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Pyörny J, Sletten IN, Jokihaara J. Concurrent validity study of QuickDASH with respect to DASH in patients with traumatic upper extremity amputation. BMC Musculoskelet Disord 2024; 25:86. [PMID: 38263085 PMCID: PMC10804815 DOI: 10.1186/s12891-024-07183-w] [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: 11/06/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The Disability of the Arm, Shoulder and Hand Outcome Measure (DASH) is a validated patient-reported outcome measure (PROM) for many upper extremity musculoskeletal disorders. In patients with severe traumatic conditions, limited evidence exists regarding the equivalence between DASH and its shortened version, QuickDASH, which is more feasible in clinical practice. The rationale of this study was to analyze the concurrent validity of QuickDASH with respect to DASH in patients with traumatic upper extremity amputation. METHODS This study is based on a consecutive cohort of traumatic upper extremity amputation patients treated with replantation or revision (completion) amputation at Tampere University Hospital between 2009 and 2019. We estimated the concurrent validity of QuickDASH with respect to DASH by correlation coefficients, mean score differences, Bland-Altman plots, and distribution density. Additionally, we assessed internal reliability with Cronbach's alpha coefficients and item-total correlations. RESULTS We found a very strong linear correlation between DASH and QuickDASH scores (r = 0.97 [CI 95% 0.97-0.98], p < 0.001). The mean difference between DASH and QuickDASH was minor (MD = -1, SD 4 [CI95% from -1 to 0] p = 0.02). The mean sub-score for the activity domain was higher for QuickDASH than DASH (MD = -3 [CI95% from -4 to -3] p < 0.000) and lower for the symptom domain (MD = 7 [CI95% from 6 to 9] p < 0.000). The Bland and Altman plot showed good agreement between DASH and QuickDASH scores, but there was measurement error in QuickDASH with high scores (r = -0.20, [CI95% from -0.31 to -0.09], p = 0.001). CONCLUSION QuickDASH demonstrates higher total scores than the full DASH and emphasizes rating of activity over symptoms. Still, on average the differences in total scores are likely less than the MCID of DASH, and consequently, this study shows that QuickDASH can be recommended instead of the full DASH when assessing a traumatic condition. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Joonas Pyörny
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Jarkko Jokihaara
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland.
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Orner CA, Bastrom TP, Pennock AT, Edmonds EW. Clinical Outcomes of Adolescents With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions Compared With Isolated Bankart Lesions. Orthop J Sports Med 2023; 11:23259671231214007. [PMID: 38035210 PMCID: PMC10686025 DOI: 10.1177/23259671231214007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 12/02/2023] Open
Abstract
Background Glenolabral articular disruption (GLAD) lesions may occur in adolescents with anterior shoulder instability, resulting in articular cartilage loss and reduced functional glenoid surface area. Purpose/Hypothesis To compare failure rates and patient-reported outcomes (PROs) between adolescents with versus without GLAD lesions who were treated for anterior shoulder instability with arthroscopic stabilization. It was hypothesized that the comparison would yield no significant differences. Study Design Cohort study; Level of evidence, 3. Methods Patients aged ≤18 years who were treated for anterior shoulder instability with arthroscopic stabilization between 2010 and 2021 were retrospectively identified. Those patients with a GLAD lesion identified at the time of surgery were compared with patients with >2 years of retrospective follow-up who were matched to the no-GLAD cohort according to pathology and management. Demographic and patient characteristics including recurrent instability, complications, and reoperations were recorded. All patients in the GLAD cohort were contacted to obtain PRO data, including the Single Assessment Numeric Evaluation; the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire; and the Pediatric Adolescent Shoulder Survey. Patients were also asked about recurrent instability and additional shoulder problems. Results Of 35 included patients (mean age, 15.4 ± 1.6 years; 80% male), 15 patients (43%) with GLAD lesions and 26 patients without GLAD lesions were identified. Both cohorts had similar patient characteristics, number of anchors, and anchor constructs; the mean follow-up period was significantly different (GLAD vs no-GLAD, 6.9 ± 3.3 vs 3.4 ± 1.2 years, respectively; P < .001). Seven of 15 GLAD patients (46.7%) underwent loose body removal; 4 of 15 GLAD patients (26.6%) and 9 of 26 no-GLAD patients (34.6%) had recurrent subjective instability (P = .7). No significant group differences were found in PRO scores, reoperation rates (15% no-GLAD vs 20% GLAD), or percentage of patients with recurrent instability between cohorts (P > .05). Conclusion Adolescent patients with and without GLAD lesions treated arthroscopically for anterior shoulder instability had similar PROs and failure rates at intermediate duration of follow-up. GLAD lesions may be managed in a similar surgical manner as isolated Bankart tears in teenagers, with expectations of similar outcomes.
