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Ibounig T, Buchbinder R, Sillanpää N, Rämö L, Toivonen P, Raatikainen S, Koskinen S, Härkänen T, Rissanen H, Czuba T, Paavola M, Jarvinen T, Taimela S. Concordance of shoulder symptoms and imaging findings: a protocol for the Finnish Imaging of Shoulder (FIMAGE) study. BMJ Open 2023; 13:e074457. [PMID: 38154899 PMCID: PMC10759117 DOI: 10.1136/bmjopen-2023-074457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Shoulder pain is a substantial medical and socioeconomic problem in most societies, affecting the ability to work or carry out leisure time activities as well as subsequently influencing physical and psychological well-being. According to a nationwide survey in Finland, 27% of the population reported shoulder pain within the last 30 days. In clinical practice, imaging findings of structural abnormalities are typically thought to explain symptoms, even though such findings are also prevalent in asymptomatic individuals, particularly with increasing age. Overall, there is a paucity of high-quality evidence on the prevalence, clinical relevance and prognosis of 'abnormal' imaging findings of the shoulder.The aim of the Finnish Imaging of Shoulder (FIMAGE) study is fourfold: to assess (1) the prevalence of shoulder symptoms and the most common anatomical variants and imaging abnormalities of the shoulder; (2) the concordance between shoulder symptoms, function and imaging abnormalities; (3) the most important determinants of symptoms, function and imaging abnormalities; and (4) the course of shoulder complaints over 5 years. METHODS The FIMAGE target population of 600 participants, aged 40-75 years, will be randomly selected from a nationally representative general population sample of 9922 individuals originally recruited for the Finnish Health 2000 Survey. On giving informed consent, the participants will be invited to a clinical visit that includes assessment of general health, shoulder symptoms, bilateral shoulder examination and imaging of both shoulders with plain radiography and MRI. ETHICS AND DISSEMINATION The study has been approved by the Institutional Review Board of the Helsinki and Uusimaa Hospital District. The findings will be published according to the Strengthening the Reporting of Observational Studies in Epidemiology criteria. TRIAL REGISTRATION NUMBER NCT05641415.
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Affiliation(s)
- Thomas Ibounig
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Niko Sillanpää
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland
- Tampere University Hospital, Tampere, Finland
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland
| | - Pirjo Toivonen
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland
| | - Saara Raatikainen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland
| | - Seppo Koskinen
- Population Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Tommi Härkänen
- Population Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Harri Rissanen
- Population Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Tomasz Czuba
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
| | - Mika Paavola
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Teppo Jarvinen
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland
| | - Simo Taimela
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland
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Hwang S, Ardebol J, Ghayyad K, Pak T, Bonadiman JA, Denard PJ, Menendez ME. Remote visual estimation of shoulder range of motion has generally high interobserver reliability but limited accuracy. JSES Int 2023; 7:2528-2533. [PMID: 37969522 PMCID: PMC10638579 DOI: 10.1016/j.jseint.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Surgeon visual estimation of shoulder range of motion (ROM) is commonplace in the outpatient office setting and routinely reported in clinical research, but the reliability and accuracy of this practice remain unclear. The purpose of this study is to establish the reliability and accuracy of remote visual estimation of shoulder ROM in healthy volunteers and symptomatic patients among a large group of shoulder surgeons. Our hypothesis is that remote visual estimation would be reliable and accurate compared with the digital goniometer method. Methods Fifty shoulder surgeon members of the PacWest Shoulder and Elbow Society independently determined the active shoulder forward flexion (FF), internal rotation at 90° abduction (IR90), external rotation at 90° abduction, external rotation at the side , and maximal spinal level reached with internal rotation (IRspine) through visual estimation of video recordings taken from 10 healthy volunteers and 10 symptomatic patients. Variations in measurements were quantified using the interobserver reliability through calculation of the intraclass correlation coefficient. Accuracy was determined through comparison with digital goniometer measurements obtained with an on-screen protractor application using Bland-Altman mean differences and 95% limits of agreement. Results The interobserver reliability among examiners showed moderate to excellent correlation, with intraclass correlation coefficient ranging from 0.768 to 0.928 for the healthy volunteers and 0.739 to 0.878 for the symptomatic patients. Accuracy was limited, with upper limits of agreement exceeding the established minimal clinically important differences (MCIDs) for FF (20° vs. MCID of 14°) and IR90 (25° vs. 18°) in the healthy volunteers and for FF (33° vs. 16°), external rotation at 90° abduction (21° vs. 18°), and IR90 (31° vs. 20°) in the symptomatic patients. Conclusion Despite generally high intersurgeon reliability in the visual estimation of shoulder ROM, there was questionable accuracy when compared to digital goniometer measurements,with measurement errors often exceeding established MCID values. Given the potential implications for the clinical response to treatment and the significance of research findings, the adoption of validated instruments to measure ROM and the standardization of examination procedures should be considered.
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Affiliation(s)
| | | | | | | | - Joao A. Bonadiman
- Instituto de Ortopedia e Traumatologia, Hospital São Vicente de Paulo, Passo Fundo, RS, Brazil
- Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, RJ, Brazil
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Beshara P, Davidson I, Pelletier M, Walsh WR. The Intra- and Inter-Rater Reliability of a Variety of Testing Methods to Measure Shoulder Range of Motion, Hand-behind-Back and External Rotation Strength in Healthy Participants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14442. [PMID: 36361321 PMCID: PMC9653808 DOI: 10.3390/ijerph192114442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
This study determined the intra- and inter-rater reliability of various shoulder testing methods to measure flexion range of motion (ROM), hand-behind-back (HBB), and external rotation (ER) strength. Twenty-four healthy adults (mean age of 31.2 and standard deviation (SD) of 10.9 years) without shoulder or neck pathology were assessed by two examiners using standardised testing protocols to measure shoulder flexion with still photography, HBB with tape measure, and isometric ER strength in two abduction positions with a hand-held dynamometer (HHD) and novel stabilisation device. Intraclass correlation coefficient (ICC) established relative reliability. Standard error of measurement (SEM) and minimum detectable change (MDC) established absolute reliability. Differences between raters were visualised with Bland-Altman plots. A paired t-test assessed for differences between dominant and non-dominant sides. Still photography demonstrated good intra- and inter-rater reliability (ICCs 0.75-0.86). HBB with tape measure demonstrated excellent inter- and intra-rater reliability (ICCs 0.94-0.98). Isometric ER strength with HHD and a stabilisation device demonstrated excellent intra-rater and inter-rater reliability in 30° and 45° abduction (ICCs 0.96-0.98). HBB and isometric ER at 45° abduction differed significantly between dominant and non-dominant sides. Standardised shoulder ROM and strength tests provide good to excellent reliability. HBB with tape measure and isometric strength testing with HHD stabilisation are clinically acceptable.
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Affiliation(s)
- Peter Beshara
- Department of Physiotherapy, Prince of Wales Hospital, Sydney, NSW 2031, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia
- Surgical & Orthopaedic Research Laboratories, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Ingrid Davidson
- Department of Physiotherapy, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Matthew Pelletier
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia
- Surgical & Orthopaedic Research Laboratories, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - William R. Walsh
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia
- Surgical & Orthopaedic Research Laboratories, Prince of Wales Hospital, Sydney, NSW 2031, Australia
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Tozzo MC, Ansanello W, Martins J, Zatiti SCA, de Oliveira AS. Inclinometer Reliability for Shoulder Ranges of Motion in Individuals With Subacromial Impingement Syndrome. J Manipulative Physiol Ther 2021; 44:236-243. [PMID: 33926742 DOI: 10.1016/j.jmpt.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/21/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to determine the intra- and interrater reliability of active and passive range of motion in the shoulders of individuals with subacromial impingement syndrome using a digital inclinometer. METHODS The raters evaluated active and passive range of motion in the shoulder of 50 individuals with unilateral subacromial impingement syndrome in movements including flexion, abduction, extension, external rotation in a neutral position, external rotation with the arm at 90° of abduction, and internal rotation with the arm at 90° of abduction. The tests were performed by 2 examiners on the same day, with a 10-minute interval, and were repeated by 1 examiner after a 2- to 4-day interval. Reliability was analyzed using the intraclass correlation coefficient (ICC2,3). RESULTS There was moderate to excellent interrater (ICC2,3 = 0.50-0.95) and intrarater (ICC2,3 = 0.74-0.94) reliability. In the interrater analysis, the standard error of measurement (SEM) ranged from 4.1° to 10°, the percentage SEM (%SEM) ranged from 2% to 17%, and the minimum detectable change ranged from 9.5° to 23.4°. In the intrarater analysis, the SEM ranged from 4° to 9.2°, %SEM ranged from 3% to 14%, and the minimum detectable change ranged from 9.3° to 21.4°. CONCLUSION The digital inclinometer showed moderate to excellent reliability for measuring active and passive range of motion in shoulders with unilateral subacromial impingement syndrome.
