Reliability and validity of the Norwegian version of the Disabilities of the Arm, Shoulder and Hand questionnaire in patients with shoulder impingement syndrome

Modified Chinese disabilities of arm, shoulder and hand tool: Validity and reliability for upper extremity injuries

DESIGN

Clinimetric evaluation study.

INTRODUCTION

The Chinese Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire has necessitated the development of a revised version to the specific needs of individuals with upper extremity injuries with the progress of times and lifestyle changes.

PURPOSE OF THE STUDY

This research aimed to evaluate the reliability and validity of Modified Chinese Disability of Arm, Shoulder and Hand (MC-DASH) questionnaire in individuals with upper extremity injuries.

METHODS

One hundred and one individuals with upper extremity injuries (UEI) were recruited. The function of upper extremity was measured using the electronic version of MC-DASH, and compared against the Chinese Disability of Arm, Shoulder and Hand. The MC-DASH was reassessed within three days in all individuals. We investigated the internal consistency, test-retest reliability, content validity, criterion validity, and construct validity of MC-DASH.

RESULTS

The internal consistency was deemed sufficient, as indicated by a Cronbach's alpha of 0.986 and an intraclass correlation coefficient of 0.957. Moreover, the mean total scores of MC-DASH on the first-test and retest were 37.86 and 38.19, respectively (ICC: 0.957, 95 %CI: 0.937-0.971, p < 0.001). Furthermore, the MC-DASH version exhibited satisfactory content validity evidenced by its strong correlation (R= 0.903, p < 0.001) with the Chinese DASH. Three major influencing factors were identified from 37 items. The cumulative variance contribution rate of the MC-DASH questionnaire was 75.76 %, confirming its construct validity.

CONCLUSION

The Modified Chinese Disability of Arm, Shoulder and Hand questionnaire has been shown to be a valid, reliable, and practical tool for use in patients with upper extremity injuries.

Assessment of structural and cross-cultural validity of the Disabilities of the Arm, Shoulder and Hand questionnaire: a scoping review

Introduction

The Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire is a patient-reported outcome measure (PROM) that has been translated and cross-culturally adapted to at least 50 languages. Since the measure was developed in 1996, many researchers have reported on the construct validity (including structural and cross-cultural validity) of this instrument following translation and cross-cultural adaptation. The aim of this scoping review was to identify the methods used for the psychometric evaluation of structural and cross-cultural validity of the DASH questionnaire.

Methods

The updated methodological guidance for the conduct of scoping reviews and the PRISMA Extension for scoping reviews checklist was utilised. EBSCOHost (Academic Search Premier, Africa Wide, CINAHL, E-Journals and Medline), PubMed and Google Scholar were searched for articles (published between 1996-2022) and considered against the eligibility criteria.

Results

The scoping review collated evidence across 50 articles (37 language versions) of the evaluation of structural and cross-cultural validity of the DASH questionnaire. Three articles conducted confirmatory factor analysis (CFA) to assess structural validity, and none performed Multiple Group Confirmatory Factor Analysis (MGCFA) to assess cross-cultural validity.

Conclusion

The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) taxonomy propose that structural validity is best evaluated through CFA, with prior evidence of dimensionality. Additionally, cross-cultural validity (measurement invariance) is to be evaluated through MGCFA. This review identified that CFA is utilised infrequently and that to date cross-cultural validity has not been appropriately assessed for translations of the DASH questionnaire.

The Greek version of shoulder rating questionnaire (SRQ): Translation, cultural adaptation, a reliability and validity study in patients with rotator cuff related shoulder pain

BACKGROUND

The Shoulder Rating Questionnaire (SRQ) was created in the English language to assess shoulder disorders in six areas: global function, pain, daily activities, recreational and athletic activities, and work.

PURPOSE

The study aimed to translate and culturally adapt Shoulder Rating Questionnaire (SRQ) into Greek.

METHODS

The SRQ English version was translated and adapted into the Greek language using forward translation, expert panel synthesis, and backward translation procedures. A pilot testing has been made in the target population, and the final version was created. A cross-sectional study was conducted in clinical settings with the SRQ and the Shoulder Pain and Disability Index. A total of 168 Greek adult patients with rotator cuff-related shoulder pain were recruited from physical therapy clinics. Τhe reliability of the SRQ Greek version was assessed using intraclass correlation coefficients. Internal consistency was assessed using the Cronbach alpha coefficient. Concurrent validity was measured by correlating the Shoulder Rating Questionnaire with the Shoulder Pain and Disability Index using Pearson's correlation coefficient.

RESULTS

The results showed that the SRQ Greek version has excellent internal consistency (Cronbach's α = 0.99), test-retest reliability (ICC = 0.976), and concurrent validity (r > 0.9). No ground or ceiling effects were found. The standard error of measurement and the minimum detectable change of the total score were 5.55 and 15.38.

CONCLUSIONS

The Greek Language Version of the SRQ is a reliable and valid instrument that can be used to evaluate adult patients with shoulder rotator cuff-related disorders in the acute or chronic phases and in clinical trials.

Psychometric evaluation of the disabilities of the arm, shoulder and hand (DASH) in patients with orthopedic shoulder impairments seeking outpatient rehabilitation

STUDY DESIGN

This is a cross-sectional, observational study.

INTRODUCTION

The disability of the arm, shoulder and hand (DASH) questionnaire is an upper-extremity specific outcome measure commonly used in routine clinical care and clinical trials.

PURPOSE OF THE STUDY

Our purposes were to: (1) examine the psychometric properties of the DASH questionnaire using factor analysis, one- and two-parameter item response theory models, and (2) develop a functional staging map illustrating the relationships between the item difficulty hierarchy of the DASH items and the patient's DASH total score.

METHODS

Data from 2724 patients with orthopedic shoulder impairments seeking outpatient physical therapy in 79 clinics in the US were analyzed.

RESULTS

Factor analysis supported a general factor, explaining 62.2% of the total variance. The coverage of DASH items was suitable for patients with shoulder impairments with no ceiling or floor effect. Endorsed items representing the most difficult items were related to feeling less capable, executing recreational activities with force or impact, and performing recreational activities in which you move your arm freely. Items with higher discriminating abilities were those related to do heavy household chores, garden/yard work, and change a light bulb overhead. With a separation index equaled to 4.94, the DASH can differentiate persons into at least 6 statistically distinct person strata. None of the DASH items exhibited differential item functioning by gender or symptom acuity, except two items by age group.

DISCUSSION

Besides a total (summed) final score obtained from a specific measure, the keyform and functional staging plots/maps can be used to assist clinicians in clinical interpretation of the scores.