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Moreno-Castillo C, Echeverría JT, Martinez FT, Reinares F. Evaluation of Surgical Approaches to Management of Traumatic Posteromedial Elbow Instability Syndrome: A Systematic Literature Review Protocol. Cureus 2023; 15:e47880. [PMID: 38021946 PMCID: PMC10681372 DOI: 10.7759/cureus.47880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Posteromedial Instability Syndrome of the Elbow (PMIE) is a condition that arises from injuries to the stabilizing structures of the elbow joint, such as the coronoid process or ulnar lateral collateral ligament. Surgical treatment is commonly performed, but there is uncertainty regarding its results. This systematic review will synthesise the available evidence regarding the efficacy of surgical approaches to PMIE. Published and unpublished primary studies that regard outcomes of patients treated for PMIE, irrespective of approach, will be considered for inclusion. Iterative searches will be performed in the PubMed/MEDLINE, EMBASE, and Cochrane CENTRAL repositories from their inception to May 2023. Grey literature repositories will also be searched. The Cochrane risk of bias tool will be used to assess the quality of eligible interventional studies, while the MINORS tool will be employed for observational studies. If possible, a meta-analysis based on the random-effects model will be conducted. Heterogeneity will be assessed using Cochrane's Q and I2 statistics, and explored through subgroup analyses and sensitivity analyses. Relevant outcomes will include elbow joint functionality as assessed by validated scales, the proportion of patients returning to usual daily life activities, the development of recurrent joint instability in the postoperative period, quality of life and the development of postoperative arthritis. This protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) at the University of York. Its registration number is CRD42023451516.
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Affiliation(s)
| | | | - Felipe T Martinez
- Investigación Clínica, Concentra Educación e Investigación Biomédica, Viña del Mar, CHL
- Medicina Interna, Escuela de Medicina, Universidad Andrés Bello, Viña del Mar, CHL
| | - Felipe Reinares
- Traumatology, Hospital Clínico Mutual de Seguridad, Santiago, CHL
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Aldaihan MM, Alnahdi AH. Responsiveness of the Arabic Quick Disabilities of the Arm, Shoulder and Hand in Patients with Upper Extremity Musculoskeletal Disorders. Healthcare (Basel) 2023; 11:2507. [PMID: 37761704 PMCID: PMC10530924 DOI: 10.3390/healthcare11182507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
This study aimed to examine the responsiveness of the Arabic Disabilities of the Arm, Shoulder and Hand short version (Quick-DASH) in patients with upper extremity musculoskeletal disorders. Participants with upper extremity musculoskeletal disorders (N = 88) under physical therapy care were assessed at initial visit and later at a follow-up visit, and they completed the Arabic Quick-DASH, DASH, Numeric Pain Rating Scale (NPRS), Global Assessment of Function (GAF), and the Global Rating of Change Scale (GRC). Responsiveness of the Arabic Quick-DASH was assessed by examining six pre-defined hypotheses. Consistent with the pre-defined hypotheses, the Arabic Quick-DASH changes scores exhibited significant positive correlation with the change in DASH (r = 0.98), GAF (r = 0.67), NPRS (r = 0.72), and the GRC (r = 0.78). As hypothesized, the Arabic Quick-DASH showed a large effect size above the pre-determined level (ES = 1.61, SRM = 1.49) in patients who reported improved upper extremity function. The Arabic Quick-DASH change score discriminated between patients who reported improvement versus no improvement in upper extremity function (area under the receiver operating characteristic curve = 0.90). The results supported 100% (six out of six) of the pre-defined hypotheses. The Arabic Quick-DASH demonstrated sufficient responsiveness where all the pre-defined hypotheses were supported, leading to the established validity of the Arabic Quick-DASH change score as a measure of change in upper extremity function and symptoms. The minimal importance change in the Arabic Quick-DASH needs to be determined in future studies.
