points obtained for the SPADI-total and DASH indicated that the change scores of at least 14.88 points on the SPADI-total and 25.41 points on the DASH is necessary to certain that a true change has occurred following a physiotherapy intervention.

     

Reliability,validity, and responsiveness of the Persian version of Shoulder Activity Scale in a group of patients with shoulder disorders

Abstract

Purpose: The aim of this methodological study was to cross-culturally translate the Shoulder Activity Scale (SAS) into the Persian and determine its clinimetric properties including reliability, validity, and responsiveness in patients with shoulder disorders. Method: Persian version of the SAS was obtained after standard forward-backward translation. Three questionnaires were completed by the respondents: SAS, shoulder pain and disability index (SPADI), and Short-Form 36 Health Survey (SF-36). The patients completed the SAS, 1 week after the first visit to evaluate the test–retest reliability. Construct validity was evaluated by examining the associations between the scores on the SAS and the scores obtained from the SPADI, SF-36, and age of the patients. To assess responsiveness, data were collected in the first visit and then again after 4 weeks physiotherapy intervention. Test–retest reliability and internal consistency were assessed using Intra-class Correlation Coefficient (ICC) and Cronbach’s alpha, respectively. To evaluate construct validity, Spearman’s rank correlation was used. The ability of the SAS to detect changes was evaluated by the receiver-operating characteristics method. Results: No problem or language difficulties were reported during translation process. Test–retest reliability of the SAS was excellent with an ICC of 0.98. Also, the marginal Cronbach’s alpha level of 0.64 was obtained. The correlation between the SAS and the SPADI was low, proving divergent validity, whereas the correlations between the SAS and the SF-36/age were moderate proving convergent validity. A marginally acceptable responsiveness was achieved for the Persian SAS. Conclusions: The study provides some evidences to support the test–retest reliability, internal consistency, construct validity, and responsiveness of the Persian version of the SAS in patients with shoulder disorders. Therefore, it seems that this instrument is a useful measure of shoulder activity level in research setting and clinical practice.

• Implications for Rehabilitation

• The shoulder activity scale (SAS) is a reliable, valid, and responsive measure of shoulder activity level in Persian-speaking patients with different shoulder disorders.

• The results on clinimetric properties of the Persian SAS are comparable with its original, English version.

• Persian version of the SAS can be used in “clinical” and “research” settings of patients with shoulder disorders.