CONCLUSIONS

Results supported the clinical usage of the DASH questionnaire in patients with orthopedic shoulder impairments seeking outpatient rehabilitation.

Choosing patient-reported outcome measures for shoulder pathology

This study was designed to identify the most frequent shoulder patient-reported outcome measures (PROMs) reported in high-quality literature.

A systematic review was performed to identify shoulder PROMs, and their diffusion within the scientific literature was tested with a subsequent dedicated search in MEDLINE.

506 studies were included in the final data analysis, for a total number of 36,553 patients.

The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the American Shoulder, Elbow Surgeons Score (ASES) and the Shoulder Pain and Disability Index (SPADI) were the most frequently reported PROMs in the analysed publications, with disease-specific PROMs being used with increasing frequency.

A core set of outcome measures for future studies on patients with shoulder pathologies, based on the international acceptance and diffusion of each PROM, is needed.

A combination of the DASH score for shoulder outcome assessment with more specific PROMs, such as the ASES for rotator cuff pathology and osteoarthritis and the SPADI for shoulder stiffness and shoulder pain of unspecified origin, is proposed as a recommended set of PROMs.

Cite this article: EFORT Open Rev 2021;6:779-787. DOI: 10.1302/2058-5241.6.200109

Validation and reliability of a Japanese version of the Shoulder Pain and Disability Index: A cross-sectional study

BACKGROUND

The Shoulder Pain and Disability Index (SPADI) is a simple disease specific questionnaire that is used to evaluate the impact of shoulder disorders. The purpose of this study was to translate the SPADI into Japanese (SPADI-Jp) and evaluate its reliability and validity in Japanese patients with shoulder disorders.

METHODS

Cross-cultural adaptation of the SPADI was performed according to international guidelines. A total of 100 patients with shoulder disorders participated in this study. Each participant was asked to finish the SPADI-Jp, Disability of Arm, Shoulder and Hand (DASH), and the Short-Form 36 (SF-36) at the initial visit. Thirty-four patients repeated the SPADI-Jp to assess the test-retest reliability. The test-retest reliability was quantified using the interclass correlation coefficient (ICC), while Cronbach's alpha was calculated to assess the internal consistency. The construct validity was assessed using Spearman's rank correlation coefficients.

RESULTS

Internal consistency in the SPADI-Jp was very high (0.969), as measured by the Cronbach's alpha. The ICC of the SPADI-Jp was 0.930. There was a strong, positive correlation between the DASH and the SPADI-Jp (r = 0.837, p < 0.001). The SPADI-Jp was significantly correlated with most of the SF-36 subscales. The correlations of the SPADI-Jp with physical subscales of the SF-36 were stronger than those with the other subscales.

CONCLUSIONS

We demonstrated that the SPADI-Jp is a reliable and valid self-assessment tool. Because cross-cultural adaptation, validation, and reliability of the disease-specific questionnaire for shoulder pain and disability have not been evaluated in Japan, the SPADI-Jp can be useful for evaluating such patients in the Japanese population.

Is the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire Adequate to Assess Individuals With Subacromial Pain Syndrome? Rasch Model and International Classification of Functioning, Disability and Health

OBJECTIVE

The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is widely used to assess patients with symptoms of subacromial pain syndrome (SPS). No study has analyzed the DASH by using the Rasch model in these patients and related the level of difficulty of the items with the International Classification of Functioning Disability and Health (ICF) domains. The purpose of this study was to evaluate the measurement properties of the DASH in individuals with SPS and to describe which ICF components are influenced by SPS based on the DASH.

METHODS

The full version of the DASH was used to assess upper limb pain and function in individuals with SPS. Responses were assessed using the Rasch model. DASH items were grouped according to the level of difficulty and associated with the ICF domains to identify the most compromised aspect in these individuals.

RESULTS

Reliability and internal consistency for the DASH were shown to be 0.93 and 0.95, respectively. Item 3 ("Turn a key") was the easiest and 25 ("Pain during specific activity") the most difficult. Only item 30 ("Less capable/confident/useful") was as an erratic item. Item 15 ("Put on a sweater") showed differential functioning by age and item 11 ("Carry a heavy object") by sex. Seven items showed differential functioning related to the angular onset of pain during arm elevation. Sixty percent of the most difficult items belonged to the "Body function" domain of the ICF.

CONCLUSION

Although some psychometric properties of the DASH are adequate according to the Rasch model, adjustments to some items are necessary for individuals with SPS. Clinicians should be cautious when interpreting the DASH, especially in patients with angular onset of pain above 120 degrees of arm elevation.

IMPACT

The information contained in this study should be used by clinicians to interpret the results of the DASH when assessing individuals with SPS. The DASH may not be adequate to assess those with shoulder pain above 120 degrees of arm elevation. These results are not generalizable to other shoulder pathologies.

Comparison of reliability, validity and responsiveness of the Japanese Orthopaedic Association Shoulder 36 Ver. 1.3 among different diagnoses of shoulder lesions

BACKGROUND

Shoulder 36 (Sh-36) is an original quality of life measure for shoulder lesions with high reliability and validity; however, in some cases, especially in those with a Bankart lesion, we observed no improvement in Sh-36 during the postoperative follow-up. Sh-36 may be less effective for a certain shoulder lesion. This study aimed to compare the reliability, validity, and responsiveness of Sh-36 among different representative diagnoses of shoulder lesions.

METHODS

Sh-36 and the Disability of the Arm, Shoulder and Hand (DASH) were measured in 192 patients with a Bankart lesion (Bankart group), rotator cuff tear (Cuff group), and SLAP lesion (SLAP group) who underwent arthroscopic surgery. Both measures were evaluated before surgery, and at 3, 6, 9, 12, 18, and 24 months postoperatively, and reliability, validity, and responsiveness of Sh-36 and the DASH were compared among the three groups.

RESULTS

Significant postoperative improvement was observed in the three groups (p < 0.0001) within 9 months. No marked improvement was observed after 9 months in the Bankart and SLAP groups due to the ceiling effect; however, most domains of Sh-36 increased continuously in the Cuff group during the whole follow-up period. Reliability and construct validity were sufficient in all the groups. The longitudinal validity was sufficient in most domains for the three groups; however, the standardized response mean in the Bankart group was lower than that in other two groups, indicating low responsiveness in this group because of the ceiling effect.

CONCLUSIONS

Sh-36 was a valid and reliable instrument in patients who have undergone arthroscopic shoulder surgery, especially for patient with a rotator cuff tear with high responsiveness. However, Sh-36 had lower standard response mean representing lower responsiveness in the Bankart group due to the ceiling effect and may not be ideal for longitudinal follow-up in patients with a Bankart lesion.