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Affiliation(s)
| | - Ali H. Alnahdi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
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Khalil LS, Abbas MJ, Rahman TM, Chan D, Cross AG, McGee AC, Cotter DL, Muh SJ, Kolowich PA. The effect of subscapularis-specific rehabilitation following total shoulder arthroplasty: a prospective, double-blinded, randomized controlled trial. J Shoulder Elbow Surg 2023; 32:1857-1866. [PMID: 37263480 DOI: 10.1016/j.jse.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Patients undergoing a total shoulder arthroplasty (TSA) through a deltopectoral approach will require repair of the subscapularis tendon. There are no universal postoperative guidelines for rehabilitation of the subscapularis specifically. We hypothesize that the addition of a subscapularis-specific regimen will result in improved subscapularis strength and function. METHODS Adult patients undergoing anatomic TSA for the treatment of primary glenohumeral osteoarthritis were included. Patients were randomized into either the traditional rehabilitation (TR) control group or the subscapularis rehabilitation (SR) group, which consisted of the traditional therapy along with early and additional subscapularis exercises. Baseline demographics, patient-reported outcome measures (PROMs), range of motion (ROM), provocative tests, and subscapularis strength using a handheld dynamometer were measured preoperatively at the initial clinic visit (ICV) as well as 3 months, 6 months, and 1 year postoperatively. The primary outcome of interest was a comparison of subscapularis strength between cohorts relative to preoperative baseline, whereas secondary outcomes were functional, ROM, and PROMs. RESULTS Sixty-six patients were included in the final analysis (32 TR vs. 34 SR). There were no statistically significant differences between cohorts at the ICV with regard to demographics, baseline subscapularis strength, functional testing, or PROMs. All postoperative time points demonstrated similar subscapularis strength testing between TR and SR groups (P > .05). Additionally, peak and average subscapularis strength testing at 3, 6, and 12 months postoperatively were similar to baseline ICV testing in both groups. Both groups demonstrated improvements across several provocative tests, ROM, and PROM outcome metrics at every postoperative time point as compared to baseline ICV values (P < .05). CONCLUSIONS Patients undergoing anatomic TSA return to baseline internal rotation strength by 3 months postoperatively and demonstrate significant improvements in function, ROM, and several patient-reported outcome measures. The addition of early and focused subscapularis strengthening exercises does not appear to significantly impact any outcomes when compared to traditional rehabilitation programs.
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Affiliation(s)
- Lafi S Khalil
- Divison of Sports Medicine, Department of Orthopaedic Surgery, McLaren Flint Hospital, Flint, MI, USA.
| | - Muhammad J Abbas
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Tahsin M Rahman
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Derek Chan
- Department of Physical Therapy, Henry Ford Health, Detroit, MI, USA
| | - Austin G Cross
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Anna C McGee
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Daniel L Cotter
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Stephanie J Muh
- Division of Shoulder and Elbow, Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Patricia A Kolowich
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
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Jonsson EÖ, Wänström J, Björnsson Hallgren H, Adolfsson L. The Oxford Elbow Score demonstrated good measurement properties when used with a shortened 7-day recall period. JSES Int 2023. [DOI: 10.1016/j.jseint.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Ponomarenko OV, Serhieieva LN, Parkhomenko KY. Surgical treatment results in patients with defects of the integumentary tissues of the trunk and limbs of mechanical origin. J Med Life 2022; 15:1358-1364. [PMID: 36567839 PMCID: PMC9762375 DOI: 10.25122/jml-2022-0019] [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] [Received: 01/20/2022] [Accepted: 09/13/2022] [Indexed: 01/03/2023] Open
Abstract
This study aimed to develop and implement a universal method for the quantitative assessment of treatment effectiveness in patients with skin and underlying soft tissue defects of the trunk and extremities. The study involved 242 patients, including 46 patients with upper extremity injuries, 179 with lesions of lower extremity tissues, and 17 patients with defects of the integumentary tissues of the trunk. The greatest treatment effectiveness was observed in patients with upper limb injury: excellent result - 60.0%, good - 33.3%, unsatisfactory - 6.7% of patients. In the group of patients with lower extremity injuries, an excellent result was recorded in 19.6% of cases, good (58.1%), satisfactory (15.1%), and unsatisfactory in 7.2% of patients. In patients with trunk injuries, an excellent treatment result was obtained in 23.5%, good - 35.5%, satisfactory - 23.5%, and unsatisfactory - 17.6%. The universal quantitative method for evaluating treatment effectiveness in patients with various types of damage to the trunk and extremities tissues was proposed. This method makes it possible to objectively determine the level of medical service provided to each patient, which is of great importance in the context of medical service reorganization in the state.