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Affiliation(s)
- Marcela C Tozzo
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Walter Ansanello
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Jaqueline Martins
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Anamaria S de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
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Holzgreve F, Maurer-Grubinger C, Isaak J, Kokott P, Mörl-Kreitschmann M, Polte L, Solimann A, Wessler L, Filmann N, van Mark A, Maltry L, Groneberg DA, Ohlendorf D. The acute effect in performing common range of motion tests in healthy young adults: a prospective study. Sci Rep 2020; 10:21722. [PMID: 33303934 PMCID: PMC7728808 DOI: 10.1038/s41598-020-78846-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
In the application of range of motion (ROM) tests there is little agreement on the number of repetitions to be measured and the number of preceding warm-up protocols. In stretch training a plateau in ROM gains can be seen after four to five repetitions. With increasing number of repetitions, the gain in ROM is reduced. This study examines the question of whether such an effect occurs in common ROM tests. Twenty-two healthy sport students (10 m/12 f.) with an average age of 25.3 ± 1.94 years (average height 174.1 ± 9.8 cm; weight 66.6 ± 11.3 kg and BMI 21.9 ± 2.0 kg/cm2) volunteered in this study. Each subject performed five ROM tests in a randomized order—measured either via a tape measure or a digital inclinometer: Tape measure was used to evaluate the Fingertip-to-Floor test (FtF) and the Lateral Inclination test (LI). Retroflexion of the trunk modified after Janda (RF), Thomas test (TT) and a Shoulder test modified after Janda (ST) were evaluated with a digital inclinometer. In order to show general acute effects within 20 repetitions we performed ANOVA/Friedman-test with multiple comparisons. A non-linear regression was then performed to identify a plateau formation. Significance level was set at 5%. In seven out of eight ROM tests (five tests in total with three tests measured both left and right sides) significant flexibility gains were observed (FtF: p < 0.001; LI-left/right: p < 0.001/0.001; RF: p = 0.009; ST-left/right: p < 0.001/p = 0.003; TT-left: p < 0.001). A non-linear regression with random effects was successfully applied on FtF, RF, LI-left/right, ST-left and TT-left and thus, indicate a gradual decline in the amount of gained ROM. An acute effect was observed in most ROM tests, which is characterized by a gradual decline of ROM gain. For those tests, we can state that the acute effect described in the stretching literature also applies to the performance of typical ROM tests. Since a non-linear behavior was shown, it is the decision of the practitioner to weigh up between measurement accuracy and expenditure. Researchers and practitioners should consider this when applying ROM assessments to healthy young adults.
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Affiliation(s)
- F Holzgreve
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany.
| | - C Maurer-Grubinger
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany
| | - J Isaak
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - P Kokott
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - M Mörl-Kreitschmann
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - L Polte
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - A Solimann
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - L Wessler
- Institute of Sport Science, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - N Filmann
- Institute of Biostatistics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - A van Mark
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany
| | - L Maltry
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany
| | - D A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany
| | - D Ohlendorf
- Institute for Occupational Medicine, Social Medicine and Environment Medicine, Goethe-University Frankfurt, Frankfurt Theodor-Stern-Kai 7, Haus 9b, 60590, Frankfurt am Main, Germany
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Intra- and inter-rater reliability of joint range of motion tests using tape measure, digital inclinometer and inertial motion capturing. PLoS One 2020; 15:e0243646. [PMID: 33301541 PMCID: PMC7728246 DOI: 10.1371/journal.pone.0243646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/25/2020] [Indexed: 12/30/2022] Open
Abstract
Background In clinical practice range of motion (RoM) is usually assessed with low-cost devices such as a tape measure (TM) or a digital inclinometer (DI). However, the intra- and inter-rater reliability of typical RoM tests differ, which impairs the evaluation of therapy progress. More objective and reliable kinematic data can be obtained with the inertial motion capture system (IMC) by Xsens. The aim of this study was to obtain the intra- and inter-rater reliability of the TM, DI and IMC methods in five RoM tests: modified Thomas test (DI), shoulder test modified after Janda (DI), retroflexion of the trunk modified after Janda (DI), lateral inclination (TM) and fingertip-to-floor test (TM). Methods Two raters executed the RoM tests (TM or DI) in a randomized order on 22 healthy individuals while, simultaneously, the IMC data (Xsens MVN) was collected. After 15 warm-up repetitions, each rater recorded five measurements. Findings Intra-rater reliabilities were (almost) perfect for tests in all three devices (ICCs 0.886–0.996). Inter-rater reliability was substantial to (almost) perfect in the DI (ICCs 0.71–0.87) and the IMC methods (ICCs 0.61–0.993) and (almost) perfect in the TM methods (ICCs 0.923–0.961). The measurement error (ME) for the tests measured in degree (°) was 0.9–3.3° for the DI methods and 0.5–1.2° for the IMC approaches. In the tests measured in centimeters the ME was 0.5–1.3cm for the TM methods and 0.6–2.7cm for the IMC methods. Pearson correlations between the results of the DI or the TM respectively with the IMC results were significant in all tests except for the shoulder test on the right body side (r = 0.41–0.81). Interpretation Measurement repetitions of either one or multiple trained raters can be considered reliable in all three devices.
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Ahn SY, Ko H, Yoon JO, Cho SU, Park JH, Cho KH. Determining the Reliability of a New Method for Measuring Joint Range of Motion Through a Randomized Controlled Trial. Ann Rehabil Med 2020; 43:707-719. [PMID: 31918533 PMCID: PMC6960083 DOI: 10.5535/arm.2019.43.6.707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/02/2019] [Indexed: 11/12/2022] Open
Abstract
Objective To compare the reliability and validity of the Korean range of motion standard protocol (KRSP) for measuring joint range of motion (ROM) with those of the conventional ROM measurement using a goniometer. Methods We conducted a randomized controlled trial involving 91 healthy elderly individuals. We compared two strategies of measuring joint ROM to evaluate the reliability and validity of each standardized protocol: first, the KRSP based on the Chungnam National University guidelines and second, handheld goniometric measurement. In the first strategy, 3 examiners (1 rehabilitation doctor, 1 physical therapist, and 1 physical therapy student) independently measured joint ROM in 46 randomly selected subjects; in the second strategy, another 3 examiners (1 rehabilitation doctor, 1 physical therapist, and 1 physical therapy student) measured joint ROM in 45 randomly selected subjects. The reliability of each protocol was calculated using intraclass correlation coefficient, ICC(2,1), and root mean square error (RMSE). Results Both protocols showed good to excellent intra-rater reliability. With goniometer use, the inter-rater reliability was low—ICC(2,1), 95% confidence interval ranged from 0.643 (0.486–0.783) to -0.078 (-0.296–0.494)— and RMSE was high. With the KRSP, the inter-rater reliability ranged from 0.846 (0.686–0.931) to 0.986 (0.972–0.994) and RMSE was low. Conclusion ROM measurements using the KRSP showed excellent reliability. These results indicate that this protocol can be the reference standard for measuring ROM in clinical settings as an alternative to goniometers.
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Affiliation(s)
- So Young Ahn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hanbit Ko
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jeong Oh Yoon
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sun Ung Cho
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jong Hyun Park
- Biomedical Engineering Center, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kang Hee Cho
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea.,Biomedical Engineering Center, Chungnam National University College of Medicine, Daejeon, Korea
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Gane EM, McPhail SM, Hatton AL, Panizza BJ, O’Leary SP. Neck and Shoulder Motor Function following Neck Dissection: A Comparison with Healthy Control Subjects. Otolaryngol Head Neck Surg 2019; 160:1009-1018. [DOI: 10.1177/0194599818821885] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective To compare the neck and shoulder motor function of patients following neck dissection, including comparison with a group of healthy volunteers. Study Design Cross-sectional study. Setting Two tertiary hospitals in Brisbane, Australia. Subjects and Methods Participants included patients 0.5 to 5 years after unilateral nerve-sparing neck dissection and healthy control subjects. Demographic and clinical information was collected with cervical and shoulder motor function measures (scapular resting position, active range of motion, and isometric muscle strength). Differences between groups were examined via regression analyses that included statistical adjustment for the potential effect of age, sex, body mass index, and other disease-related variables. Results The 57 patients (68%, men; median age, 62 years) were typically older than the 34 healthy controls (47%, men; median age, 46 years). There were no differences between types of nerve-preserving neck dissection for any of the motor function measures. When adjusted for age, sex, and body mass index, healthy volunteers (vs patients) had significantly greater cervical range (eg, extension coefficient [95% CI]: 11.04° [4.41°-17.67°]), greater affected shoulder range (eg, abduction: 16.64° [1.19°-31.36°]), and greater isometric strength of the cervical flexors (eg, men: 4.24 kgf [1.56-6.93]) and shoulder flexors (eg, men: 8.00 kgf [1.62-14.38]). Conclusions Strength and flexibility of the neck and shoulder are impaired following neck dissection in comparison with healthy controls. Clinicians and researchers are encouraged to consider the neck—and the neck dissection as a whole—as a source of motor impairment for these patients and not just the status of the accessory nerve.
