Persian Version of the Modified Constant Score in Overhead Athletes: A Reliability and Validation Study

CONTEXT

Shoulder impingement syndrome (SIS) is the most common shoulder injury among overhead athletes. The Constant score (CS) is a combined scoring system to evaluate functional status of the shoulder in patients with shoulder pain.

DESIGN

Cross-sectional study.

METHODS

Cultural adaptation of the Persian version of CS was conducted using Beaton's guideline. Sixty-three overhead athletes (23.57 [7.50] y old) with SIS completed the final version for psychometric assessment. After 5 to 7 days, a group of 33 patients completed the Persian CS again to assess test-retest reliability. Internal consistency, floor/ceiling effects, and item-total correlation were evaluated in patients with SIS. Concurrent validity was assessed through comparison with the disability of the arm, shoulder, and hand questionnaire scores. Twenty-five healthy athletes (31.80 [7.32] y old) participated for determining discriminant validity.

RESULTS

The Persian CS demonstrated good test-retest reliability, with subjective and objective intraclass correlation coefficients of .79 and .80, respectively. The internal consistency was satisfactory (Cronbach alpha = .74). No ceiling or floor effects were noted. The Pearson correlation coefficient between CS and disability questionnaire was -.68. The mean total score for patients was 67.02, while for the healthy group was 96.99 (P = .000). The standard error of measurement was 1.51 for patients and 0.7 for healthy group. The smallest detectable change was 16.95 for patients and 5.71 for healthy group.

CONCLUSION

The translation and cross-cultural adaptation of CS into Persian were successful. The Persian version demonstrates sufficient reliability and validity to evaluate shoulder function in overhead athletes with SIS.

Pain, Function, and Elastosonographic Assessment After Shockwave Therapy in Non-Calcific Supraspinatus Tendinopathy: A Retrospective Observational Study

Background: Non-calcific supraspinatus tendinopathy (SNCCT) is a frequent cause of shoulder pain, often associated with functional impairment and reduced quality of life. Recent advancements in diagnostic imaging, including shear wave elastography (SWE), provide quantitative data on tendon stiffness and thickness, facilitating more precise evaluations. Extracorporeal shockwave therapy (ESWT) has emerged as a minimally invasive and effective treatment for SNCCT, but its effects on tendon properties measured through SWE require further investigation. Objective: This retrospective observational study aimed to evaluate the impact of ESWT on supraspinatus tendon characteristics in patients with SNCCT by assessing tendon thickness, SWE velocity, and clinical outcomes. Methods: This observational study enrolled 39 patients with SNCCT, aged 30-75 years, who received three ESWT sessions over 3 weeks. The intervention was delivered using a Modulith SLK system at an energy level of 0.20 mJ/mm2 with 2400 pulses per session. SWE and conventional ultrasound were used to measure tendon thickness and SWEv at baseline (T0) and 6 months post-treatment (T1). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Constant and Murley Score (CMS), and modified Roles and Maudsley scale. Data were analyzed using paired t-tests and correlation analyses. Results: At baseline, affected tendons exhibited increased thickness (7.5 ± 0.9 mm) and reduced SWEv (3.1 ± 0.7 m/s) compared to healthy tendons (4.5 ± 0.7 mm and 6.9 ± 1 m/s, respectively; p < 0.05). Six months after ESWT, tendon thickness decreased significantly (6.2 ± 0.9 mm, p < 0.05), and SWEv increased (5.7 ± 1.8 m/s, p < 0.05), indicating improved elasticity. Clinical outcomes improved significantly, with the VAS scores decreasing from 6.5 ± 1.4 to 3.2 ± 2.1, the CMS score rising from 59.1 ± 17.3 to 78.2 ± 17.7, and the modified Roles and Maudsley scale improving from 2.3 ± 0.6 to 1.5 ± 0.8 (p < 0.05 for all). SWEv positively correlated with the CMS (r = 0.4) and negatively with the VAS and the modified Roles and Maudsley scale (r = -0.6 and r = -0.5, respectively). Conclusions: ESWT significantly reduces tendon thickness and enhances elasticity, correlating with improvements in pain and functional scores. SWE proved to be a reliable method for monitoring structural and clinical changes in SNCCT. Further research, including randomized controlled trials, is recommended to confirm these findings and explore longer-term outcomes.

Determining minimal important differences for patient-reported outcome measures in shoulder, lateral elbow, patellar and Achilles tendinopathies using distribution-based methods

BACKGROUND

Minimal important difference (MID) is a concept used inconsistently and arbitrarily in tendinopathy research. Our aim was to determine the MIDs for the most commonly used tendinopathy outcome measures using data-driven approaches.

METHODS

Recently published systematic reviews of randomised controlled trials (RCTs) on tendinopathy management were identified and used for extraction of eligible studies through a literature search. Each eligible RCT was used to obtain information on MID where this was used and it also contributed data for the calculation of the baseline pooled standard deviation (SD) for each tendinopathy (shoulder, lateral elbow, patellar and Achilles). The rule of "half SD" was used for the computation of MIDs for patient-reported pain (visual analogue scale, VAS 0-10, single-item questionnaire) and function (multi-item questionnaires) and the rule of "one standard error of measurement (SEM)" was additionally used for the multi-item functional outcome measures.