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Affiliation(s)
- Olena Vasylivna Ponomarenko
- Department of Medicine of Catastrophes, Military Medicine and Neurosurgery, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine,Corresponding Author: Olena Vasylivna Ponomarenko, Department of Medicine of Catastrophes, Military Medicine and Neurosurgery, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine E-mail:
| | - Ludmila Nylsivna Serhieieva
- Department of Medical Physics, Biophysics and Higher Mathematics, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine
| | - Kyrylo Yuriiovych Parkhomenko
- Department of General Practice Family Medicine and Internal Medicine, Kharkiv National Medical University, Kharkiv, Ukraine
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Leow JM, Krahelski O, Keenan OJF, Clement ND, McBirnie JM. Functional outcome following arthroscopic repair of massive rotator cuff tears is equal to smaller rotator cuff tears: a retrospective case-control study. Shoulder Elbow 2022; 14:52-58. [PMID: 35845624 PMCID: PMC9284260 DOI: 10.1177/1758573220925040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/17/2020] [Accepted: 04/15/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a paucity of studies comparing patient-reported outcomes of arthroscopic massive rotator cuff repairs against non-massive rotator cuff repairs. The aim of this study is to assess the Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Oxford Shoulder Score at a minimum of one-year follow-up according to the size of the rotator cuff tear. METHODS A retrospective case-control study was undertaken. All patients underwent rotator cuff repairs using the same technique by a single surgeon. Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Oxford Shoulder Score were collected pre-operatively and at final review with a minimum follow-up of one year. Patients with massive rotator cuff repairs were compared to patients who had non-massive rotator cuff repairs. RESULTS Eighty-two patients were included in the study of which 42 (51%) underwent massive rotator cuff repair. The mean follow-up period was 17.5 months. Quick Disabilities of the Arm, Shoulder and Hand questionnaire improved significantly (p < 0.001) from 46.1 pre-operatively to 15.6 at final follow-up for massive rotator cuff repairs. Oxford Shoulder Score improved significantly (p < 0.001) from 26.9 pre-operatively to 41.4 at final follow-up for massive rotator cuff repairs. There was no significant difference in the final Quick Disabilities of the Arm, Shoulder and Hand questionnaire (p = 0.35) or Oxford Shoulder Score (p = 0.45) between the groups. No revision surgery was required within the follow-up period. CONCLUSION Arthroscopic massive rotator cuff repairs have comparable functional outcome to smaller rotator cuff repair in the short-term and should be considered in a selected group of patients.
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Affiliation(s)
- Jun M Leow
- Trauma and Orthopaedic Department, Royal
Infirmary of Edinburgh, Edinburgh, UK,Jun M Leow, Department of Orthopaedics and
Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK.