The minimal important change for the seven-item disability of the arm, shoulder, and hand (DASH 7) questionnaire - Assessing shoulder function in patients with subacromial pain

Background

The DASH 7 is a recently published activity-related 7-item short form of the disability of the arm, shoulder, and hand (DASH) questionnaire developed to assess shoulder function in patients with subacromial pain. Before implementation in both intervention studies and in clinical practice, it is essential to evaluate its responsiveness. The objective of this study was to determine the minimal important change (MIC) in the DASH 7 questionnaire for patients with subacromial pain after a 3 months exercise intervention in a primary care context.

Methods

In this psychometric study the anchor-based MIC-distribution method was used to establish the MIC. The Patient Global Impression of Change (PGIC) was used as external criterion. Data from a clinical implementation study, aimed to implement a specific exercise strategy for patients with subacromial pain among physiotherapists in primary care, were used. Data from 70 patients were included in the analyses.

Results

The correlation coefficient between Patient Global Impression of Change and the DASH 7 score change was 0.67 and the area under the curve was 0.94 (95% confidence interval: 0.88-1.0). The MIC_ROC for improvement was detected at a mean change in 6.5 points with the sensitivity at 0.98 (98%) and the specificity at 0.78 (78%), and the MIC_{95% limit} for improvement was detected at a mean change of 25.7 points. There were 77% of the patients who reached at least this MIC_ROC and 51% who reached at least the MIC_{95% limit} after 3 months of exercise intervention_.

Conclusion

The DASH 7 is responsive to change over time and can discriminate between patients considered to be improved and patients considered not improved. These MIC values for patients with subacromial pain in the primary care setting can be used in clinical practice and in intervention studies as an indication on the patients clinically important level of score change for improvement.

Validation and reliability of a Japanese version of the Simple Shoulder Test: a cross-sectional study

Background

The Simple Shoulder Test (SST) is a widely used patient-reported outcome assessment. The purpose of this study was to develop and validate a Japanese version of the SST (SST-Jp).

Methods

A two-stage observational study was conducted to validate the cross-cultural adaptation of the SST. A total of 100 patients with shoulder disorders completed the SST-Jp; the Disability of Arm, Shoulder, and Hand assessment; and the Medical Outcomes Short-Form 36 (SF-36) at an initial visit. Thirty-four of the patients repeated the SST-Jp one week after the first examination. The test-retest reliability was quantified using the interclass correlation coefficient, and Cronbach's alpha (α) was calculated to assess internal consistency. Construct validity was assessed using Spearman's rank correlation coefficient.

Results

The internal consistency of the SST-Jp was very high (α = 0.826). The interclass correlation coefficient of the SST-Jp was also high (0.859). There was a strong, positive correlation between the Disability of Arm, Shoulder, and Hand and the SST-Jp (r = 0.717, P < .001). The SST-Jp was significantly correlated with most of the SF-36 subscales. The correlations of the SST-Jp with physical subscales of the SF-36 were stronger than those with the other subscales.

Conclusions

The SST-Jp was found to be a valid and reliable measurement for shoulder joint pain and function assessment among the Japanese population.

Reliability, validity and responsiveness of Brazilian version of QuickDASH

OBJECTIVE

To analyse the construct validity, test-retest reliability and responsiveness of the Brazilian version of Quick-DASH (QD-Br) in patients with upper limb disorders.

METHOD

Participants completed the full Brazilian DASH, the QD-Br and the SF-12 Brazil questionnaires at the beginning of treatment, after 48-72h and the after 2-12 months. Construct validity was analysed by Pearson's correlation coefficient (r). To evaluate the test-retest reliability we used the Intraclass Correlation Coefficient (ICC) and the Cronbach's alpha coefficient to test the internal consistency. Responsiveness was analysed by Standardized Response Mean (SRM) and Effect Size (ES). The Minimal detectable change (MDC) score was based upon calculations of the standard error of measurement (SEM), confidence interval of 95%.

RESULTS

The construct validity presented strong direct correlation with the total QD-Br score and the Brazilian DASH (r = 0.91), a moderate inverse correlation between the total QD-Br score and the physical component of the SF- 12 Brazil (r = -0.55) and weak inverse correlation between the QD-Br and the mental component of SF-12 Brazil (r = -0.49). The ICC test-retest showed good reliability of 0.81 (0.72-0.87). QD-BR presented high responsiveness, with ES of 1.06 and SRM of 0.94. The MDC was 17.27 points.

CONCLUSION

These results provide evidence that the QD-Br was a valid, reliable and responsive instrument when utilized in patients with upper limb traumatic and no-traumatic disorders in the Brazilian population.

Effects of Home Exercises on Shoulder Pain and Pathology in Chronic Spinal Cord Injury: A Randomized Controlled Trial

OBJECTIVE

The aims of this study were to replicate findings that a home exercise program intervention improved shoulder pain and function and to assess changes in supraspinatus tendon pathology associated with the home exercise program in persons with chronic spinal cord injury.

DESIGN

The study is a single-blind randomized controlled trial. Individuals with spinal cord injury of at least 1 yr and chronic shoulder pain of moderate or greater average intensity were enrolled. Participants were randomized to a 12-wk home exercise program consisting of strengthening and stretching exercises or to an education-only control group, with immediate postintervention and 4-wk postintervention (16 wks) follow-ups. The main outcome measures were self-report measures of shoulder pain and impairment, the Physical Examination of the Shoulder Scale, quantitative ultrasound metrics of the supraspinatus tendon, and the Ultrasound Shoulder Pathology Rating Scale.

RESULTS

Thirty-two participants were randomized to home exercise program or education-only control condition. The mean ± SD age was 44.8 ± 12.5; 81.3% were male; 65.6% had motor complete paraplegia. Using a per-protocol, within-group analysis method, significant differences were observed between baseline and postintervention for the home exercise program group for the least pain intensity (P = 0.02), number of days with shoulder pain (P = 0.042), Physical Examination of the Shoulder Scale scores (dominant side, P = 0.036; nondominant side, P = 0.008), the Disabilities of the Arm, Shoulder, and Hand (P = 0.028), and the Patient Global Impression of Change (P = 0.015). The education-only control condition group demonstrated significant changes in average unpleasantness of shoulder pain after the intervention period (P = 0.049). Comparisons in changes from baseline between groups showed that the home exercise program group had greater improvements in nondominant-side Physical Examination of the Shoulder Scale scores and global impression of change, whereas the education-only control condition group had greater improvements in depressive symptoms.For quantitative ultrasound measures, no significant changes were found with within-group analyses for the home exercise program group, although the education-only control condition group demonstrated a decrease in tendon width in the nondominant-side supraspinatus tendon (P = 0.036). Comparison of changes between groups suggests that the education-only control condition group had a greater increase in dominant shoulder supraspinatus tendon ultrasound contrast at the end of the study.