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Affiliation(s)
- Elise M. Gane
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
| | - Steven M. McPhail
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
- School of Public Health and Social Work and the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Anna L. Hatton
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Benedict J. Panizza
- School of Medicine, The University of Queensland, Brisbane, Australia
- Department of Otolaryngology–Head and Neck Surgery, Princess Alexandra Hospital, Queensland Health, Brisbane, Australia
| | - Shaun P. O’Leary
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Department of Physiotherapy, Royal Brisbane and Women’s Hospital, Queensland Health, Brisbane, Australia
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Holzgreve F, Maltry L, Lampe J, Schmidt H, Bader A, Rey J, Groneberg DA, van Mark A, Ohlendorf D. The office work and stretch training (OST) study: an individualized and standardized approach for reducing musculoskeletal disorders in office workers. J Occup Med Toxicol 2018; 13:37. [PMID: 30564280 PMCID: PMC6296036 DOI: 10.1186/s12995-018-0220-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background Musculoskeletal disorders (MSD) are a common health problem in office workers. In Germany, MSD (mainly back pain related) are the main cause of workdays lost to incapacity. This is not only bothersome for the employees, but also causes higher costs for the health system and employers. Workplace health promotion programmes (WHPP) can help to reduce this as they reach large target groups and are easily accessible. In this context, stretch training exercises have already proven to be effective. In the present study, a new approach focusing on trunk extension is to be investigated. Methods To evaluate the training device “five-Business”, 250 office workers will train two times a week for 3 months. The control group will consist of 100 office employees. The device “five-Business” enables five different full body exercises. The intervention will be evaluated before week one and after week twelve via three assessments: a) the Short Form-36 (SF-36) to record the general health status and health-related quality of life, taking into account physical, psychological and social factors, b) the Nordic Questionnaire to evaluate complaints of the musculoskeletal system, c) Range of Motion (ROM) measurements using a digital inclinometer and a measuring tape respectively. Conclusion The “five-Business” combines elements of yoga and the McKenzie fundamentals, taking into account the Myers myofascial pathways in a highly torso-oriented, standardized stretching program. Due to the given exercise execution on the device and the individual adjustment possibilities of the stretching position (body size and range of motion) by the abutment, all exercises are individualized and standardized at the same time. In comparison to existing stretching interventions, this is a new approach in the framework of reducing musculoskeletal disorders and improving the quality of life in workplace health promotion.
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Affiliation(s)
- Fabian Holzgreve
- 1Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe- University, Theodor-Stern-Kai 7, Building 9a, 60596 Frankfurt am Main, Germany
| | - Laura Maltry
- 1Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe- University, Theodor-Stern-Kai 7, Building 9a, 60596 Frankfurt am Main, Germany
| | - Jasmin Lampe
- 1Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe- University, Theodor-Stern-Kai 7, Building 9a, 60596 Frankfurt am Main, Germany
| | - Helmut Schmidt
- 2Managing Director, Health and Safety, Daimler AG, Stuttgart, Germany
| | - Andreas Bader
- 3Manager Corporate Health Promotion, Health and Safety, Daimler AG, Stuttgart, Germany
| | - Julia Rey
- 4Institute of Biostatistics and Mathematical Modeling, Goethe-University, Frankfurt/Main, Germany
| | - David A Groneberg
- 1Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe- University, Theodor-Stern-Kai 7, Building 9a, 60596 Frankfurt am Main, Germany
| | - Anke van Mark
- 1Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe- University, Theodor-Stern-Kai 7, Building 9a, 60596 Frankfurt am Main, Germany
| | - Daniela Ohlendorf
- 1Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe- University, Theodor-Stern-Kai 7, Building 9a, 60596 Frankfurt am Main, Germany
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The relationship between physical impairments, quality of life and disability of the neck and upper limb in patients following neck dissection. J Cancer Surviv 2018; 12:619-631. [DOI: 10.1007/s11764-018-0697-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
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Abstract
Rotator cuff disease affects a large proportion of the overall population and encompasses a wide spectrum of pathologies, including subacromial impingement, rotator cuff tendinopathy or tear, and calcific tendinitis. Various injection therapies have been used for the treatment of rotator cuff disease, including corticosteroid, prolotherapy, platelet-rich plasma, stem cells, and ultrasound-guided barbotage for calcific tendinitis. However, the existing evidence for these therapies remains controversial or sparse. Ultimately, improved understanding of the underlying structural and compositional deficiencies of the injured rotator cuff tissue is needed to identify the biological needs that can potentially be targeted with injection therapies.
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Affiliation(s)
- Kenneth M Lin
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Dean Wang
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
| | - Joshua S Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
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Satpute KH, Hall T, Adanani A. Validity of an Alternate Hand Behind Back Shoulder Range of Motion Measurement in Patients With Shoulder Pain and Movement Dysfunction. J Manipulative Physiol Ther 2018; 41:242-251. [PMID: 29482874 DOI: 10.1016/j.jmpt.2017.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/31/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
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. METHODS This cross-sectional study design evaluated shoulder ROM, pain, fear-avoidance beliefs, and disability in 60 people (aged 35-70 years, 31 male) with chronic unilateral shoulder dysfunction (mean duration 15.73 weeks). Shoulder HBB ROM was measured with a bubble inclinometer in a manner that did not require the patient to disrobe. Correlations were sought between HBB ROM and other shoulder movements, as well as scores recorded on the Shoulder Pain and Disability Index (SPADI), visual analogue scale for pain, Fear Avoidance Beliefs Questionnaire (FABQ), and duration of symptoms. RESULTS Restriction of HBB movement was significantly correlated with SPADI total disability score (r = 0.39, P < .01), flexion ROM (r = 0.30, P < .05), abduction ROM (r = 0.39, P < .01), and external rotation ROM (r = 0.60, P < .01). Other variables were not significantly correlated with HBB ROM. Multiple linear regression analysis indicated that the variance in HBB ROM was explained by the SPADI disability subscore (P = .01) but not by visual analogue scale score (P = .05), FABQ score (P = .65), or duration of symptoms (P = .73). The FABQ score was not explained by limitation in HBB ROM and shoulder movements. CONCLUSION These findings suggest that this novel method of measuring HBB ROM could be used as a functional outcome measure in the evaluation of patients with shoulder disorders. This method could be considered as an additional or alternative where there are challenges in measuring HBB because of restrictions in undressing a patient, such as for cultural reasons.
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Affiliation(s)
- Kiran H Satpute
- Department of Kinesiotherapy and Physical Diagnosis, Smt. Kashibai Navale College of Physiotherapy, Pune, Maharashatra, India.
| | - Toby Hall
- School of Physiotherapy and Curtin Health Innovation Research, Curtin University, Perth, Australia
| | - Aditi Adanani
- Smt. Kashibai Navale College of Physiotherapy, Pune, Maharashatra, India
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Ahn JH, Lee DH, Kang H, Lee MY, Kang DR, Yoon SH. Early Intra-articular Corticosteroid Injection Improves Pain and Function in Adhesive Capsulitis of the Shoulder: 1-Year Retrospective Longitudinal Study. PM R 2017; 10:19-27. [DOI: 10.1016/j.pmrj.2017.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 05/25/2017] [Accepted: 06/03/2017] [Indexed: 11/24/2022]
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14
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De Groef A, Meeus M, De Vrieze T, Vos L, Van Kampen M, Christiaens MR, Neven P, Geraerts I, Devoogdt N. Pain characteristics as important contributing factors to upper limb dysfunctions in breast cancer survivors at long term. Musculoskelet Sci Pract 2017; 29:52-59. [PMID: 28319882 DOI: 10.1016/j.msksp.2017.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/10/2017] [Accepted: 03/11/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to explore the treatment, patient, and impairment-related risk factors associated with upper limb dysfunctions in breast cancer survivors. METHODS A cross-sectional study was performed in 274 women treated for breast cancer. The following risk factors were analysed by bivariable and multivariable analysis: 1) treatment-related variables (type of surgery, levels of lymph node dissected, radiotherapy, chemotherapy, hormone therapy and trastuzumab); 2) patient's related variables (age and Body Mass Index); 3) and finally impairment-related variables such as pain (intensity, quality and pressure hypersensitivity, signs of central sensitisation, the degree of pain catastrophizing and vigilance and awareness to pain), active ROM and upper limb strength were investigated. The dependent variable was upper limb function measured with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Additionally, a stepwise regression was performed. RESULTS An impaired upper limb function was noted in 170 (62%) of patients. Mean time after surgery was 1.5 (1.6) years. From multivariable analysis, it appears that in particular certain pain characteristics such as pain intensity, pain quality, signs of central sensitisation and pain catastrophizing are contributing to upper limb dysfunctions after breast cancer treatment at long term. Additionally, higher age, shoulder ROM and handgrip strength are possible contributing factors. The stepwise regression analysis revealed that central sensitisation mechanisms alone can explain about 40% of the variance in upper limb function. CONCLUSIONS At long term, especially pain and central sensitisation mechanisms contribute to upper limb function in breast cancer survivors.