| | - Oliver Krahelski
- College of Medicine and Veterinary
Medicine, University of Edinburgh, Edinburgh, UK
| | - Oisin JF Keenan
- Trauma and Orthopaedic Department, Royal
Infirmary of Edinburgh, Edinburgh, UK
| | - Nicholas D Clement
- Trauma and Orthopaedic Department, Royal
Infirmary of Edinburgh, Edinburgh, UK
| | - Julie M McBirnie
- Trauma and Orthopaedic Department, Royal
Infirmary of Edinburgh, Edinburgh, UK
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Furtado R, Bobos P, Ziebart C, Vincent J, MacDermid J. Patient-reported outcome measures used for shoulder disorders: An overview of systematic reviews. J Hand Ther 2022; 35:174-185. [PMID: 35491299 DOI: 10.1016/j.jht.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/08/2022] [Accepted: 03/27/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of this study was to synthesize the psychometric evidence on different patient reported outcome measures (PROMs) for shoulder disorders. METHODS This overview conducted a search of six databases. Included systematic reviews must address at least one psychometric property from a PROM for shoulder disorders. Risk of bias was assessed by A MeaSurement Tool to Assess Systematic Reviews (AMSTAR). RESULTS Thirteen systematic reviews were identified that assessed measurement properties of 15 different PROMs. Based on AMSTAR, 1 review had a high risk of bias and 7 reviews had a moderate risk of bias. Excellent test-reliability scores of intraclass correlation coefficients (0.85-0.99) were reported by the Disabilities of the Arm, Shoulder and Hand, Shoulder Pain and Dsiability Index, American Shoulder and Elbow Surgeon score and Western Ontario Rotator Cuff Index. Construct validity was supported (r = 0.5-0.8) for the Disabilities of the Arm, Shoulder and Hand, Shoulder Pain and Dsiability Index, American Shoulder and Elbow Surgeon score and Western Ontario Rotator Cuff Index. Limited evidence of responsiveness was reported across various PROMs. CONCLUSION Strong reliability and convergent validity properties have been reported across multiple reviews for the Disabilities of the Arm, Shoulder and Hand, Shoulder Pain and Dsiability Index, American Shoulder and Elbow Surgeon score, Simple Shoulder Test and Western Ontario Rotator Cuff Index, which could be considered for a core clinical outcome set.
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Affiliation(s)
- Rochelle Furtado
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada; School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada; Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada.
| | - Pavlos Bobos
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada; School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada; Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada; Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, Ontario, Canada
| | - Christina Ziebart
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada; School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada; Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Joshua Vincent
- School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Joy MacDermid
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada; School of Physical Therapy, Faculty of Health Science, Western University, London, Ontario, Canada; Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Karanasios S, Korakakis V, Diochnou A, Oikonomou G, Gedikoglou IA, Gioftsos G. Cross cultural adaptation and validation of the Greek version of the Western Ontario Rotator Cuff (WORC) index. Disabil Rehabil 2022:1-10. [PMID: 35680400 DOI: 10.1080/09638288.2022.2083704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE We aimed to translate and cross-culturally adapt the Western Ontario Rotator Cuff index into Greek (WORC-GR) and evaluate its reliability and validity in a Greek speaking population with rotator cuff (RC) disorders. MATERIALS AND METHODS Translation and cross-cultural adaptation process followed published guidelines. Content and face validity were assessed by 9 experts and 16 patients with RC pathologies, respectively. Internal structure, reliability, measurement error, and convergent validity (correlation with the Disability of the Arm, Shoulder and Hand - DASH, Shoulder Pain and Disability Index - SPADI, and Short Form-36) of the index were evaluated in 104 participants (44.2% women, mean age ± SD: 44.9 ± 15.01 years) with RC related pain. RESULTS The WORC-GR showed excellent item and scale content validity index (0.875-1.00 and 0.975, respectively), internal consistency (Cronbach's alpha range 0.749 - 0.903) and test-retest reliability (intraclass correlation coefficient: 0.942, 95% CI: 0.913-0.961). Factorial validity testing revealed a 4-factor structure explaining 69.7% of the total variance. High positive correlations were found with DASH (r = 0.806) and SPADI (r = 0.852). CONCLUSIONS WORC-GR is a reliable and valid instrument to assess symptoms in patients with RC disorders. Further research on the content validity, internal structure, and responsiveness of the tool is required. Implications for rehabilitationThe Greek version of WORC (WORC-GR) is a clear and comprehensible patient reported outcome measure.WORC-GR has excellent internal consistency, test-retest reliability and with no floor and ceiling effects.WORC-GR is a valid outcome measure for patients with rotator cuff disorders.