CONCLUSIONS

Changes in several measures of shoulder pain and function occurred after the home exercise program intervention, although the magnitude of changes was only significantly greater than those of the education-only control condition group for two measures. Significant changes in supraspinatus pathology were not detected with quantitative ultrasound metrics.

Rasch analysis of the Disabilities of the Arm, Shoulder and Hand (DASH) instrument in patients with a humeral shaft fracture

BACKGROUND

The Disabilities of the Arm, Shoulder and Hand (DASH) instrument was developed to assess the disability experienced by patients with any musculoskeletal condition of the upper extremity and to monitor change in symptoms and upper-limb function over time. The 30 items are scored on a 5-point rating scale. The Dutch-language version of the DASH instrument (DASH-DLV) has been examined with the classical test theory in patients with a humeral shaft fracture. This study aimed to examine the DASH-DLV with a more rigorous and extensive analysis by applying the Rasch model.

METHODS

Data of 400 patients included in a multicenter, prospective study comparing operative and nonoperative treatment of adult patients with a humeral shaft fracture were used. The person-item map, item fit statistics, reliability, response category ordering, and dimensionality were examined. Raw data were converted to linear measures using the Rasch model.

RESULTS

The DASH-DLV showed a good fit to the Rasch model, except for item 26 ("Tingling [pins and needles] in your arm, shoulder or hand"). The person reliability was 0.92. In general, the category functioning of the 5-point rating scale was working well. Dimensionality analysis revealed that the DASH-DLV is a unidimensional scale. Differential item functioning for sex was not detected, and only item 26 exhibited differential item functioning as a function for age.

CONCLUSION

The DASH-DLV fits the stringent Rasch model in a clinical situation with a group of adult patients with a humeral shaft fracture. Adequate measurement for scientific research can be obtained to evaluate longitudinal intervention research.

Norwegian translation, cross-cultural adaptation and validation of the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow questionnaire

The Kerlan-Jobe Orthopaedic Clinic (KJOC) shoulder and elbow questionnaire, with 10 items and a total score ranging from zero to 100, provides more clinically relevant information about overhead athletes than other shoulder or upper limb patient-reported outcomes.

The Validity, Reliability and Internal Consistency of the Cross-Cultural Adaptation of the FIL-DASH (Filipino Version of the Disability of the Arm, Shoulder and Hand) Questionnaire in Patients with Traumatic Brachial Plexus Injuries

Background: The objective of this paper was to determine the validity, reliability and internal consistency of the translated FILIPINO DASH (FIL-DASH) questionnaire in patients with traumatic brachial plexus injuries. Methods: Thirty-five adult patients with traumatic brachial plexus injury were enrolled in the validation stage. The same questionnaire was given to the patient between 7 to 14 days for the test-retest reliability. The validated Filipino version of the SF-36 was used as the gold standard to determine the construct validity of the translated DASH. We also compared the DASH score with the SF-36 total and subscale, validated Brief Pain Inventory Severity and Interference Scale and the Visual Acuity Scale (VAS) for Pain. Results: The internal consistency was adequate, with Cronbach's Alpha for the 30 items of 0.93 and an average inter-item covariance of 0.399. The test-retest reliability was 0.87 (p < 0.001). There was no significant difference in establising the validity of the translated DASH against SF-36 total and Subscale, validated Brief Pain Inventory Severity and Interference Scale and the Visual Analogue Scale (VAS). Conclusions: The translated DASH (FIL-DASH) questionnaire was internally consistent and showed no difference in testing for test-retest reliability and validity against functional outcome measures and pain scales validated for adult Filipinos.

Psychometric properties of patient-reported outcome questionnaires for patients with musculoskeletal disorders of the shoulder

PURPOSE

To evaluate the psychometric properties of self-administered patient-reported outcome (PRO) questionnaires which were used in non-surgical homogeneous populations with musculoskeletal shoulder disorders.

METHODS

The included studies were identified using eligibility criteria. The methodological quality of each article was assessed using the COSMIN checklist. The psychometric properties of original versions and translated versions of PROs were also assessed.

RESULTS

Twenty articles were included. Two musculoskeletal shoulder disorders were identified that met the selection criteria: rotator cuff disease and glenohumeral instability. A total of 11 PROs were identified. In general, the methodological quality of the included studies is fair or poor. The Western Ontario Rotator Cuff Index (WORC) and the Shoulder Pain and Disability Index (SPADI) are the most frequently evaluated PROs for patients with rotator cuff disease, and their psychometric properties seem to vary according to what language that they are in. For glenohumeral instability, the Western Ontario Shoulder Instability Index (WOSI) and the Oxford Instability Shoulder Score (OISS) are the most frequently evaluated PROs, and their psychometric properties seem to be adequate.

CONCLUSION

Using for rotator cuff disease is advised, for Norwegian users, the SPADI, WORC, Oxford Shoulder Score, and disabilities of the arm, shoulder and hand. Dutch and Persian users could use the WORC. For Greek speakers, the SPADI is recommended. Turkish users could use the rotator cuff quality-of-life measure. For glenohumeral instability, Dutch and Norwegian speakers could use the WOSI and the OISS. Italian, Japanese, and Turkish users could use the WOSI. For English users, the OISS and the Shoulder Rating Questionnaire are recommended.

LEVEL OF EVIDENCE

III.

Clinical comparative effectiveness of acupuncture versus manual therapy treatment of lateral epicondylitis: feasibility randomized clinical trial

Background

Lateral epicondylitis (LE) is a challenging condition for clinicians, and research has yet not proven the superiority of one specific treatment approach. However, manual therapy (elbow mobilization) in addition to eccentric exercise has been found to be superior to exercise alone. As well, acupuncture is effective in short-term pain relief when compared with sham treatment, but there is little knowledge on the comparative effectiveness of manual therapy and acupuncture treatment of LE in terms of pain relief. The primary objective of this pilot trial was to assess the feasibility (retention and adherence rates) of performing a randomized controlled trial (RCT) to explore the clinical effectiveness of acupuncture and manual therapy treatment of LE.