RESULTS

A total of 119 RCTs were included for the 4 tendinopathies. MID was defined and used by 58 studies (49%) and there were significant inconsistencies amongst studies where the same outcome measure was used as MID. From our data-driven methods the following suggested MIDs were obtained: a) Shoulder tendinopathy, pain VAS (combined) 1.3 points, Constant-Murley score 6.9 (half SD) and 7.0 (one SEM) points; b) lateral elbow tendinopathy, pain VAS (combined) 1.0 point, Disabilities of Arm, Shoulder and Hand questionnaire 8.9 (half SD) and 4.1 (one SEM) points; c) Patellar tendinopathy, pain VAS (combined) 1.2 points, Victorian Institute of Sport Assessment - Patella (VISA-P) 7.3 (half SD) and 6.6 points (one SEM); d) Achilles tendinopathy, pain VAS (combined) 1.1 points, VISA-Achilles (VISA-A) 8.2 (half SD) and 7.8 points (one SEM). The rules of half SD and one SEM produced very similar MIDs except for DASH due to its very high internal consistency. MIDs were also calculated for different pain settings for each tendinopathy.

CONCLUSIONS

Our computed MIDs can be used in tendinopathy research to increase consistency. Clearly defined MIDs should be used with consistency in tendinopathy management studies in the future.

Arthroscopic repair of rotator cuff injury with bioabsorbable suture anchor vs. all-suture anchor: a non-inferiority study

BACKGROUND

Compare all-suture anchors to traditional anchors through clinical and radiological evaluation at pre-established end-points.

MATERIALS AND METHODS

We performed a two-arms non-inferiority study on all-suture anchor (2.3 iconix™, Stryker) device with respect to traditional anchor (5.5 healix Advance™ BR, Depuy/Mitek) device under unpaired samples with size equal to 30 patients per group, all suffering from supraspinatus tendon rupture. We administrated DASH (Disabilities of the Arm, Shoulder and Hand); constant; and SST (Simple Shoulder Test) questionnaires in pre-operative, 3 ± 1 months post-intervention and 8 ± 1 months post-intervention. Questionnaires scores were the primary outcome. We also evaluated RMI at 3 and at 8 months after surgery to assess the presence of oedema or any loosening of the implant.

RESULTS

All-suture anchor approach has been proven to have non-inferior performances with respect to traditional anchor approach, according to questionnaires scores at the 3-month endpoint. We observed 26 patients with oedema by MRI (18 in control group, 6 in experimental group). In the 8-month endpoint we found persistent edema in 12 patients (all treated with healix), 2 had mobilitazions (healix), 10 had partial retears (8 healix, 2 iconix) and 1 implant failure (healix).

CONCLUSIONS

All suture devices have clinical and functional results comparable to traditional devices, while they tend to give fewer complications in terms of bone edema, loosening and retear rate. The effectiveness of all-suture devices should be further investigated in rotator cuff suture arthroscopic revision surgery, given the advantages they offer.

Translation, cross-cultural adaptation and psychometric properties of the Urdu version of knee injury and osteoarthritis outcome score questionnaire for Pakistani population

Background

Knee injury and osteoarthritis outcome score questionnaire is a widely used tool for measuring short and long-term patient-relevant outcomes following knee injury. KOOS is neither translated nor examined for psychometric properties before. Therefore, the aim of this study was to translate, culturally adapt and check the psychometric properties of the KOOS in Urdu.

Methodology

The translation and cultural adaptation was performed according to pre-defined guidelines. A total of 117 participants (54 males and 63 females) were recruited. The study had two steps: 1) Translation and cultural adaptation 2) Reliability and validity testing. The reliability (test-retest and internal consistency at (95% confidence interval) as well as the validity (Convergent validity) of final Urdu version of KOOS was tested.

Results

For all five domains, the KOOS Urdu version (KOOS-U) has demonstrated high test-retest reliability ICC = 0.90–0.96(CI = 95%). For all domains, the internal consistency was determined to be excellent (α = 0.82–0.96). There were no floor or ceiling impacts noted. Convergent validity was found to be good, as measured by Pearson’s correlation coefficient. The findings revealed a strong negative association between the KOOS-U (QOL and pain) and the NPRS. And there was a low to high positive correlation between five KOOS-U domains and all SF-12 domains, i.e., there was a significant positive correlation between the pain domains of both KOOS and SF-12 with the r = 0.87(p < 0.05).

Conclusion

The Urdu version of KOOS is a valid, reliable, and responsive instrument to assess functional disability of patients with Knee Osteoarthritis with excellent psychometric properties.

How to Assess Shoulder Functionality: A Systematic Review of Existing Validated Outcome Measures

The objective of this review was to compile validated functional shoulder assessment tools and analyse the methodological quality of their validations. Secondarily, we aimed to provide a comparison of the tools, including parameter descriptions, indications/applications, languages and operating instructions, to choose the most suitable for future clinical and research approaches. A systematic review (PRISMA) was conducted using: PubMed, WoS Scopus, CINHAL, Dialnet and reference lists until 2020. The main criteria for inclusion were that papers were original studies of validated tools or validation studies. Pre-established tables showed tools, validations, items/components, etc. The QUADAS-2 and COSMIN-RB were used to assess the methodological quality of validations. Ultimately, 85 studies were selected, 32 tools and 111 validations. Risk of bias scored lower than applicability, and patient selection got the best scores (QUADAS-2). Internal consistency had the highest quality and PROMs development the lowest (COSMIN-RB). Responsiveness was the most analysed metric property. Modified UCLA and SST obtained the highest quality in shoulder instability surgery, and SPADI in pain. The most approached topic was activities of daily living (81%). We compiled 32 validated functional shoulder assessment tools, and conducted an analysis of the methodological quality of 111 validations associated with them. Modified UCLA and SST showed the highest methodological quality in instability surgery and SPADI in pain.