Reliability and validity of shoulder function outcome measures in people with a proximal humeral fracture

Abstract

Purpose: Investigate test--retest reliability and validity of five shoulder outcome measures in people during their active rehabilitation after a shoulder fracture. Method: This prospective longitudinal study assessed shoulder function in 20 people (16 women, mean age 68.1 years) with surgical or conservative management at 6, 12 and 13 weeks post proximal humeral fracture using three patient-reported (Disabilities of Arm, Shoulder and Hand; Oxford Shoulder Score; Subjective Shoulder Value) and two clinician-administered (Constant Score; UCLA Shoulder score) outcome measures. Results: Content analysis categorised items into multiple domains of functioning for each outcome measure. Construct validity testing between measures found moderate to strong correlations (r?=?0.43–0.92). Longitudinal validity (responsiveness), represented by correlations between change scores, was moderate to strong (r?=?0.44–0.83). Although ICCs_2,1 for test–retest reliability ranged from 0.75 to 0.93, Limits of Agreement between measurements were relatively wide (10–23% of available range of scores). Minimal clinically important difference estimates varied between anchor- and distribution-based methods. Conclusions: The five outcome measures assessing shoulder function provided values for reliability and validity that meet measurement requirements for use in groups of people after a proximal humeral fracture. However, the use of these outcome measures might be limited by low absolute agreement between measurements and their content covering multiple domains of functioning.

• Implications for Rehabilitation

• Linking the International Classification of Functioning, Disability and Health (ICF) to the content of common shoulder function outcome measures showed that multiple domains of functioning are combined into a single score. This might not be preferred for measurement of the single construct of “shoulder function”.

• Currently available shoulder function outcome measures may not be sufficiently reliable to monitor change in an individual after a proximal humeral fracture during the rehabilitation phase.

     

The ability of preoperative factors to predict patient-reported disability following surgery for rotator cuff pathology

Purpose: Minimal research has examined the prognostic ability of shoulder examination data or psychosocial factors in predicting patient-reported disability following surgery for rotator cuff pathology. The purpose of this study was to examine these factors for prognostic value in order to help clinicians and patients understand preoperative factors that impact disability following surgery.

Methods: Sixty-two patients scheduled for subacromial decompression with or without supraspinatus repair were recruited. Six-month follow-up data were available for 46 patients. Patient characteristics, history of the condition, shoulder impairments, psychosocial factors, and patient-reported disability questionnaires were collected preoperatively. Six months following surgery, the Western Ontario Rotator Cuff Index (WORC) and global rating of change dichotomized subjects into responders versus nonresponders. Logistic regression quantified prognostic ability and created the most parsimonious model to predict outcome.

Results: Being on modified job duty (OR?=?.17, 95%CI: 0.03–0.94), and having a worker’s compensation claim (OR?=?0.08, 95%CI: 0.01–0.74) decreased probability of a positive outcome, while surgery on the dominant shoulder (OR?=?11.96, 95%CI: 2.91–49.18) increased probability. From the examination, only impaired internal rotation strength was a significant univariate predictor. The Fear-avoidance Beliefs Questionnaire (FABQ) score (OR?=?0.95, 95%CI: 0.91–0.98) and the FABQ_work subscale (OR?=?0.92, 95%CI: 0.87–0.97) were univariate predictors. In the final model, surgery on the dominant shoulder (OR?=?8.9, 95%CI 1.75–45.7) and FABQ_work subscale score?≤25 (OR?=?15.3, 95%CI 2.3–101.9) remained significant.

Discussion: Surgery on the dominant arm resulted in greater improvement in patient-reported disability, thereby increasing the odds of a successful surgery. The predictive ability of the FABQ_work subscale highlights the potential impact of psychosocial factors on patient-reported disability.

• Implications for Rehabilitation

• Impairment-based shoulder measurements were not strong predictors of patient-reported outcome.

• Having high fear-avoidance behavior scores on the FABQ, especially the work subscale, resulted in a much lower chance of responding well to rotator cuff surgery as measured by self-reported disability.

• Having surgery on the dominant shoulder, as compared to the nondominant side, resulted in larger improvements in disability levels.