Methods

This pilot trial took place in an outpatient interdisciplinary institute of sports medicine and rehabilitation in Oslo, Norway. Thirty-six adults with clinically diagnosed LE were randomly allocated into one of three groups: eccentric exercise alone, eccentric exercise plus acupuncture, or eccentric exercise plus manual therapy for a 12-week treatment period. Primary outcomes were patient retention and adherence rates. Secondary outcomes included patient-reported pain (NRS), level of disability (Quick-DASH), and participant’s satisfaction with treatment and global perceived effect.

Results

Nine (69%) patients in the acupuncture group completed the 1-year follow-up, compared to eight (67%) in the manual therapy group and five (45%) in exercise alone. Our goal was to demonstrate a retention rate above 80% to avoid serious threats to validity, but the result was lower than expected. The majority of participants (64%) in both treatment groups received only three-treatment sessions; the reasons included non-attendance or recovery from pain. Secondary outcomes support the rationale for conduction of an RCT. There were no adverse advents related to study participation.

Conclusions

Based on differences in pain relief between groups, patient retention, and adherence rates, an RCT seems to be feasible to assess treatment effectiveness more precisely. In a future definitive trial, greater dropout may be reduced by maintaining contact with the participants in the exercise alone group throughout the intervention, and objective assessments might be considered.

Trial registration

ClinicalTrials.gov, NCT02321696

Effect of Psychomotricity in Combination With 3 Months of Active Shoulder Exercises in Individuals With Chronic Shoulder Pain: Primary Results From an Investigator-Blinded, Randomized, Controlled Trial

OBJECTIVE

To evaluate whether psychomotor therapy (PMT) in combination with usual care active exercise (AE) rehabilitation for the shoulder is superior to merely AE.

DESIGN

The trial was a single-center, stratified (by corticosteroid injection [yes or no]), randomized, and controlled superiority trial.

SETTING

Shoulder unit of the orthopedic department at Hospital Lillebaelt, Vejle Hospital.

PARTICIPANTS

Eligible participants (N=87) were adults aged 18-75 years with shoulder complaints lasting for at least 3 months, in addition to a score equal to or below 3 on the Multidimensional Assessment of Interoceptive Awareness score. Furthermore, patients had at least a visual analog scale pain score of 2 at rest, 3 at night, and 5 in activity (range: 0-10).

INTERVENTIONS

Patients were randomized to 12 weeks of AE (control group) or in combination with 5 PMT sessions (intervention group).

MAIN OUTCOME MEASURE

The primary outcome was the patient-reported outcome score Disability of the Arm, Shoulder and Hand questionnaire. The primary endpoint was 12 weeks after baseline.

RESULTS

There was no between-group difference in function between the intervention group and control group.

CONCLUSIONS

Our results showed no additional benefit on patient-reported function and pain from PMT over usual care in patients with long-lasting shoulder pain and low body awareness. This finding suggests that PMT adds no additional benefit to patients' recovery in relation to pain and active function in comparison to standard care.

Shoulder Complex Mechanics in Adolescent Idiopathic Scoliosis and Their Relation to Patient-perceived Function

BACKGROUND

Proper contribution of the scapulothoracic joint is necessary for adequate shoulder complex function. Associations between trunk shape and abnormal scapular kinematics and subsequent shoulder dysfunction have been established; however, the extent of shoulder dysfunction in adolescent idiopathic scoliosis (AIS) is still poorly understood. The purpose of this study was to perform a comprehensive analysis of scapular kinematics during multiplanar arm motion in patients with AIS and compare kinematics and patient-reported function with that of a typically developing cohort.

METHODS

Typically developing adolescents (n=33) and patients with AIS (n=26) with no history of spine or shoulder surgery were recruited for this study. A 3-dimensional optoelectronic motion capture system was used to analyze scapular kinematics in 4 positions: rest, full abduction, forward reach, and hand to spine. Subjects in each group also completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a measure of patient-reported function.

RESULTS

The convex shoulders of the patients with AIS exhibited deficits in scapular upward rotation and posterior tilt in all positions and reduced protraction range of motion during reaching. The AIS group also reported worse patient-perceived shoulder function than the typically developing group; however, this dysfunction was not related to specific scapular kinematic patterns.

CONCLUSIONS

Patients with AIS show alterations in scapular kinematics that are associated with shoulder pathology. Despite displaying an unaffected ability to place the hand in space, the underlying joint mechanics place these adolescents at risk for future pathology. Accordingly, consideration of scapulothoracic and glenohumeral joint function is warranted in the treatment of AIS.

LEVEL OF EVIDENCE

Level III-cross-sectional comparison.

Validity and reliability of the Disabilities of Arm, Shoulder, and Hand scale in dental students: A transnational study

This study aimed to evaluate the validity and reliability of the Disabilities of Arm, Shoulder, and Hand (DASH) scale in Brazilian and American dental students and assess the influence of demographic variables on disability in them. A cross-sectional observational study was conducted with a nonprobabilistic sample. The sample was composed of students of both genders from the School of Dentistry of Araraquara, State University of São Paulo (UNESP) (n = 288), and students from Stony Brook University, New York, NY, USA (n = 149). The disabilities of the upper limbs were estimated using the DASH scale. The samples were characterized by collecting information on gender, academic year, and sports and work activities. The refined bifactorial model presented goodness-of-fit indices for both countries. There was a significant effect of the variables gender and academic year for the Brazilian sample and the variable sports practices for the American sample. The refined bifactorial model was valid and reliable for the Brazilian and American populations. In this model, the removal of item 17 for the Brazilian sample and items 3, 13, and 23 for the American sample was necessary. Demographic variables such as gender, academic year, and sports practice contributed significantly to the level of disability in the study populations.

Structural validity of the Dutch version of the disability of arm, shoulder and hand questionnaire (DASH-DLV) in adult patients with hand and wrist injuries

Background

Fractures of the hand and wrist are one of the most common injuries seen in adults. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire has been developed as a patient-reported assessment of pain and disability to evaluate the outcome after hand and wrist injuries. Patient reported outcomes (PROs) can be interpreted as pain, function or patient satisfaction. To be able to interpret clinical relevance of a PRO, the structural validity and internal consistency is tested. The Dutch version of the DASH has not yet been validated.

The aim of this study was to evaluate the structural validity and the internal consistency of the existing Dutch version of the DASH. The relevance of reporting subscale scores was investigated.

Methods

This study was a retrospective analysis of cross-sectional data of 370 patients with an isolated hand or wrist injury. Adult patients aged 18 to 65 years treated conservatively or surgically were included. Patients unable to understand or read the Dutch language were excluded. Confirmatory factor analysis was used to investigate the structural validity, while Cronbach’s alpha and coefficient omega were used to assess internal consistency.