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Affiliation(s)
- An De Groef
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium.
| | - Mira Meeus
- Univeristy of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium
| | - Tessa De Vrieze
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Lore Vos
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Marijke Van Kampen
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Marie-Rose Christiaens
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium; KU Leuven - University of Leuven, Oncology Department, Department of Surgical Oncology, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Inge Geraerts
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Nele Devoogdt
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
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Satpute K, Hall T, Kumar S, Deodhar A. A new method of measuring shoulder hand behind back movement: Reliability, values in symptomatic and asymptomatic people, effect of hand dominance, and side-to-side variability. Physiother Theory Pract 2016; 32:520-7. [DOI: 10.1080/09593985.2016.1222041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Walker H, Pizzari T, Wajswelner H, Blanch P, Schwab L, Bennell K, Gabbe B. The reliability of shoulder range of motion measures in competitive swimmers. Phys Ther Sport 2016; 21:26-30. [DOI: 10.1016/j.ptsp.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/10/2016] [Accepted: 03/03/2016] [Indexed: 01/12/2023]
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De Groef A, Van Kampen M, Tieto E, Schönweger P, Christiaens MR, Neven P, Geraerts I, Gebruers N, Devoogdt N. Arm lymphoedema and upper limb impairments in sentinel node-negative breast cancer patients: A one year follow-up study. Breast 2016; 29:102-8. [PMID: 27479040 DOI: 10.1016/j.breast.2016.07.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/24/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study is (1) to investigate the prevalence rate of arm lymphedema, pain, impaired shoulder range of motion, strength and shoulder function one year after a sentinel lymph node biopsy (SLNB) for breast cancer and (2) to determine predictive factors for these complications. METHODS A longitudinal study was performed. One hundred patients with a sentinel-lymph node negative breast cancer were included. All patients were measured before surgery and one year after. Arm lymphedema was measured with the perimeter, pain with the Visual Analogue Scale, shoulder range of motion with an inclinometer, strength with a handheld dynamometer and shoulder function with the Disability of Arm, Shoulder and Hand questionnaire. Patient-, breast cancer- and treatment-related variables were recorded. RESULTS One year after surgery 8% of sentinel node-negative breast cancer patients had developed arm lymphedema. Fifty percent of patients had pain, 30% had an impaired shoulder range of motion, 8% had a decreased handgrip strength and 49% had an impaired shoulder function. Pain, shoulder range of motion, strength and shoulder dysfunctions changed significantly over one year (p < 0.001). Higher Body Mass Index is a predictive variable for shoulder dysfunctions one year post-SLNB. CONCLUSIONS Prevalence rate of lymphedema and other upper limb impairments may not be underestimated after SLNB. Pain, shoulder range of motion, handgrip strength and shoulder function change significantly up to one year compared to preoperative values in sentinel node-negative breast cancer patients.
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Affiliation(s)
- An De Groef
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium.
| | - Marijke Van Kampen
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Elena Tieto
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Petra Schönweger
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Marie-Rose Christiaens
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium; KU Leuven - University of Leuven, Oncology Department, Department of Surgical Oncology, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Inge Geraerts
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
| | - Nick Gebruers
- Univeristy of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium
| | - Nele Devoogdt
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium
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Abstract
OBJECTIVES To investigate inter-rater reliability of a set of shoulder measurements including inclinometry [shoulder range of motion (ROM)], acromion-table distance and pectoralis minor muscle length (static scapular positioning), upward rotation with two inclinometers (scapular kinematics) and pain pressure thresholds (muscle tenderness) in middle-aged women. DESIGN Observational study. PARTICIPANTS Thirty symptom-free middle-aged women (first cohort) were measured by two raters. All measurements with an intraclass correlation coefficient (ICC) below 0.75 were retested after an additional training period in a second cohort of 30 symptom-free middle-aged women. MAIN OUTCOME MEASURES Inter-rater reliability of all variables was measured with the ICC (95% confidence interval) and standard error of measurement (SEM). RESULTS Acromion-table distance (ICC=0.91, SEM 0.22 to 0.28% of body length), pectoralis minor muscle length (ICC=0.91, SEM 0.16% of body length), pain pressure thresholds (ICC=0.78 to 0.85, SEM 0.39 to 0.70kg) and abduction ROM (ICC=0.77, SEM 5°) showed good to excellent inter-rater reliability in the first cohort. After an additional training period, forward flexion ROM showed good inter-rater reliability (ICC=0.83, SEM 5°), scapular upward rotation in resting position showed moderate reliability (ICC=0.52, SEM 2°), and other scaption angles showed weak reliability (ICC=0.26 to 0.43, SEM 3 to 8°). CONCLUSIONS In a battery of clinical tools to evaluate factors contributing to shoulder pain, static scapular positioning and pressure pain thresholds were found to have good to excellent inter-rater reliability in middle-aged women. Additional training is recommended for measurements with a gravity inclinometer.
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Sharma SP, Bærheim A, Moe-Nilssen R, Kvåle A. Adhesive capsulitis of the shoulder, treatment with corticosteroid, corticosteroid with distension or treatment-as-usual; a randomised controlled trial in primary care. BMC Musculoskelet Disord 2016; 17:232. [PMID: 27229470 PMCID: PMC4880881 DOI: 10.1186/s12891-016-1081-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 05/13/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Optimal management for adhesive shoulder capsulitis (frozen shoulder) is currently unclear. We intended to explore whether treatment by intra-articular injections with corticosteroid and distension is more effective than treating with corticosteroids alone or treatment-as-usual in a primary care setting in Norway. METHODS In this prospective randomised intention to treat parallel study, 106 patients were block randomised to three groups; 36 (analysed 35) receiving steroid injection and Lidocaine (IS), 34 receiving steroid and additional saline as distension (ISD) and 36 had treatment-as-usual (TAU). Intervention groups received four injections within 8 weeks, assessed on 1st visit, at the 4th and 8th week. Outcomes were Shoulder Pain and Disability Index (SPADI), Numerical pain rating scale (NPRS) and passive range of motion (PROM). Postal assessment was repeated after 1 year for SPADI. Patients in the IS and ISD groups were "blinded" for intervention received and the assessor was "blinded" to group allocation. RESULTS At baseline there were no differences between groups in outcome measures. There were no statistical significant differences between the intervention groups in SPADI, NPRS and PROM at baseline, at short-term (4-and 8 weeks) or long-term (12 months). There were statistically significant differences (p < 0.01) in change scores at short-term for SPADI when comparing the IS and TAU groups (-20.8; CI-28.9 to -12.7), and the ISD and TAU groups (-21.7; CI-29.4 to -14.0), respectively for NPRS (-2.0; CI-2.8 to -1.1 and -2.2; CI-3.0 to -1.4), and for PROM, but not at long-term for SPADI (p > 0.05). Effect size (ES) at 8 weeks was large between both injection groups and TAU (ES 1.2). At 12 months ES was reduced to 0.3 and 0.4 respectively. Transitory side effects as flushing and after-pain were reported by 14 % in intervention groups. CONCLUSION This intention to treat RCT in primary care indicates that four injections with corticosteroid with or without distension, given with increasing intervals during 8 weeks, were better than treatment-as-usual in treatment of adhesive shoulder capsulitis. However, in the long run no difference was found between any of the groups, indicating that natural healing takes place independent of treatment or not. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov/ identifier: NCT01570985.
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Affiliation(s)
- Satya Pal Sharma
- Research Group, Section for General Practice, Department of Global Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Anders Bærheim
- Research Group, Section for General Practice, Department of Global Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
| | - Rolf Moe-Nilssen
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Alice Kvåle
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
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Glendon K, Hood V. Upper limb joint position sense during shoulder flexion in healthy individuals: a pilot study to develop a new assessment method. Shoulder Elbow 2016; 8:54-60. [PMID: 27583002 PMCID: PMC4935174 DOI: 10.1177/1758573215603916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 08/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Altered shoulder joint position sense (JPS) following shoulder injury has been demonstrated in the literature and may increase the risk of injury. A JPS assessment targeting the shoulder will provide the clinician with an objective marker. The present study aimed to develop an assessment method of JPS using an active relocation test (ART). METHODS In total, 40 healthy participants were recruited. A laser-pointer attached to the index finger during an ART allowed measurement (mm) of JPS by measuring the distance between the target and relocated position. Participants were blindfolded and stood an arm's length (approximately 1 m) away from the wall. Whilst keeping the wrist in neutral and elbow extended, the participant actively moved to the target position (90° glenohumeral flexion), held for 5 seconds, returned their arm to their side and actively returned to the target position. A mean was calculated from three trials to provide an ART score. RESULTS The mean (SD) dominant and nondominant ART score was 89.2 (SD 35.5) mm (95% confidence interval = 77.87 mm to 100.5 mm) and 94.1 (34.5) mm (95% confidence interval = 83.1 mm to 105.2 mm), respectively. Arm dominance did not significantly affect ART scores. CONCLUSIONS No significant difference was demonstrated between the dominant and nondominant arm using an ART assessing JPS acuity. Further studies are needed to establish inter-rater and intra-rater reliability.