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Affiliation(s)
- Stefanos Karanasios
- Physiotherapy Department, Laboratory of Advanced Physiotherapy (LAdPhys), School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
| | - Vasileios Korakakis
- Hellenic OMT eDu, Athens, Greece.,Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | | | - George Gioftsos
- Physiotherapy Department, Laboratory of Advanced Physiotherapy (LAdPhys), School of Health and Care Sciences, University of West Attica, Aigaleo, Greece
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Zwaan E, Cheung E, IJsselmuiden A, Holtzer C, Schreuders T, Kofflard M, Alings M, Coert JH. Predictive Value of the (Quick)DASH Tool for Upper Extremity Dysfunction Following Percutaneous Coronary Intervention. Patient Relat Outcome Meas 2022; 13:145-155. [PMID: 35783347 PMCID: PMC9249092 DOI: 10.2147/prom.s353895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eva Zwaan
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elena Cheung
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
- Correspondence: Elena Cheung, Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands, Tel +31 88 755 6954, Email
| | | | - Carlo Holtzer
- Department of Plastic and Reconstructive Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Ton Schreuders
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marcel Kofflard
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Marco Alings
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Correia FD, Molinos M, Luís S, Carvalho D, Carvalho C, Costa P, Seabra R, Francisco G, Bento V, Lains J. Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:237-249. [PMID: 33935152 PMCID: PMC8826616 DOI: 10.1097/phm.0000000000001780] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation. DESIGN The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion. RESULTS Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group. CONCLUSIONS The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.Level of evidence: II.
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Grohnert LS, Bonato M, Schöffl V. Evaluation of a four-week Adjunct Compensatory Training for the treatment of climbing-specific overstrain syndromes of the shoulder. SPORTVERLETZUNG-SPORTSCHADEN 2022; 36:138-144. [PMID: 35016244 DOI: 10.1055/a-1397-1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although climbing is an increasingly popular sport, there is a lack of scientific evaluation of suitable training methods for climbers, especially with a view to prevention and rehabilitation. A specific rehabilitation program, Adjunct Compensatory Training (ACT), has recently been presented, but it has not been evaluated scientifically to date. OBJECTIVE To investigate the effects of Adjunct Compensatory Training on climbing-specific overstrain syndromes of the shoulder. METHODS Twenty active boulderers and climbers with an average age of 28.9 (± 7.4) years performed a guided shoulder program of six specific exercises from the ACT program over a period of four weeks. They were examined before and after the intervention. Pre- and post-interventional measurements included the Constant-Murley Score, the QuickDASH Score and the measurement of shoulder ROM (range of motion). RESULTS The Constant-Murley Score increased from 82 (± 10.0) to 104.1 (± 8.2) at follow-up (p < 0.001). The VAS value for bouldering and climbing decreased from 5.25 (± 1.4) before to 2.4 (± 1.6) after the intervention (p < 0.001). Shoulder flexion increased from 167.5 (± 14.9) to 173.1 (± 7.7) after the intervention (p < 0.05), abduction from 172.5 (± 14.9) to 179.6 (± 5.9) (n. s.), external rotation from neutral zero position from 77.6 (± 16.8) to 86.3 ± (8.3) (p < 0.05). Feasibility and acceptance of the intervention were good. Ninety-five percent of the participants continued to exercise, and 100 percent recommended the program to others. CONCLUSION The ACT led to an improvement in pain, activities of daily living, range of motion and strength in boulderers and climbers with overstrain symptoms of the shoulder. It is also classified as a realistically feasible workout. The extent to which this effect will continue, and whether or not the program can prevent injuries, remains to be seen. It can only be presumed that regular exercises prevent shoulder injuries in the climbing population.