Results

All investigated models (a single factor model, a 3-correlated factor, and a bifactor model) were associated with a good model fit. Both the single factor and the 3-correlated factor model were associated with factor loadings of at least 0.70. In addition, the covariance between the factors in the 3-correlated factor model was positive (at least 0.89) and statistically significant (p < 0.001). In the bifactor model, the additional value of subscales was limited as the items loaded high on the general factor but low on the subscale factors.

Conclusion

This study indicates that the Dutch version of the DASH should be considered as an unidimensional trait. A single score should be reported.

Hand, shoulder and back stiffness in long-term type 1 diabetes; cross-sectional association with skin collagen advanced glycation end-products. The Dialong study

AIMS

We aimed to: (i) estimate the prevalence of Dupuytren's disease, trigger finger, carpal tunnel syndrome and frozen shoulder; (ii) assess stiffness of the hand, shoulder and back; and (iii) explore the association of joint stiffness with both long-term HbA_1c and collagen advanced glycation end-products (AGEs) in long-term type 1 diabetes mellitus (T1DM).

METHODS

Patients with T1DM from 1970 or earlier attending a specialized diabetes center were included in this cross-sectional controlled study. We collected HbA₁/HbA_1c measurements from 1980 to 2015 and data on hand and shoulder diagnoses and joint stiffness through interviews, charts, and standardized examination. Skin biopsies were analyzed for collagen AGEs by liquid chromatography-mass spectrometry.

RESULTS

Lifetime prevalence of hand and shoulder diagnoses in the diabetes group (n=102) ranged from 37%-76% (frozen shoulder) versus 11%-15% in controls (n=73) (p<0.001). There was an association between joint stiffness and long-term HbA_1c (odds ratio 2.01 [95% CI 1.10-3.7]) and the AGEs methyl-glyoxal-lysine-dimer (odds ratio 1.68 [95% CI 1.03-2.73]) and pentosidine (odds ratio 1.81 [95% CI 1.04-3.16]).

CONCLUSIONS

Patients with T1DM >45years had a very high prevalence of hand and shoulder diagnoses versus controls. Joint stiffness was associated with collagen AGEs. However, joint biopsies and prospective studies must explore this association further.

Responsiveness and minimal important change of the Norwegian version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) in patients with subacromial pain syndrome

Background

The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) is a valid and reliable patient-reported outcome measure (PROM). It was designed to measure physical disability and symptoms in patients with musculoskeletal disorders of the upper extremity, and is one of the most commonly used PROMs for patients with shoulder pain. The aim of this study was to examine responsiveness, the smallest detectable change (SDC) and the minimal important change (MIC) of the DASH, in line with international (COSMIN) recommendations.

Methods

The study sample consisted of 50 patients with subacromial pain syndrome, undergoing physical therapy for 3–4 months. Responsiveness to change was examined by calculating area under the receiver operating characteristic curves (AUC) and testing a priori-formulated hypothesis regarding correlations with changes in other instruments that measuring the same construct. The SDC was calculated using a test re-test protocol, and the MIC was calculated by the anchor-based MIC distribution. MIC values for patients with low and high baseline scores were also calculated.

Results

DASH appeared to be responsive, as it was able to distinguish patients who reported to be improved from those unchanged (AUC 0.77). All of the hypotheses were accepted. The SDC was 11.8, and the MIC was 4.4.

Conclusion

This study shows that the Norwegian version of the DASH has good responsiveness to change and may thus be recommended to measure outcome in patients with shoulder pain in Norway.

KALK study: ultrasound guided needling and lavage (barbotage) with steroid injection versus sham barbotage with and without steroid injection - protocol for a randomized, double-blinded, controlled, multicenter study

Background

For the treatment of calcific tendinitis of the shoulder a variety of treatment regimes exist. Commonly used treatment measures include medication with oral analgesics, corticosteroid injections, extracorporeal shockwave therapy, ultrasound guided needling and lavage, and surgical treatment. Earlier cohort studies suggest that patients may benefit from these treatments, but there are few randomized studies and conflicting evidence about the effectiveness of the various treatments. In the present study we aim to compare the effectiveness of ultrasound guided needling and lavage (barbotage) together with a steroid injection to sham barbotage with and without an additional steroid injection.

Methods

The study will be performed in six secondary-care institutions in Norway and Sweden. It is designed as a pragmatic, randomized, three-arm, parallel group, double-blinded, sham-controlled clinical trial with a 2-year follow-up. It will be performed on 210 patients, aged 30 years or older, presenting with painful arc, positive impingement sign and a calcium deposit > 5 mm. Randomization to one of the three treatment options will be performed by using an online central randomization system. The three treatment groups are barbotage together with a subacromial steroid injection (the barbotage group), sham barbotage together with a subacromial steroid injection (the steroid group) or sham barbotage without a subacromial steroid injection (the placebo group). In the placebo group the steroid injection will be replaced by a short-acting local anaesthetic. Standardized home-based post-treatment physiotherapy will be performed by all patients for 8 weeks. Follow-ups are at 2 and 6 weeks, 4, 8, 12 and 24 months after treatment was given and will be performed with the patients and the outcome assessors blinded for group assignment. Primary outcome will be the Oxford shoulder score at 4 month follow-up. Secondary outcome measures are the QuickDASH upper extremity score, the EQ-5D-5L general health score and visual analogue scales for pain at rest, during activity, and at night.

Discussion

The scientific evidence from this placebo-controlled trial will be of importance for future treatment recommendations in patients with calcific tendinitis.

Trial registration

ClinicalTrials.gov: NCT02419040, registered 10 April 2015

EudraCT: 2015-002343-34, registered 23 September 2015 (retrospectively registered)

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-017-1501-9) contains supplementary material, which is available to authorized users.

What is the effect of a shoulder-strengthening program to prevent shoulder pain among junior female team handball players?

Background

Excessively high stresses are applied to the shoulder joint of handball players, mainly caused by overhead throwing. Shoulder pain is a significant problem among junior female team handball players and both male and female top-level team handball players in Norway.

Method

A randomized selection was performed among the best female junior teams (J 16) in the Trøndelag region of Norway in the 2014–2015 season. Three teams were randomized to the intervention group and three teams to the control group. Players in the intervention group (n=53) participated in a seven-month, three-times-a-week shoulder-muscle strength-training program, while those in the control group (n=53) participated in a comparable handball training, but did not conduct any specific strength training during the season.