     

Shoulder function,pain and health related quality of life in adults with joint hypermobility syndrome/Ehlers–Danlos syndrome-hypermobility type

Purpose To investigate shoulder function, pain and Health-Related Quality of life (HRQoL) among adults with joint hypermobility syndrome/Ehlers–Danlos syndrome-hypermobility type (JHS/EDS-HT), compared with the general population (controls). Method In a cross-sectional study using postal survey, 110 patients diagnosed with JHS/EDS-HT and 140 gender- and age-matched healthy controls from Statistics Norway participated. Shoulder function, pain and HRQol were registered by Western Ontario Shoulder Instability Index (WOSI), Numerical Rating Scale (NRS), pain drawings, 36-item Short Form (SF-36). Results Eighty-one individuals responded, with response rate 34% (JHS/EDS-HT: 53%, controls: 21%). JHS/EDS-HT had lower shoulder function (WOSI total: 49.9 versus 83.3; p?p?p?Conclusions Adults with JHS/EDS-HT have impaired shoulder function, increased pain intensity, as well as reduced physical HRQoL compared with controls. Although neck and shoulder were most frequently rated as painful, significantly more JHS/EDS-HT also reported generalized pain compared to controls.

• Implications for Rehabilitation

• Adults with JHS/EDS-HT have impaired shoulder function, and most often painful areas in the neck and shoulder joints, which need to be targeted in the treatment strategy.

• Compared with the general population adults with JHS/EDS-HT have reduced physical HRQoL, supporting a physical approach for this group.

• Adults with JHS/EDS-HT may present with both specific painful joints and generalized pain.

     

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.

     

Physiotherapy treatment of the diabetic shoulder: health-related quality of life and measures of shoulder function regarding patients with type 1 diabetes

Purpose: The aim of this study was to investigate how health-related quality of life (HRQoL) and functional shoulder range of motion are affected among patients with diabetes with shoulder problems, treated with a specific physiotherapy programme. A further aim was to investigate how health-related quality of life, functional shoulder range of motion, pain intensity, and shoulder function correlate within the group of patients after the treatment period.

Method: A pre–post treatment design was applied for a study group of ten patients with type 1 diabetes and shoulder problems. The physiotherapy treatment consisted of exercises promoting enhanced micro-circulation in the shoulder tissues, optimal shoulder co-ordination, and muscle relaxation. The Short Form-36 (SF-36), shoulder range of motion measures, the Shoulder Rating Scale – Swedish version, and pain intensity measures were used. The results regarding SF-36 were compared with the results of a control group of patients having either type 1 or type 2 diabetes and shoulder problems that did not receive any specific physiotherapy treatment.

Results: As a potential result of physiotherapy training, a significant change towards higher scores was observed in the physical component summary (PCS) measure of SF-36. There was a significant improvement regarding PCS in the study group as compared with the control group. There were negative correlations between the four aspects of pain intensity and PCS and Shoulder Rating Scale – Swedish version, respectively, but a positive correlation between PCS and Shoulder Rating Scale – Swedish version. “Hand-raising” and “hand-behind-back” were significantly improved, and proved to be positively correlated with Shoulder Rating Scale – Swedish version.

Conclusions: The results of this study indicate that patients with type 1 diabetes and shoulder problems, treated with a specific physiotherapy programme, may improve with respect to physical aspects of health-related quality of life, and partially regain their range of motion in the shoulder joint. Based on these results, the associated treatment protocol may be recommended for physiotherapy treatment in such patients.

• Implications for Rehabilitation

• Diabetes is a significant risk factor in the development of shoulder pain and disability.

• Health-related quality of life (HRQoL) is affected in patients with diabetes and shoulder problems.

• A specific physiotherapy programme may improve physical aspects of HRQoL in patients with diabetes and shoulder problems.

• Specific physiotherapy intervention may also improve range of motion in the shoulder joint in patients with diabetes and shoulder problems.