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Affiliation(s)
- Kerry Glendon
- Perform Spire Healthcare, St Georges Park, National Football Centre, Needwood, Staffordshire, UK,Kerry Glendon, Perform Spire Healthcare, St Georges Park, National Football Centre, Newborough Road, Needwood, Staffordshire DE13 9PD, UK.
| | - Victoria Hood
- Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK
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Furness J, Johnstone S, Hing W, Abbott A, Climstein M. Assessment of shoulder active range of motion in prone versus supine: a reliability and concurrent validity study. Physiother Theory Pract 2015; 31:489-95. [DOI: 10.3109/09593985.2015.1027070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Otter SJ, Agalliu B, Baer N, Hales G, Harvey K, James K, Keating R, McConnell W, Nelson R, Qureshi S, Ryan S, St. John A, Waddington H, Warren K, Wong D. The reliability of a smartphone goniometer application compared with a traditional goniometer for measuring first metatarsophalangeal joint dorsiflexion. J Foot Ankle Res 2015; 8:30. [PMID: 26207142 PMCID: PMC4512018 DOI: 10.1186/s13047-015-0088-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 07/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate sagittal plane motion of the first metatarsalphalangeal joint (1st MTPJ) is important during normal gait and goniometric measurement is commonly used as a diagnostic and outcome assessment tool. We aimed to determine the intra and inter-rater reliability together with the concurrent validity of a universal plastic goniometer (UG) and a smartphone applicationlication (Dr G) for the measurement of dorsiflexion at the 1st MTPJ. METHODS Measurement of joint position and passive range of motion of the 1st MTPJ dorsiflexion was compared using a UG and DrG goniometer. A double-blind repeated measures design was utilized, with intraclass correlation coefficient (ICC) used to determine levels of reliability. RESULTS For joint position good intra-rater reliability (ICC >0.861) and good inter-rater reliability (ICC >0.823) was noted. However, the Dr G application consistently measured lower angles (mean 27.8° (SD 8.37)) than the UG (mean 32° (SD 11.7)) and these associations were significant (r = 0.399, p < 0.001). For passive range of motion, the mean total range of dorsiflexion motion (from maximum plantarflexed position to maximum dorsiflexed position) was 82.8° (SD 12.2) for the UG and 82.9° (SD 11.3) for the Dr G application. Both instruments demonstrated high levels of intra-rater reliability (ICC >0.809). Inter-rater reliability was moderate to good for the UG (ICC 0.693 (95 % CI 0.580 to 0.788)) and good for the Dr G application (ICC 0.708 (95 % CI 0.597 to 0.799)). CONCLUSIONS Moderate to high intra and inter-rater reliability of joint position and passive 1st MTPJ motion can be achieved with traditional and smartphone-based goniometric measurement. The Dr G application may provide a slightly higher reliability, but devices should not be used inter-changeably as significant variation in measurement between devices may occur.
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Affiliation(s)
- Simon J. Otter
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | | | - Nicola Baer
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | - Georgie Hales
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | - Katrina Harvey
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | - Keeley James
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | - Richard Keating
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | | | - Rachel Nelson
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | - Saddaf Qureshi
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | - Steven Ryan
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | | | | | - Katie Warren
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
| | - Duane Wong
- School of Health Science, 49 Darley Rd, Eastbourne, BN20 7UR UK
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Lindenfeld TN, Fleckenstein CM, Levy MS, Grood ES, Frush TJ, Parameswaran AD. Reliability of a New Clinical Instrument for Measuring Internal and External Glenohumeral Rotation. Sports Health 2015; 7:312-7. [PMID: 26137176 PMCID: PMC4481671 DOI: 10.1177/1941738113512094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: The shoulder plays a critical role in many overhead athletic activities. Several studies have shown alterations in shoulder range of motion (ROM) in the dominant shoulder of overhead athletes and correlation with significantly increased risk of injury to the shoulder and elbow. The purpose of this study was to measure isolated glenohumeral joint internal/external rotation (IR/ER) to determine inter- and intraobserver reliability of a new clinical device. Hypothesis: (1) Inter- and intraobserver reliability would exceed 90% for measures of glenohumeral joint IR, ER, and total arc of motion; (2) the dominant arm would exhibit significantly increased ER, significantly decreased IR, and no difference in total arc of motion compared with the nondominant shoulder; and (3) a significant difference exists in total arc between male and female patients. Study Design: Case series. Level of Evidence: Level 4. Methods: Thirty-seven subjects (mean age, 23 years; range, 13-54 years) were tested by 2 orthopaedic surgeons. A single test consisted of 1 arc of motion from neutral to external rotation to internal rotation and back to neutral within preset torque limits. Each examiner performed 3 tests on the dominant and nondominant shoulders. Each examiner completed 2 installations. Results: Testing reliability demonstrated that neither trial, installation, nor observer were significant sources of variation. The maximum standard deviation was 1.3° for total arc of motion and less than 2° for most other measurements. Dominant arm ER was significantly greater than nondominant arm ER (P = 0.02), and dominant arm IR was significantly less than nondominant arm IR (P = 0.00). Mean total rotation was 162°, with no significant differences in total rotation between dominant and nondominant arms (P = 0.34). Mean total arc of motion was 45° greater in female subjects. Differences in total arc of motion between male and female subjects was statistically significant (P < 0.00). Conclusion: This simple, clinical device allows for both inter- and intraobserver reliability measurements of glenohumeral internal and external rotation.
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Affiliation(s)
- Thomas N Lindenfeld
- Cincinnati Sports Medicine Research and Education Foundation, Cincinnati, Ohio
| | | | | | - Edward S Grood
- Cincinnati Sports Medicine Research and Education Foundation, Cincinnati, Ohio
| | - Todd J Frush
- Porretta Center for Orthopaedic Surgery-Novi Orthopaedic Center, Novi, Michigan
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Development of a novel index of shoulder's mobility based on the configuration space volume and its link to mono-axial amplitudes. ACTA ACUST UNITED AC 2015; 20:433-9. [DOI: 10.1016/j.math.2014.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 10/25/2014] [Accepted: 10/31/2014] [Indexed: 11/17/2022]
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25
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Sharma SP, Bærheim A, Kvåle A. Passive range of motion in patients with adhesive shoulder capsulitis, an intertester reliability study over eight weeks. BMC Musculoskelet Disord 2015; 16:37. [PMID: 25888419 PMCID: PMC4340115 DOI: 10.1186/s12891-015-0495-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measuring range of motion (ROM) in the shoulder joint is important for the diagnosis and monitoring of change over time. To what degree passive ROM can be trusted as a reliable outcome measure was examined as part of an on-going randomized controlled trial for patients with shoulder capsulitis. The aim of this study was to examine intertester reliability of passive ROM in the shoulder joint over a period of eight weeks in patients with adhesive capsulitis stage II. METHODS Fifty patients with a clinical diagnosis of adhesive shoulder capsulitis were examined by two independent testers. A predefined protocol was used for measuring passive range of motion with an inclinometer, a plurimeter, in both affected and non-affected shoulders three times; at the start of the study and after 4 and 8 weeks. RESULTS Very good to excellent intertester agreements were found for most parameters for the affected arm at all three test points. The intraclass correlation coefficient (ICC 2.1) values ranged from 0.76 to 0.98, i.e. from very reliable to excellent. The measurement error was in general small for the affected arm (5°-7°). ICCs were slightly lower for the non-affected arm at 8 weeks, but with acceptable measurement errors. CONCLUSIONS Intertester reliability between two testers was very good at three visits over a time period of eight weeks using a plurimeter to measure passive range of motion in patients with adhesive shoulder capsulitis. This method can reliably determine passive range of motion in this patient population and be a reliable outcome measure.
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Affiliation(s)
- Satya Pal Sharma
- Department of Global Public Health and Primary Care, Research Group for General Practice, University of Bergen, Bergen, Norway.
| | - Anders Bærheim
- Department of Global Public Health and Primary Care, Research Group for General Practice, University of Bergen, Bergen, Norway.
| | - Alice Kvåle
- Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Bergen, Norway.
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Werner BC, Holzgrefe RE, Griffin JW, Lyons ML, Cosgrove CT, Hart JM, Brockmeier SF. Validation of an innovative method of shoulder range-of-motion measurement using a smartphone clinometer application. J Shoulder Elbow Surg 2014; 23:e275-82. [PMID: 24925699 DOI: 10.1016/j.jse.2014.02.030] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/13/2014] [Accepted: 02/27/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND An accurate and reliable measurement of shoulder range of motion (ROM) is important in the evaluation of the shoulder. A smartphone digital clinometer application is a potentially simpler method for measuring shoulder ROM. The goal of this study was to establish the reliability and validity of shoulder ROM measurements among varying health care providers using a smartphone clinometer application in healthy and symptomatic adults. METHODS An attending surgeon, fellow, resident, physician assistant, and student served as examiners. Bilateral shoulders of 24 healthy subjects were included. Fifteen postoperative patients served as the symptomatic cohort. Examiners measured ROM of each shoulder, first using visual estimation and then using a goniometer and smartphone clinometer in a randomized fashion. RESULTS The interobserver reliability among examiners showed significant correlation, with average intraclass correlation coefficient [ICC(2,1)] values of 0.61 (estimation), 0.69 (goniometer), and 0.80 (smartphone). All 5 examiners had substantial agreement with the gold standard in healthy subjects, with average ICC(2,1) values ranging from 0.62 to 0.79. The interobserver reliability in symptomatic patients showed significant correlation, with average ICC(2,1) values of 0.72 (estimation), 0.79 (goniometer), and 0.89 (smartphone). Examiners had excellent agreement with the gold standard in symptomatic patients, with an average ICC(2,1) value of 0.98. CONCLUSION The smartphone clinometer has excellent agreement with a goniometer-based gold standard for measurement of shoulder ROM in both healthy and symptomatic subjects. There is good correlation among different skill levels of providers for measurements obtained using the smartphone. A smartphone-based clinometer is a good resource for shoulder ROM measurement in both healthy subjects and symptomatic patients.