Results

A strength-training program had no effect on the prevention of shoulder pain. Overall, the players reported shoulder pain, but graded the pain low on visual analog scale (VAS). Both the intervention group and the control group reported pain under 1 on VAS at baseline and posttest, and there was no significant difference within or between the groups when it came to the intensity of pain reported on VAS. A significant difference (p<0.048) was found between the groups on the sport-specific part of the quick-Disability of the Arm, Shoulder and Hand (DASH) form, but it did not fulfill the minimal demand to change and the players scored it low, something that indicates little functional problems when it comes to team handball. The intervention group was significantly stronger (p<0.008) on the push-ups test compared to the control group on the posttest. The intervention group increased the number of push-ups from 3.1 to 6.4, while the control group went from 2.3 to 3.6. Aside from this, there were no significant differences in between the groups.

Conclusion

A shoulder-strengthening program had no effect on the prevention of shoulder pain among junior female team handball players.

Very High Prevalence of Frozen Shoulder in Patients With Type 1 Diabetes of ≥45 Years' Duration: The Dialong Shoulder Study

OBJECTIVES

To compare the prevalence of shoulder disorders and self-reported shoulder disability in patients with long-term type 1 diabetes mellitus and diabetes-free subjects; and to explore the association between the long-term glycemic burden and shoulder disability in the diabetes group.

DESIGN

Cross-sectional study of shoulder diagnoses with 30 years' historical data on glycemic burden in patients with diabetes.

SETTING

Diabetics center and a university hospital.

PARTICIPANTS

Subjects attending the Norwegian Diabetics Center in 2015 with type 1 diabetes since 1970 or earlier were eligible (N=136). One hundred and five patients were included, and 102 (50% women; mean age, 61.9y) completed the study together with 73 diabetes-free subjects (55% women; mean age, 62.5y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Shoulder diagnoses decided through clinical examination according to scientific diagnostic criteria.

RESULTS

Frozen shoulder was diagnosed in 60 (59%) patients with diabetes and 0 diabetes-free subjects, with a lifetime prevalence of 76% in the diabetes group versus 14% in the diabetes-free subjects. Patients with diabetes had higher disability and higher mean QuickDASH scores (23.0±19.9) than diabetes-free subjects (8.9±12.0), with a mean difference of -14.2 (95% confidence interval, -19.3 to -9.0) points (P<.001). We found an association between chronic hyperglycemia and QuickDASH scores, with a 6.16-point increase in QuickDASH scores per unit increase in glycated hemoglobin A_1c (HbA_1c) (P=.014).

CONCLUSIONS

The point prevalence of frozen shoulder in patients with long-lasting type 1 diabetes was 59%, and the lifetime prevalence was 76%. The diabetes group had more shoulder disability than diabetes-free subjects. The historical HbA_1c level was associated with increased shoulder disability.

Reliability, validity, responsiveness, and minimal important change of the Disabilities of the Arm, Shoulder and Hand and Constant-Murley scores in patients with a humeral shaft fracture

BACKGROUND

The Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores are commonly used instruments. The DASH is patient-reported, and the Constant-Murley combines a clinician-reported and a patient-reported part. For patients with a humeral shaft fracture, their validity, reliability, responsiveness, and minimal important change (MIC) have not been published. This study evaluated the measurement properties of these instruments in patients who sustained a humeral shaft fracture.

METHODS

The DASH and Constant-Murley instruments were completed 5 times until 1 year after trauma. Pain score, Short Form 36, and EuroQol-5D were completed for comparison. Internal consistency was determined by the Cronbach α. Construct and longitudinal validity were evaluated by assessing hypotheses about expected Spearman rank correlations in scores and change scores, respectively, between patient-reported outcome measures (sub)scales. The smallest detectable change (SDC) was calculated. The MIC was determined using an anchor-based approach. The presence of floor and ceiling effects was determined.

RESULTS

A total of 140 patients were included. Internal consistency was sufficient for DASH (Cronbach α = 0.96) but was insufficient for Constant-Murley (α = 0.61). Construct and longitudinal validity were sufficient for both patient-reported outcome measures (>75% of correlations hypothesized correctly). The MIC and SDC were 6.7 (95% confidence interval, 5.0-15.8) and 19.0 (standard error of measurement, 6.9), respectively, for DASH and 6.1 (95% CI -6.8 to 17.4) and 17.7 (standard error of measurement, 6.4), respectively, for Constant-Murley.

CONCLUSIONS

The DASH and Constant-Murley are valid instruments for evaluating outcome in patients with a humeral shaft fracture. Reliability was only shown for the DASH, making this the preferred instrument. The observed MIC and SDC values provide a basis for sample size calculations for future research.

The Greek version of Shoulder Pain and Disability Index (SPADI): translation, cultural adaptation, and validation in patients with rotator cuff tear

BACKGROUND

This study aimed to translate and culturally adapt a Greek version of the Shoulder Pain and Disability Index (SPADI) questionnaire and to validate its usage in Greek patients.

MATERIALS AND METHODS

A forward and backward translation was performed, and the final version of the Greek questionnaire was administered to 134 outpatients (mean age 47.4 ± 14.5) with rotator cuff tear under conservative treatment. The questionnaire was re-administered 2-5 days later to assess test-retest reliability. Patients completed the Greek SPADI, the Greek version of the Quick DASH (Disability of the Arm, Shoulder and Hand Questionnaire) and the EuroQoL EQ-5D. 102 of the 134 questionnaires were considered valid.

RESULTS

The internal consistencies of the SPADI total and its subscales measured with Cronbach's alpha coefficient were high (0.932 for SPADI-Total, 0.899 for SPADI-Disability, 0.905 for SPADI-Pain). Intraclass correlation coefficients showed excellent test-retest reliability (0.899 for Disability, 0.902 for Pain, and 0.929 for total SPADI). A significantly high positive correlation was found between the SPADI total score and its subscales, and Quick DASH for Pain and Disability. Significant correlations were also found between SPADI scales and EQ-5D variables. There was a moderate positive correlation with the variables "self-reliance" (r = 0.66), "common activities" (r = 0.58), and "pain/discomfort" (r = 0.49), and a weaker correlation with the "mobility" variable (r = 0.20). Factor analysis (PAF method) revealed a bidimensional formation of the SPADI. Eight items (five pain/three disability) weighted the first factor by >0.5, and five disability items weighted the second factor.

CONCLUSIONS

The Greek SPADI represents a valid and reliable tool for measuring pain and disability in patients with painful shoulder disorders.

LEVEL OF EVIDENCE

Level 3.

Evaluation of measurement properties of self-administered PROMs aimed at patients with non-specific shoulder pain and "activity limitations": a systematic review

OBJECTIVE

To critically appraise and compare the measurement properties of self-administered patient-reported outcome measures (PROMs) focussing on the shoulder, assessing "activity limitations."