     

The Effectiveness of Ischemic Compression Technique on Pain and Function in Individuals With Shoulder Pain: A Systematic Review

ObjectiveTo systematically review current literature to determine the effectiveness of the ischemic compression (IC) technique on pain and function in individuals with shoulder pain.MethodsThis review was conducted according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration for Systematic Reviews; a search was performed in the electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence Database, and Web of Science. Randomized clinical trials and quasi-randomized clinical trials were included, and the methodological quality was evaluated through the Physiotherapy Evidence Database scale.ResultsThe search found 572 studies; of these, 71 were selected by title and, subsequently, 29 were selected through abstract analyses. After critical analyses, 5 studies were included. The methodological quality ranged from 4 (reasonable) to 9 (excellent) points. Pain was assessed by all studies using the visual analog scale, Global Perceived Effect scale, Numerical Rating Scale, pressure pain threshold, or Perceived Amelioration Numerical Scale. Function was evaluated by 3 studies through the Shoulder Pain and Disability Index; Neck Disability Index; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment; and Disabilities of the Arm, Shoulder, and Hand questionnaires. The studies showed that the IC technique produces immediate and short-term positive effects for pain, and positive short-term effects for shoulder function in individuals with shoulder pain.ConclusionThe IC technique seems to be beneficial for pain and shoulder function. However, caution is needed when considering this evidence owing to the limited quality of some studies, the few articles found, and the lack of standardization of the application parameters of the technique to facilitate its reproducibility.     

The relationship between functional disability and health-related quality of life in patients with a rotator cuff tear

Purpose:To determine the relationship between functional disability and health-related quality of life (HRQoL) in rotator cuff tear (RCT) patients. Method:In 67 RCT patients (mean age, 54 years; 57% males), functional disability was self-reported with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), HRQoL with the Short-Form 36 Health Survey (SF-36), and pain by visual analogue scale. ASES results were divided into tertiles (12–38, 39–51, and 52–82). Results:Mean ASES score was 48 (range, 12–82). Patients with the highest functional disability and highest pain level had the lowest HRQoL. For the highest, middle, and lowest ASES categories, respectively, mean SF-36 Physical Component Summary (PCS) scores were 35 SD 5, 36 SD 8, and 41 SD 6 (p< 0.001) (r = 0.47 for ASES vs. PCS; p< 0.001), and Mental Component Summary (MCS) scores were 50 SD 13, 56 SD 10, and 58 SD 8 (p = 0.011) (r = 0.37 for ASES vs. MCS; p= 0.003). Conclusions: Patients with higher functional disability had lower HRQoL. RCT extensively affects patients’ lives; therefore, capturing both generic and shoulder-specific measures of RCT problems is recommended.

Implications for Rehabilitation

• Rotator cuff tears (RCTs) result from injury or degeneration, and tear prevalence increases with age.

• RCT causes disabling pain, decline in muscle strength and shoulder mobility.

• RCT patients with decreased functioning have impaired quality of life.

     

Cross-cultural adaptation,reliability and validity of the Turkish version of the Lower Limb Functional Index

Abstract

Purpose: This study aims to adapt culturally a Turkish version of the Lower Limb Functional Index (LLFI) and to determine its validity, reliability, internal consistency, measurement sensitivity and factor structure in lower limb problems. Method: The LLFI was translated into Turkish and cross-culturally adapted with a double forward–backward protocol that determined face and content validity. Individuals (n?=?120) with lower limb musculoskeletal disorders completed the LLFI and Short Form-36 questionnaires and the Timed Up and Go physical test. The psychometric properties were evaluated for the all participants from patient-reported outcome measures made at baseline and repeated at day 3 to determine criterion between scores (Pearson’s r), internal consistency (Cronbachs α) and test–retest reliability (intraclass correlation coefficient – ICC_2.1). Error was determined using standard error of the measurement (SEM) and minimal detectable change at the 90% level (MDC₉₀), while factor structure was determined using exploratory factor analysis with maximum likelihood extraction and Varimax rotation. Results: The psychometric characteristics showed strong criterion validity (r?=?0.74–0.76), high internal consistency (α?=?0.82) and high test–retest reability (ICC_2.1?=?0.97). The SEM of 3.2% gave an MDC₉₀?=?5.8%. The factor structure was uni-dimensional. Conclusions: Turkish version of LLFI was found to be valid and reliable for the measurement of lower limb function in a Turkish population.

• Implications for Rehabilitation

• Lower extremity musculoskeletal disorders are common and greatly impact activities among the affected individuals pertaining to daily living, work, leisure and quality of life.

• Patient-reported outcome (PRO) measures have advantages as they are practical, cost-effective and clinically convenient for use in patient-centered care.