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Affiliation(s)
- Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Russell E Holzgrefe
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Justin W Griffin
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Matthew L Lyons
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Christopher T Cosgrove
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Joseph M Hart
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
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van den Dolder PA, Ferreira PH, Refshauge K. Intra- and inter-rater reliability of a modified measure of hand behind back range of motion. ACTA ACUST UNITED AC 2013; 19:72-6. [PMID: 24269329 DOI: 10.1016/j.math.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 07/30/2013] [Accepted: 08/22/2013] [Indexed: 11/30/2022]
Abstract
The aim of this reliability study was to identify the clinimetric properties, specifically intra- and inter-rater reliability, for measuring the functionally and clinically important hand behind back (combined shoulder internal rotation/adduction and elbow flexion) range of motion using a modified technique. Sixty asymptomatic participants (20 male, 40 female) aged 45.4 ± 11.7 years (mean ± SD). Hand behind back was measured as the distance from the mid-line between the posterior superior iliac spines (PSIS) to the tip of the thumb and recorded in centimetres above the PSIS (a positive measure) or below the PSIS (a negative measure). The intra- and inter-rater reliability for the measurement were excellent, with ICC (2,1) of 0.95 for intra-rater and ICC (2,2) of 0.96 for inter-rater reliability. The standard error of the measurement (SEM) and smallest real difference (SRD) values showed acceptable levels of measurement error, SEM 4.3 mm and SRD 12.8 mm for intra-rater reliability and SEM 2.6 mm and SRD 7.7 mm for inter-rater reliability. The assessment of hand-behind-back motion from a point equidistant between the PSISs to the tip of the thumb is more reliable than traditional methods and a useful clinical tool.
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Affiliation(s)
- Paul A van den Dolder
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; Illawarra Shoalhaven Local Health District, Wollongong, Australia.
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Kathryn Refshauge
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Roy JS, Esculier JF. Psychometric evidence for clinical outcome measures assessing shoulder disorders. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Perdomo M, Sebelski CA, Davies C. Oncology Section Task Force on Breast Cancer Outcomes: Shoulder and Glenohumeral Outcome Measures. REHABILITATION ONCOLOGY 2013. [DOI: 10.1097/01893697-201331010-00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Within-day reliability of shoulder range of motion measurement with a smartphone. ACTA ACUST UNITED AC 2012; 17:298-304. [DOI: 10.1016/j.math.2012.02.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 01/09/2012] [Accepted: 02/16/2012] [Indexed: 11/18/2022]
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Rah UW, Yoon SH, Moon DJ, Kwack KS, Hong JY, Lim YC, Joen B. Subacromial Corticosteroid Injection on Poststroke Hemiplegic Shoulder Pain: A Randomized, Triple-Blind, Placebo-Controlled Trial. Arch Phys Med Rehabil 2012; 93:949-56. [DOI: 10.1016/j.apmr.2012.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 01/24/2012] [Accepted: 02/03/2012] [Indexed: 11/30/2022]
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Roren A, Lefevre-Colau MM, Roby-Brami A, Revel M, Fermanian J, Gautheron V, Poiraudeau S, Fayad F. Modified 3D scapular kinematic patterns for activities of daily living in painful shoulders with restricted mobility: A comparison with contralateral unaffected shoulders. J Biomech 2012; 45:1305-11. [DOI: 10.1016/j.jbiomech.2012.01.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/21/2012] [Accepted: 01/29/2012] [Indexed: 10/28/2022]
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Hanney WJ, Kolber MJ, Marshall JS. The reliability of clinical measurements designed to quantify shoulder mobility. PHYSICAL THERAPY REVIEWS 2011. [DOI: 10.1179/1743288x11y.0000000023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kolber MJ, Fuller C, Marshall J, Wright A, Hanney WJ. The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer. Physiother Theory Pract 2011; 28:161-8. [PMID: 21721999 DOI: 10.3109/09593985.2011.574203] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study investigated the reliability and concurrent validity of active shoulder elevation in the scapular plane (scaption) using a digital inclinometer and goniometer. Two investigators used a goniometer and digital inclinometer to measure scaption on 30 asymptomatic participants in a blinded repeated measures design. Good reliability was present with intraclass correlation coefficients (ICCs) for intrarater reliability of goniometry = 0.87, intrarater digital inclinometry = 0.88, interrater goniometry = 0.92, and interrater digital inclinometry = 0.89. The minimal detectable change (MDC95) for the interrater analysis indicated that a change equal to or greater than 8 degrees for goniometry and 9 degrees for inclinometry is required to be 95% certain that the change is not due to intertrial variability or measurement error. The concurrent validity between goniometry and digital inclinometry was excellent with an ICC value of 0.94 for both raters. The 95% limits of agreement suggest that the difference between these two measurement instruments can be expected to vary by up to ±11 degrees. The results support the interchangeable use of goniometry and digital inclinometer for measuring scaption. Clinicians and researchers should consider the MDC values presented when interpreting change during subsequent measurement sessions.
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Affiliation(s)
- Morey J Kolber
- Nova Southeastern University, Department of Physical Therapy, Fort Lauderdale, Florida, USA
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Juul-Kristensen B, Hilt K, Enoch F, Remvig L, Sjøgaard G. Scapular dyskinesis in trapezius myalgia and intraexaminer reproducibility of clinical tests. Physiother Theory Pract 2011; 27:492-502. [PMID: 21548819 DOI: 10.3109/09593985.2010.528548] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aims were to test the intraexaminer reproducibility and report the presence of specific clinical variables of scapular dyskinesis in cases with trapezius myalgia and healthy controls, along with general health and work ability. A total of 38 cases and 23 controls were tested for scapular dyskinesis, general health, and work ability, and 19 cases and 14 controls participated in the reproducibility study. Intraexaminer reproducibility was good to excellent for 6 of 10 clinical variables (Intraclass Correlation Coefficient [ICC] 0.76-0.91; kappa 0.84-1.00), and fair to good for four variables (ICC 0.42-0.74), test for muscular weakness having the lowest ICC (0.42). Cases showed significantly larger medial border misalignment, larger lower horizontal distance of the inferior scapular angle and larger passive shoulder internal rotation, by 110% (1.02 cm), 15% (1.38 cm), and 8% (5.5°), respectively. Cases with the highest degree of scapular dyskinesis showed reduced work ability and general health. The present specific clinical variables on scapular dyskinesis showed satisfactory intraexaminer reproducibility. An increased standardization must be implemented to increase reproducibility of tests for muscular weakness, and the interexaminer reproducibility must be tested for all variables. Finally, scapular dyskinesis in cases with trapezius myalgia must be followed longitudinally for clinical importance.
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Affiliation(s)
- Birgit Juul-Kristensen
- University of Southern Denmark, Institute of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, Odense M.