STUDY DESIGN

Systematic review. The study population had to consist of patients with shoulder pain. We excluded postoperative patients or patients with generic diseases. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using the COSMIN checklist.

RESULTS

Out of a total of 3427 unique hits, 31 articles, evaluating 7 different questionnaires, were included. The SPADI is the most frequently evaluated PROM and its measurement properties seem adequate apart from a lack of information regarding its measurement error and content validity.

CONCLUSION

For English, Norwegian and Turkish users, we recommend to use the SPADI. Dutch users could use either the SDQ or the SST. In German, we recommend the DASH. In Tamil, Slovene, Spanish and the Danish languages, the evaluated PROMs were not yet of acceptable validity. None of these PROMs showed strong positive evidence for all measurement properties. We propose to develop a new shoulder PROM focused on activity limitations, taking new knowledge and techniques into account.

The use of self-report questions to examine the prevalence of musculoskeletal problems: a test-retest study

Background

Case definition has long been an issue for comparability of results obtained for musculoskeletal pain prevalence, however the test-retest reliability of questions used to determine joint pain prevalence has not been examined. The objective of this study was to determine question reliability and the impact of question wording, ordering and the time between questions on responses.

Methods

A Computer Assisted Telephone Interviewing (CATI) survey was used to re-administer questions collected as part of a population-based longitudinal cohort study. On two different occasions questions were asked of the same sample of 203 community dwelling respondents (which were initially randomly selected) aged 18 years and over at two time points 14 to 27 days apart (average 15 days). Reliability of the questions was assessed using Cohen’s kappa (κ) and intraclass correlation coefficient (ICC) and whether question wording and period effects existed was assessed using a crossover design.

Results

The self-reported prevalence of doctor diagnosed arthritis demonstrated excellent reliability (κ = 0.84 and κ = 0.79 for questionnaires 1 and 2 respectively). The reliability of questions relating to musculoskeletal pain and/or stiffness ranged from moderate to excellent for both types of questions, that is, those related to ever having joint pain on most days for at least a month (κ = 0.52 to κ = 0.95) and having pain and/or stiffness on most days for the last month (κ = 0.52 to κ = 0.90). However there was an effect of question wording on the results obtained for hand, foot and back pain and/or stiffness indicating that the area of pain may influence prevalence estimates.

Conclusions

Joint pain and stiffness questions are reliable and can be used to determine prevalence. However, question wording and pain area may impact on estimates with issues such as pain perception and effect on activities playing a possible role in the recall of musculoskeletal pain.

Test-retest reliability of self-reported diabetes diagnosis in the Norwegian Women and Cancer Study: A population-based longitudinal study (n =33,919)

Objective:

Self-reported information from questionnaires is frequently used in epidemiological studies, but few of these studies provide information on the reproducibility of individual items contained in the questionnaire. We studied the test–retest reliability of self-reported diabetes among 33,919 participants in Norwegian Women and Cancer Study.

Methods:

The test–retest reliability of self-reported type 1 and type 2 diabetes diagnoses was evaluated between three self-administered questionnaires (completed in 1991, 1998, and 2005 by Norwegian Women and Cancer participants) by kappa agreement. The time interval between the test–retest studies was ~7 and ~14 years. Sensitivity of the kappa agreement for type 1 and type 2 diabetes diagnoses was assessed. Subgroup analysis was performed to assess whether test–retest reliability varies with age, body mass index, physical activity, education, and smoking status.

Results:

The kappa agreement for both types of self-reported diabetes diagnoses combined was good (⩾0.65) for all three test–retest studies (1991–1998, 1991–2005, and 1998–2005). The kappa agreement for type 1 diabetes was good (⩾0.73) in the 1991–2005 and the 1998–2005 test–retest studies, and very good (0.83) in the 1991–1998 test–retest study. The kappa agreement for type 2 diabetes was moderate (0.57) in the 1991–2005 test–retest study and good (⩾0.66) in the 1991–1998 and 1998–2005 test–retest studies. The overall kappa agreement in the 1991–1998 test–retest study was stronger than in the 1991–2005 test–retest study and the 1998–2005 test–retest study. There was no clear pattern of inconsistency in the kappa agreements within different strata of age, BMI, physical activity, and smoking. The kappa agreement was strongest among the respondents with 17 or more years of education, while generally it was weaker among the least educated group.

Conclusion:

The test–retest reliability of the diabetes was acceptable and there was no clear pattern of inconsistency in the kappa agreement stratified by age, body mass index, physical activity, and smoking. The study suggests that self-reported diabetes diagnosis from middle-aged women enrolled in the Norwegian Women and Cancer Study is reliable.

Does pectoralis major flap harvesting induce upper extremity dysfunction?

OBJECTIVE

To evaluate the effect of pectoralis major myocutaneous (PMM) flap reconstruction on upper extremity dysfunction.

METHODS

Patients undergoing PMM flap reconstruction following head and neck cancer resection were enrolled. The control group comprised age-, sex- and clinical characteristic-matched patients undergoing non-PMM flap reconstruction. All patients completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire preoperatively and >1 year postoperatively.

RESULTS

There was no significant difference between pre- and postoperative DASH scores in the control group (n = 46; 2.38 ± 3.33 and 2.99 ± 4.21, respectively). In the PMM flap group (n = 46), the postoperative DASH score was significantly higher than the preoperative score (7.00 ± 9.13 and 2.44 ± 3.50, respectively). In the PMM flap group, flap size was significantly associated with postoperative DASH score.

CONCLUSION

PMM flap reconstruction has a small but significant negative effect on upper extremity dysfunction.

Validation of the simplified Chinese (Mainland) version of the Disability of the Arm, Shoulder, and Hand questionnaire (DASH-CHNPLAGH)

Background

We developed a simplified Chinese version of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire (shorthand for DASH-CHNPLAGH) by conducting cross-cultural adaptation and evaluating its reliability and validity.

Methods

Both the forward and back translations were performed by language officers and medical professionals from different fields to translate the original DASH version into the DASH-CHNPLAGH version with minimized culture discrepancies. A total of 300 patients with upper extremity disorders were recruited to complete two DASH-CHNPLAGH questionnaires with 3-week test interval time.

Results

The intraclass coefficient (ICC) and Cronbach’s alpha for the 30-item disability/symptom of the DASH-CHNPLAGH was 0.94 and 0.96, respectively, which were relatively high among that reported in previous literatures. DASH-CHNPLAGH showed a positive correlation with a visual analogue scale (VAS) and a negative correlation with SF-36 items.

Conclusion

The simple Chinese version of DASH is a reliable and valid measurement for patients with upper extremity problems.