• The Lower Limb Functional Index is a recently validated PRO measure shown to have strong clinimetric properties.

     

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.

     

The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome

Abstract

Purpose: Motor imagery (MI) has been used as a complementary therapeutic tool for motor recovery after central nervous system disease and peripheral injuries. However, it has never been used as a preventive tool. We investigated the use of MI in the rehabilitation of stage II shoulder impingement syndrome. For the first time, MI is used before surgery. Method: Sixteen participants were randomly assigned to either a MI or control group. Shoulder functional assessment (Constant score), range of motion and pain were measured before and after intervention. Results: Higher Constant score was observed in the MI than in the control group (p?=?0.04). Participants in the MI group further displayed greater movement amplitude (extension (p?<?0.001); flexion (p?=?0.025); lateral rotation (p?<?0.001). Finally, the MI group showed greater pain decrease (p?=?0.01). Conclusion: MI intervention seems to alleviate pain and enhance mobility, this is probably due to changes in muscle control and consequently in joint amplitude. MI might contribute to postpone or even protect from passing to stage III that may require surgery.

• Implications for Rehabilitation

• Adding motor imagery training to classical physical therapy in a stage II impingement syndrome:

• Helps in alleviating pain

• Enhances shoulder mobility

• Motor imagery is a valuable technique that can be used as a preventive tool before the stage III of the impingement syndrome.

     

Shoulder pain after stroke – experiences,consequences in daily life and effects of interventions: a qualitative study

Purpose: To describe experiences of shoulder pain after stroke, how pain affects daily life and perceived effects of interventions.

Method: A qualitative interview study including 13 community-dwelling persons (six women; median age 65?years) with persistent shoulder pain after stroke.

Results: Three categories emerged from the content analysis. In “Multiple pain characteristics” an insidious pain onset was reported. The pain existed both day and night and could be located around the shoulder girdle but also have radiation to the arm and hand. An explanation of the pain was seldom given. In “Limitations caused by the pain” it was described how the pain negatively influenced personal care, household activities and leisure, but also could lead to emotional reactions. In “Multiple pain interventions with various effects” a variety of interventions were described. Self-management interventions with gentle movements were perceived most effective. A restraint attitude to pain medication due to side effects was reported.

Conclusions: Shoulder pain after stroke can lead to a variety of pain characteristics. As the pain is complex and may affect many important areas in a person’s life, multidisciplinary rehabilitation interventions are important.

• Implications for rehabilitation

• Shoulder pain after stroke can lead to a variety of pain characteristics with radiation to the arm and hand

• Shoulder pain often influence personal care, household activities and leisure negatively, which may lead to emotional reactions

• Self-management interventions with gentle movements are perceived most effective

• As the shoulder pain after stroke is complex, interventions by a multidisciplinary team may be needed

     

The relationship of preoperative factors to patient-reported outcome in rotator cuff repair: a systematic review

Background: Understanding preoperatively available factors that predict valid, patient-reported outcomes following rotator cuff repair can assist clinicians and their patients in making an informed, shared-decision on rotator cuff repair, and assist in setting an evidence-based prognosis.

Objectives: To perform a systematic review of the preoperative factors related to patient-reported outcome following rotator cuff repair.

Methods: A systematic review of the literature was performed to identify studies analyzing the relationship of preoperative factors to valid, patient-reported outcome measures. To be included in the review, outcome had to be measured by at least one valid upper extremity or shoulder-specific patient-reported outcome.

Results: Twenty-three studies met the criteria for inclusion. Of these, 15 studies scored 3 or less on a 7-point scale of study quality indicating a paucity of strong trials investigating these prognostic factors. Prognostic factors reviewed included age, sex, worker’s compensation status, involvement of dominant arm, fatty infiltration of the cuff musculature, duration of symptoms, comorbidities, and smoking status. Increasing age predicted worse Disabilities of Arm, Shoulder and Hand Scores (DASH) but did not predict outcome of any other patient-reported outcome. A worker’s compensation claim predicted a negative impact on patient-reported outcome. Evidence for the remaining factors indicated they do not predict patient-reported outcome.