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Jia X, Ji JH, Pannirselvam V, Petersen SA, McFarland EG. Does a positive neer impingement sign reflect rotator cuff contact with the acromion? Clin Orthop Relat Res 2011; 469:813-8. [PMID: 20878281 PMCID: PMC3032859 DOI: 10.1007/s11999-010-1590-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 09/10/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND One possible cause of shoulder pain is rotator cuff contact with the superior glenoid (cuff-glenoid contact) with the arm in flexion, as occurs during a Neer impingement sign. It has been assumed that the pain with a Neer impingement sign on physical examination of the shoulder was secondary to the rotator cuff making contact with the anterior and lateral acromion. QUESTIONS/PURPOSES We determined if the arm position where pain occurs with a Neer impingement sign would correlate with the position where the rotator cuff made contact with the superior glenoid, as determined by arthroscopic evaluation. PATIENTS AND METHODS We prospectively studied 398 consecutive patients with a positive Neer impingement sign during office examination and used a handheld goniometer to measure (in degrees of flexion) the arm position in which impingement pain occurred. During subsequent arthroscopy, the arm was moved into a similar position, and we measured the arm's position in flexion at the point the rotator cuff made contact with the superior glenoid using a handheld goniometer. We compared the degrees of flexion at which pain occurred preoperatively and at which there was cuff-glenoid contact. RESULTS Among the 398 patients, 302 (76%) had arthroscopically documented cuff-glenoid contact, whereas 96 did not. For the 302 patients with a positive Neer sign preoperatively and with arthroscopically documented cuff-glenoid contact, the average preoperative impingement pain position was 120.1°±26.7°, similar to that of the average intraoperative cuff-glenoid contact position of 120.6°±14.7°. CONCLUSIONS Our data suggest pain associated with a positive Neer sign more often relates to contact of the rotator cuff with the superior glenoid than to contact between the rotator cuff and acromion. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Xiaofeng Jia
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Jong Hun Ji
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Vinodhkumar Pannirselvam
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Steve A. Petersen
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Edward G. McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780 USA
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Cadogan A, Laslett M, Hing W, McNair P, Williams M. Reliability of a new hand-held dynamometer in measuring shoulder range of motion and strength. ACTA ACUST UNITED AC 2011; 16:97-101. [DOI: 10.1016/j.math.2010.05.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 03/14/2010] [Accepted: 05/07/2010] [Indexed: 11/29/2022]
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Muir SW, Corea CL, Beaupre L. Evaluating change in clinical status: reliability and measures of agreement for the assessment of glenohumeral range of motion. NORTH AMERICAN JOURNAL OF SPORTS PHYSICAL THERAPY : NAJSPT 2010; 5:98-110. [PMID: 21589666 PMCID: PMC2971638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To evaluate intra-rater and inter-rater reliability and measurement error in glenohumeral range of motion (ROM) measurements using a standard goniometer. STUDY DESIGN 17 adult subjects with and without shoulder pathology were evaluated for active and passive range of motion. Fifteen shoulder motions were assessed by two raters to determine reliability. The intra-class correlation coefficients (ICC) were calculated and examined to determine if reliability of ICC ≥ 0.70 existed. The standard error of measurement (SEM) and the minimal clinical difference (MCD) were also calculated. RESULTS Thxe criterion reliability was achieved in both groups for intra-rater reliability of standing AROM abduction; supine AROM and PROM abduction, flexion, external rotation at 0° abduction; and for inter-rater reliability of supine AROM and PROM abduction, external rotation at 0° abduction. The SEM ranged from 4°-7° for intra-rater and 6°-9° for inter-rater agreement on movements that achieved the criterion reliability. The MCD ranged from 11°-16° for a single evaluator and 14°-24° for two evaluators. CONCLUSIONS Assessment of AROM and PROM in supine achieves superior reliability. The use of either a single or multiple raters affects the number of movements that achieved clinically meaningful reliability. Some movements consistently did not achieve the criterion and may not be the best movements to monitor treatment outcome.
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Kolber MJ, Vega F, Widmayer K, Cheng MSS. The reliability and minimal detectable change of shoulder mobility measurements using a digital inclinometer. Physiother Theory Pract 2010; 27:176-84. [PMID: 20690872 DOI: 10.3109/09593985.2010.481011] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The present study investigated the intrarater reliability, interrater reliability and minimal detectable change at the 90% confidence interval (MDC₉₀) of active shoulder range of motion measurements using digital inclinometry. Two investigators each measured two repetitions of active flexion, abduction, external rotation (ER), and internal rotation (IR) on the nondominant shoulder of 30 asymptomatic participants in a blinded repeated measures design. Results indicated good intrarater reliability with Intraclass Correlation Coefficients (ICCs) (3, k) of Flexion=0.83, Abduction=0.91, ER=0.94 and IR=0.87. Interrater ICC values (2, k) were moderate to good with Flexion=0.58, Abduction=0.95, ER=0.88 and IR=0.93. The MDC₉₀ for the interrater analysis indicated that a change of equal to or greater than 8° (Flexion), 4° (Abduction), 8° (IR), and 9° (ER) would be required to be 90% certain that the change is not due to intertrial variability or measurement error. Digital inclinometry appears to be a reliable instrument for quantifying normal shoulder mobility when strict measurement protocols are adhered to. Clinicians and researchers should consider the MDC values presented when interpreting change values during subsequent measurement sessions.
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Affiliation(s)
- Morey J Kolber
- Department of Physical Therapy, Nova Southeastern University, Ft. Lauderdale, Florida, USA.
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Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: a case series. J Orthop Sports Phys Ther 2010; 40:474-93. [PMID: 20710088 DOI: 10.2519/jospt.2010.3223] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case series. BACKGROUND Few studies have defined the dosage and specific techniques of manual therapy and exercise for rehabilitation for patients with subacromial impingement syndrome. This case series describes a standardized treatment program for subacromial impingement syndrome and the time course and outcomes over a 12-week period. CASE DESCRIPTION Ten patients (age range, 19-70 years) with subacromial impingement syndrome defined by inclusion and exclusion criteria were treated with a standardized protocol for 10 visits over 6 to 8 weeks. The protocol included a 3-phase progressive strengthening program, manual stretching, thrust and nonthrust manipulation to the shoulder and spine, patient education, activity modification, and a daily home exercise program of stretching and strengthening. Patients completed a history and measures of impairments and functional disability at 2, 4, 6, and 12 weeks. OUTCOMES Treatment success was defined as both a 50% improvement on the Disabilities of the Arm, Shoulder, and Hand (DASH) score and a global rating of change of at least "moderately better." At 6 weeks, 6 of 10 patients had a successful (mean +/- SD) DASH outcome score (initial, 33.9 +/- 16.2; 6 weeks, 8.1 +/- 9.2). At 12 weeks, 8 of 10 patients had a successful DASH outcome score (initial, 33.1 +/- 14; 12 weeks, 8.3 +/- 6.4). As a group, the largest improvement was in the first 2 weeks. The most common impairments for all 10 patients were rotator cuff and trapezius muscle weakness (10 of 10 patients), limited shoulder internal rotation motion (8 of 10 patients), and reduced kyphosis of the midthoracic area (7 of 10 patients). DISCUSSION A program aimed at strengthening rotator cuff and scapular muscles, with stretching and manual therapy aimed at thoracic spine and the posterior and inferior soft-tissue structures of the glenohumeral joint appeared to be successful in the majority of patients. This case series describes a comprehensive impairment-based treatment which resulted in symptomatic and functional improvement in 8 of 10 patients in 6 to 12 weeks. LEVEL OF EVIDENCE Therapy, level 4.
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Abstract
The promise of evidence-based medicine is to integrate the highest levels of clinical data with patient outcomes. After framing the question and identifying appropriate studies, evaluating their relevance to clinical practice is highly dependent on the instruments and measures selected to demonstrate outcomes. Currently, there are hundreds of outcomes measures available in the orthopedic literature evaluating these treatments, and it is not uncommon for different measures to produce conflicting results. Consequently, the ability to evaluate an outcomes measure is critical in determining the value of a specific treatment intervention. Similarly, selecting the appropriate outcomes measure for research or clinical purposes is an important decision that may have far reaching implications on reimbursement, surgeon reputation, and patient treatment success. Evidence-based orthopedic surgery is indeed possible, but demands a detailed understanding of why appropriate outcomes selection is important, the difference between clinician-based and patient-reported outcomes (PROs), and potential future directions in orthopedics outcomes research.
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Affiliation(s)
- Michael Suk
- University of Florida Health Science Center, Jacksonville, FL 32209, USA.
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van den Dolder P, Ferreira P, Refshauge K. Is soft tissue massage an effective treatment for mechanical shoulder pain? A study protocol. J Man Manip Ther 2010; 18:50-4. [PMID: 21655424 PMCID: PMC3103116 DOI: 10.1179/106698110x12595770849687] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Very little research has been conducted into the effectiveness of soft tissue massage as an intervention for the treatment of mechanical shoulder pain. Studies that have been conducted suffer from methodological issues, poor long-term follow-up and have conflicting results. The aim of this study, therefore, is to provide treating clinicians with improved evidence regarding the effectiveness of soft tissue massage for shoulder pain of local mechanical origin. Participants referred to the trial with mechanical shoulder pain will be assessed for range of motion, functional ability, and pain by a blinded assessor. Participants will then be randomly allocated to either an exercise-only group or an exercise and soft tissue massage group. Both groups will receive seven treatment sessions from a physical therapist over a period of 4 weeks. One week after the cessation of treatment, all participants will be reassessed by the same blinded assessor. Three months after cessation of treatment, subjects will again be reassessed. The primary outcome will be pain measured on a visual analogue scale (VAS) 1 week following the cessation of treatment. Secondary analyses will be pain at 3 months, the descriptive and present pain index sections of the short form McGill pain questionnaire, patient specific functional scale, and percentage improvement in pain scores and range of motion at 1 week following the cessation of treatment and at 3 month follow-up. Analysis of data will be carried out by a statistician who is blinded to group membership. Primary analyses will by intention-to-treat.