Conclusion: Six of the eight preoperative factors reviewed did not show a relationship with patient-reported outcome following rotator cuff repair. Evidence indicates a worker’s compensation claim negatively impacts patient-reported outcomes and increasing age resulted in a less favorable DASH score. However, age was not predictive of other patient-reported outcomes such as the Constant score or American Shoulder and Elbow Surgeons Shoulder Score. Overall quality of the included studies was low and future studies with stronger methodologies should be conducted.     

Establishing the Turkish version of the SIGAM mobility scale,and determining its validity and reliability in lower extremity amputees

Purpose: The aim of this study is to adapt the Special Interest Group in Amputee Medicine (SIGAM) mobility scale to Turkish, and to test its validity and reliability in lower extremity amputees.

Material and methods: Adaptation of the scale into Turkish was performed by following the steps in American Association of Orthopedic Surgeons (AAOS) guideline. Turkish version of the scale was tested twice on 109 patients who had lower extremity amputations, at hours 0 and 72. The reliability of the Turkish version was tested for internal consistency and test–retest reliability. Structural validity was tested using the “scale validity” method. For this purpose, the scores of the Short Form-36 (SF-36), Functional Ambulation Scale (FAS), Get Up and Go Test, and Satisfaction with the Prosthesis Questionnaire (SATPRO) were calculated, and analyzed using Spearman’s correlation test.

Results: Cronbach’s alpha coefficient was 0.67 for the Turkish version of the SIGAM mobility scale. Cohen's kappa coefficients were between 0.224 and 0.999. Repeatability according to the results of the SIGAM mobility scale (grades A–F) was 0.822. We found significant and strong positive correlations of the SIGAM mobility scale results with the FAS, Get Up and Go Test, SATPRO, and all of the SF-36 subscales.

Conclusion: In our study, the Turkish version of the SIGAM mobility scale was found as a reliable, valid, and easy to use scale in everyday practice for measuring mobility in lower extremity amputees.

• Implications for Rehabilitation

• Amputation is the surgical removal of a severely injured and nonfunctional extremity, at a level of one or more bones proximal to the body.

• Loss of a lower extremity is one of the most important conditions that cause functional disability.

• The Special Interest Group in Amputee Medicine (SIGAM) mobility scale contains 21 questions that evaluate the mobility of lower extremity amputees.

• Lack of a specific Turkish scale that evaluates rehabilitation results and mobility of lower extremity amputees, and determines their needs, directed us to perform a study on this topic when we took the number of amputations performed in our country into consideration.

• SIGAM mobility scale is directed at rehabilitation specialists who are working in amputee medicine. Turkish version of this scale was found both reliable and valid in our study and hence it can be used in clinical practice and studies.

     

Pain,fatigue, function and participation among long-term manual wheelchair users partnered with a mobility service dog

Purpose: To assess the effects of a mobility service dog (MSD) on pain, fatigue, wheelchair-related functional tasks, participation and satisfaction among manual wheelchair users over a nine-month period.

Method: A longitudinal study with repeated assessment times before and three, six and nine months after intervention was achieved. Intervention consisted in partnering each participant with a MSD. The setting is a well-established provincial service dog training school and participants homes. A convenience sample of 24 long-term manual wheelchair users with a spinal cord injury was involved. Outcome measures were: Wheelchair User’s Shoulder Pain Index (WUSPI), Rate of Perceived Exertion (RPE), vitality scale from the SF-36, grip strength, Wheelchair Skills Test (WST), Canadian Occupational Performance Measure (COPM), Reintegration to Normal Living Index (RNLI), Life Space Assessment, Psychosocial Impact of Assistive Devices Scale (PIADS) and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0).

Results: Shoulder and wrist pain as well as fatigue decreased significantly over time with the use of a MSD as evidenced by scores from WUSPI, RPE and SF-36 (feeling less worn out). Manual wheelchair propulsion skills (steep slopes, soft surfaces and thresholds) improved significantly over time as confirmed by the WST. Participation increased significantly over time as revealed by the COPM (for five occupations) and the RNLI (for five items). Satisfaction with the MSD was high over time (QUEST: nine items) and with a high positive psychosocial impact (PIADS: 10 items).

Conclusion: MSD represents a valuable mobility assistive technology option for manual wheelchair users.

• IMPLICATIONS FOR REHABILITATION

• For manual wheelchair users partenered with mobility service dog ??Shoulder pain and fatigue significantly decreased and continued to decrease between the third and sixth month and the ninth month.

• ??Performance with propelling the wheelchair up steep slopes increased from 41 to 88% and on soft surfaces increased from 53 to 100% after 3 months, respectively.

• ??Occupational performance satisfaction was significantly increased for mobility in relation with the transfers, navigating in a natural environment and picking up objects.

• ??High satisfaction towards psychosocial competency, psychosocial adequacy and self-esteem were reported at months three, six and nine.

     

The hemiplegic arm: Interrater reliability and concurrent validity of passive range of motion measurements

Purpose. To assess whether our measurement protocol using two raters simultaneously yielded reliable passive range of motion measurements of the hemiplegic arm. Additionally, motion ranges were correlated to several factors to examine the concurrent validity of these measurements.

Method. Two raters simultaneously assessed five arm motions at baseline, after five and ten weeks in respectively 18, 13 and 12 stroke patients. One tester made the passive movement and the other read the hydrogoniometer. Raters then switched roles.

Results. Intraclass correlation coefficients revealed high agreement between the raters with intraclass correlation coefficients (ICCs) ranging between 0.84 and 0.99. Standard errors of measurement and smallest detectable differences were large for shoulder abduction. Significant correlations were found between shoulder external rotation and flexion. All arm motions correlated negatively to pain at the end range of these motions. Shoulder external rotation and flexion were significantly correlated to the time post stroke. Concurrent validity with Ashworth Scale, Fugl-Meyer Assessment and Barthel Index was limited.

Conclusions. The current measurement protocol yielded high reliability indices and seems useful for further use. However, standard error of measurement and smallest detectable difference for shoulder abduction were high, implying the neccesity to include a large sample size in future studies. Correlations revealed that restricted range of arm motions relate to the time post-stroke and coincide with pain.     

Intertester reliability of shoulder complaints diagnoses in primary health care

Objective: Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting.

Design: Cross-sectional study.

Setting: Four primary health care clinicians used patients’ history and functional examination of the shoulder by selective tissue tension techniques (STTs), to diagnose shoulder complaints.

Subjects: 62 patients, aged 18–75 years.

Main outcome measure: Reliability of diagnoses was assessed by observed intertester agreement and Cohen’s kappa. A total of 372 diagnostic pairs were available for intertester comparisons.

Results: Six diagnoses were assigned by all clinicians; supraspinatus-, infraspinatus-, subscapularis-tendinopathies; chronic subacromial bursitis; glenohumeral capsulitis, and acromioclavicular joint lesion. The observed agreement on these diagnoses ranged from 0.84 for glenohumeral capsulitis to 0.97 for acromioclavicular joint lesion. Kappa scores were 0.46 (95% CI 0.33, 0.58) for chronic subacromial bursitis; 0.53 (95% CI 0.34, 0.68), 0.59 (95% CI 0.47, 0.70), and 0.68 (95% CI 0.53, 0.82) for infraspinatus -, supraspinatus -, and subscapularis-tendinopathy, respectively. For glenohumeral capsulitis and acromioclavicular lesion kappa scores were 0.66 (95% CI 0.57, 0.73) and 0.78 (95% CI 0.61, 0.90). Kappa scores were higher for individual diagnoses than for individual tests, except for limitation in passive abduction (0.70, 95% CI 0.62, 0.78) and passive lateral rotation (0.66, 95% CI 0.57, 0.73).

Conclusions: Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints.

• Key points

• Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we investigated the agreement of shoulder complaints diagnoses across four primary health care clinicians and 62 patients.

• ??Agreements on diagnoses were generally better than the agreement on individual tests.

• ??Good kappa scores were obtained for the diagnoses glenohumeral capsulitis, rotator cuff tendinopathy, and acromioclavicular lesion.

• ??Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.