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Camarinos J, Marinko L. Effectiveness of manual physical therapy for painful shoulder conditions: a systematic review. J Man Manip Ther 2010; 17:206-15. [PMID: 20140151 DOI: 10.1179/106698109791352076] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Multiple disease-specific systematic reviews on the effectiveness of physical therapy intervention for shoulder dysfunction have been inconclusive. To date, there have been two systematic reviews that examined manual therapy specifically but both considered effects within diagnoses. The purpose of this systematic review was to identify the effectiveness of manual therapy to the glenohumeral joint across all painful shoulder conditions. A search of MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Randomized Controlled Trials for articles dated 1996 to June 2009 was performed. Inclusion for review were manual therapy performed to the glenohumeral joint only; non-surgical painful shoulder disorders; subjects 18-80 years; and outcomes of range of motion, pain, function, and/or quality of life. Quality assessment was performed using the PEDro scale with subsequent data extraction. Seventeen related articles were found with seven fitting the inclusion criteria. The average PEDro score was 7.86, meeting the cutoff score for high quality. Significant heterogeneity in outcome measures prohibited meta-analysis. Five studies demonstrated benefits utilizing manual therapy for mobility, and four demonstrated a trend towards decreasing pain values. Functional outcomes and quality-of-life measures varied greatly among all studies. Manual therapy appears to increase either active or passive mobility of the shoulder. A trend was found favoring manual therapy for decreasing pain, but the effect on function and quality of life remains inconclusive. Future research utilizing consistent outcome measurements is necessary.
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Affiliation(s)
- James Camarinos
- College of Health and Rehabilitation Sciences; Sargent College, Boston University, Boston, MA. 635 Commonwealth Ave, Boston, MA 02115, Boston University
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Kolber MJ, Saltzman SB, Beekhuizen KS, Cheng MSS. Reliability and minimal detectable change of inclinometric shoulder mobility measurements. Physiother Theory Pract 2009; 25:572-81. [DOI: 10.3109/09593980802667995] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nomden JG, Slagers AJ, Bergman GJ, Winters JC, Kropmans TJ, Dijkstra PU. Interobserver reliability of physical examination of shoulder girdle. ACTA ACUST UNITED AC 2009; 14:152-9. [DOI: 10.1016/j.math.2008.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 12/20/2007] [Accepted: 01/06/2008] [Indexed: 11/30/2022]
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Awerbuch MS. The clinical utility of ultrasonography for rotator cuff disease, shoulder impingement syndrome and subacromial bursitis. Med J Aust 2008; 188:50-3. [PMID: 18205566 DOI: 10.5694/j.1326-5377.2008.tb01507.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 08/31/2007] [Indexed: 11/17/2022]
Abstract
Periarticular shoulder disorders are common in clinical practice, and diagnosis is often difficult. Medicare statistics indicate that between 2001 and 2006 the use of diagnostic shoulder ultrasonography increased significantly. Rotator cuff disease, shoulder impingement syndrome and subacromial bursitis are among the most common diagnoses reported on shoulder ultrasonography. Shoulder ultrasonography is useful in the diagnosis of full thickness tears, but its utility for other rotator cuff disorders, shoulder impingement syndrome and subacromial bursitis is less well established.
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Tveitå EK, Ekeberg OM, Juel NG, Bautz-Holter E. Range of shoulder motion in patients with adhesive capsulitis; intra-tester reproducibility is acceptable for group comparisons. BMC Musculoskelet Disord 2008; 9:49. [PMID: 18405388 PMCID: PMC2373295 DOI: 10.1186/1471-2474-9-49] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 04/12/2008] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Measurements of range of motion play a key role in shoulder research. The purpose of this study is to investigate intra-observer reproducibility of measurements of active and passive range of motion in patients with adhesive capsulitis. METHODS The study was carried out in a population consisting of 32 patients with clinical signs of adhesive capsulitis. A specified measurement protocol was used, and range of motion in affected and non-affected shoulders was measured twice for each patient with a one-week interval. RESULTS For most of the investigated individual movements, test-retest differences in range of motion score of more than approximately 15 degrees are not likely to occur as a result of measurement error only. Point-estimates for the intraclass correlation coefficient ranged from 0.61 to 0.93. CONCLUSION Range of motion of patients with adhesive capsulitis can be measured with acceptable reproducibility in settings where groups are compared. Scores for individual patients should be interpreted with caution.
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Affiliation(s)
- Einar Kristian Tveitå
- Department of Physical Medicine and Rehabilitation, Ullevål University Hospital, University of Oslo, Norway
| | - Ole Marius Ekeberg
- Department of Physical Medicine and Rehabilitation, Ullevål University Hospital, University of Oslo, Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Ullevål University Hospital, University of Oslo, Norway
| | - Erik Bautz-Holter
- Department of Physical Medicine and Rehabilitation, Ullevål University Hospital, University of Oslo, Norway
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Abstract
With the increased emphasis on evidence-based medicine in orthopaedics, the surgeon is faced with the challenge of evaluating the effectiveness of various treatment interventions. Health care authorities are also interested in measuring competing interventions, but out of concern for controlling costs. The success or failure of an intervention is often determined based on treatment outcomes. There are many outcomes measures available in the orthopaedic literature, and it is not uncommon for different measures to produce conflicting results. The orthopaedic surgeon must have the ability to accurately evaluate an outcomes measure to determine the value of a specific intervention. Similarly, selecting the appropriate outcomes measure for research or clinical purposes is an important decision that may have far-reaching implications on reimbursement and determining treatment success. To best select outcomes measures and to select the appropriate treatment for each patient, the orthopaedic surgeon needs to understand the recommended contents of a quality instrument, the difference between clinician-based and patient-reported outcomes, and how to evaluate outcomes reported in the literature.
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Palmer KT. Diagnosing soft tissue rheumatic disorders of the upper limb in epidemiological studies of vibration-exposed populations. Int Arch Occup Environ Health 2007; 81:575-93. [PMID: 17909839 PMCID: PMC3636680 DOI: 10.1007/s00420-007-0254-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 09/05/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate approaches adopted to diagnose soft tissue rheumatic disorders of the upper limb (ULDs) in vibration-exposed populations and in other settings, and to compare their methodological qualities. METHODS Systematic searches were made of the Medline, Embase, and CINAHL electronic bibliographic databases, and of various supplementary sources (textbooks, reviews, conference and workshop proceedings, personal files). For vibration-exposed populations, qualifying papers were scored in terms of the provenance of their measuring instruments (adequacy of documentation, standardisation, reliability, criterion-related and content validity). Similar criteria were applied to general proposals for whole diagnostic schemes, and evidence was collated on the test-retest reliability of symptom histories and clinical signs. RESULTS In total, 23 relevant reports were identified concerning vibration-exposed populations--21 involving symptoms and 9 involving examination/diagnosis. Most of the instruments employed scored poorly in terms of methodological quality. The search also identified, from the wider literature, more than a dozen schemes directed at classifying ULDs, and 18 studies of test-retest reliability of symptoms and physical signs in the upper limb. Findings support the use of the standardised Nordic questionnaire for symptom inquiry and suggest that a range of physical signs can be elicited with reasonable between-observer agreement. Four classification schemes rated well in terms of content validity. One of these had excellent documentation, and one had been tested for repeatability, agreement with an external reference standard, and utility in distinguishing groups that differed in disability, prognosis and associated risk factors. CONCLUSIONS Hitherto, most studies of ULDs in vibration-exposed populations have used custom-specified diagnostic methods, poorly documented, and non-stringent in terms of standardisation and supporting evidence of reliability and/or validity. The broader literature contains several question sets and procedures that improve upon this, and offer scope in vibration-exposed populations to diagnose ULDs more systematically.
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Affiliation(s)
- Keith T Palmer
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK.
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50
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Rajaratnam BS, Venketasubramanian N, Kumar PV, Goh JC, Chan YH. Predictability of Simple Clinical Tests to Identify Shoulder Pain After Stroke. Arch Phys Med Rehabil 2007; 88:1016-21. [PMID: 17678664 DOI: 10.1016/j.apmr.2007.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify simple diagnostic musculoskeletal tests that can be performed early after stroke to predict patients' likelihood of reporting early signs of hemiplegic shoulder pain. DESIGN Case control. SETTING Multicenter acute care hospitals. PARTICIPANTS A total of 152 adults after a first episode of stroke, of whom 135 met the inclusion criteria. Thirty patients were assigned to the experimental group because they reported moderate intensity of hemiplegic shoulder pain at rest. The remaining 105 patients made up the control group. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Therapists measured the performance of combined upper-limb movement including the hand-behind-neck (HBN) maneuver, passive pain-free ranges of shoulder motion, 3 musculoskeletal tests, and the strength of deltoid muscles during each patient's hospital stay. The numeric rating scale (NRS) identified those who reported moderate or greater intensities of hemiplegic shoulder pain during rest and during assessment. RESULTS In our study, 22.2% (95% confidence interval, 15.5-30.2) of the patients reported hemiplegic shoulder pain, on average 1 week after the onset of stroke. Positive Neer test (NRS score >or=5) during the HBN maneuver and a difference of more than 10 degrees of passive range of external rotation between shoulders had a 98% probability of predicting the presence of hemiplegic shoulder pain (receiver operating characteristic, .994; sensitivity, 96.7%; specificity, 99.0%; positive predictive value, 96.7%; negative predictive value, 99.0%; P<.001). CONCLUSIONS Three diagnostic clinical tests that can be performed during a bedside evaluation increase the likelihood of determining those who complain of hemiplegic shoulder pain after an acute episode of stroke.
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