     

Shoulder function and active motion deficit in patients with rheumatoid arthritis

Purpose: To discover whether there are differences between patients with RA with and without active motion deficit in the shoulder (passive ROM greater than active ROM) concerning disease characteristics and shoulder function, and examine the role of active motion deficit in explaining limitations of shoulder function in daily life. Methods: This cross-sectional study included 123 patients with RA having shoulder pain. Disease activity and duration of shoulder pain and disease were registered, active and passive shoulder ROM, pain and muscle strength were measured. Shoulder function in daily life was assessed by Disability of the Arm, Shoulder and Hand (DASH). Results: Patients with active motion deficit (36%) had statistical significant worse scores on disease activity, shoulder pain, muscle strength, and DASH function than those without active motion deficit (p ≤ 0.05). No differences between the groups were found for duration of shoulder pain or disease (p > 0.05). Active motion deficit, passive ROM, muscle strength and pain explained 33.7% of the variation in the DASH function score. Conclusion: Active motion deficit in the shoulder seems frequent in patients with RA. Together with passive ROM, muscle strength and pain, active motion deficit explained about one-third of the limitations in shoulder function in daily life.

Implications for Rehabilitation

• Rheumatoid arthritis (RA) is a chronic inflammatory disease that primarily affects the joints and periarticular tissue. Pain, muscle weakness, and joint destruction may result in reduced range of motion (ROM), which in turn may affect the performance of activities in daily life.

• Shoulder affection is frequent in patients with RA. About one-third of the patients in the present study had an active motion deficit in the shoulders.

• Patients with active motion deficit had more shoulder pain and more impaired shoulder function than those without deficit. Active motion deficit associated with limitations in shoulder function in daily life.

     

Psychometric properties of the performing arts module of the Disabilities of the Arm,Shoulder, and Hand questionnaire

Abstract

Background: The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) offers an optional performing arts module. The goal was to examine the psychometric properties of this module in musicians.

Methods: This study is a secondary analysis of a randomized controlled trial on the effectiveness of a biopsychosocial intervention to prevent or reduce playing-related disability in conservatory students. Baseline data were used to examine internal consistency and discriminative validity of the performing arts module of the DASH questionnaire. Construct validity was analyzed by hypotheses testing. The performing arts module outcomes were compared to scores from the general DASH questionnaire, pain disability index, Short-Form 36, playing-related musculoskeletal disorder (PRMD) intensity, and pain intensity.

Results: Questionnaires completed by 130 conservatory students were analyzed, 55% of the population was female. Median age was 20 years (IQR 4). The performing arts module showed good internal consistency (Cronbach’s alpha 0.893). Discriminative validity between students with and without PRMDs was good. Three out of six hypotheses were accepted, indicating moderate construct validity.

Conclusions: The performing arts module showed good internal consistency, good discriminative validity and moderate construct validity in a population of conservatory students.

• Implications for Rehabilitation

• Musicians suffer frequently from musculoskeletal disorders, mostly in the upper extremity.

• The Disabilities of the Arm, Shoulder, and Hand questionnaire is a well-known outcome measure, which also includes a performing arts module.

• This study is the first to explore psychometric properties of the performing arts module.

• The performing arts module of the Disabilities of the Arm, Shoulder, and Hand questionnaire showed good internal consistency, good discriminative validity, and moderate construct validity.

     

Evidence for increased neuromuscular drive following spinal manipulation in individuals with subacromial pain syndrome

BackgroundThoracic spinal manipulation can improve pain and function in individuals with shoulder pain; however, the mechanisms underlying these benefits remain unclear. Here, we evaluated the effects of thoracic spinal manipulation on muscle activity, as alteration in muscle activity is a key impairment for those with shoulder pain. We also evaluated the relationship between changes in muscle activity and clinical outcomes, to characterize the meaningful context of a change in neuromuscular drive.MethodsParticipants with shoulder pain related to subacromial pain syndrome (n = 28) received thoracic manipulation of low amplitude high velocity thrusts to the lower, middle and upper thoracic spine. Electromyographic muscle activity (trapezius-upper, middle, lower; serratus anterior; deltoid; infraspinatus) and shoulder pain (11-point scale) was collected pre and post-manipulation during arm elevation, and normalized to a reference contraction. Clinical benefits were assessed using the Pennsylvania Shoulder Score (Penn) at baseline and 2–3 days post-intervention.FindingsA significant increase in muscle activity was observed during arm ascent (p = 0.002). Using backward stepwise regression analysis, a specific increase in the serratus anterior muscle activity during arm elevation explained improved Penn scores following post-manipulation (p < 0.05).InterpretationThoracic spinal manipulation immediately increases neuromuscular drive. In addition, increased serratus anterior muscle activity, a key muscle for scapular motion, is associated with short-term improvements in shoulder clinical outcomes.