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Affiliation(s)
| | | | - Volker Schöffl
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Germany.,Klinik für Unfallchirurgie und orthopädische Chirurgie, Friedrich-Alexander Universität Erlangen-Nürnberg, Germany.,Section Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, USA.,School of Clinical and Applied Sciences, Leeds Becket University, UK
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Tsang P, Larocerie-Salgado J, MacDermid JC, Miller TA, Doherty C, Ross DC. Postoperative management and rehabilitation after the supercharged end-to-side anterior interosseous nerve to ulnar motor nerve transfer: A report of 3 cases. J Hand Ther 2021; 34:469-478. [PMID: 32571598 DOI: 10.1016/j.jht.2020.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Compressive ulnar neuropathy at the elbow is the second most common compressive neuropathy. Nerve transfers are used for severe ulnar neuropathies as a means of facilitating recovery. Hand therapy and rehabilitation after nerve transfers have not been extensively explored. PURPOSE OF THE STUDY The aim of this repeated case study was to describe the responses, functional outcome, and neuromuscular health of three participants after the supercharged end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar motor nerve transfer do describe the hand therapy and recovery of 3 cases reflecting different recovery potential mediators, trajectories, and outcomes. STUDY DESIGN Repeated case study. METHODS Three participants of similar age (76-80 years) that had severe ulnar neuropathy who underwent surgical treatment including a SETS AIN to ulnar motor nerve surgery were purposively selected from an ongoing clinical trial, based on their response to the surgical and the rehabilitation intervention (large, moderate, and small improvements). Clinical evaluations included measuring range of motion, strength testing, and clinical tests (ie, Egawa's sign) and, subjective assessment of rehabilitation adherence., Quick Disability of Arm, Shoulder and Hand and decomposition-based quantitative electromyography were performed at >23 months to evaluate patients. RESULTS All the three participants completed the surgical and hand therapy interventions, demonstrating a variable course of recovery and functional outcomes. The Quick Disability of Arm, Shoulder and Hand scores (>23 months) for participants A, B, and C were 68, 30, and 18, respectively. The person with the least improvement had idiopathic Parkinson's disease, dyslipidemia, history of depression, and gout. Comparison across cases suggested that the comorbidities, longer time from neuropathy to the surgical intervention, and psychosocial barriers to exercise and rehabilitation adherence influenced the recovery process. The participants with the best outcomes demonstrated improvements in his lower motor neurons or motor unit counts (109 and 18 motor units in the abductor digiti minimi (ADM) and first dorsal interosseous, respectively) and motor unit stability (39.5% and 37.6% near-fiber jiggle in the ADM and first dorsal interosseous, respectively). The participant with moderate response to the interventions had a motor unit count of 93 for the ADM muscle. We were unable to determine motor unit counts and measurements from the participant with the poorest outcomes due to his physical limitations. CONCLUSIONS SETS AIN to ulnar motor nerve followed by multimodal hand therapy provides measurable improvements in neurophysiology and function, although engagement in hand therapy and outcomes appear to be mediated by comorbid physical and psychosocial health.
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Affiliation(s)
- Philemon Tsang
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Hand and Upper Limb Centre Clinical Research Lab, St. Joseph's Health Centre, London, Ontario, Canada.
| | | | - Joy C MacDermid
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Hand and Upper Limb Centre Clinical Research Lab, St. Joseph's Health Centre, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Thomas A Miller
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christopher Doherty
- Division of Plastic Surgery, University of British Columbia, London, Ontario, Canada
| | - Douglas C Ross
- Division of Plastic Surgery, Department of Surgery, Roth-McFarlane Hand & Upper Limb Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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15
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Bhamra JK, Naqvi WM, Arora SP. Effect of Smartphone on Hand Performance and Strength in the Healthy Population. Cureus 2021; 13:e15798. [PMID: 34306866 PMCID: PMC8294013 DOI: 10.7759/cureus.15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/06/2022] Open
Abstract
The study aimed to determine the interactive effects of smartphone use on hand grip strength as well as functional hand performance in young people. The evolution of technology smartphone has become our necessity. It has made our lifestyle more comfortable in the form of browsing the internet, important conversation, and source of entertainment. However, it has negatively impacted our lifestyle too. Smartphone consumption among the young population has become broadly popular for different purposes aside from communication including playing games as well as internet browsing. The main complications associated with the increase in the use of smartphones results in weakness of the hand as well as wrist. High levels of smartphone use diminished hand grip strengths as well as and hand function leading to decreased hand grip strength in their dominant hand.
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Affiliation(s)
| | - Waqar M Naqvi
- Community Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sakshi P Arora
- Community Physiotherapy, Ravi Nair Physiotherapy College, Wardha, IND
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16
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Alnahdi AH. Validity and reliability of the Arabic quick disabilities of the arm, Shoulder and Hand (QuickDASH-Arabic). Musculoskelet Sci Pract 2021; 53:102372. [PMID: 33780697 DOI: 10.1016/j.msksp.2021.102372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 03/03/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The QuickDASH is a commonly used upper extremity region-specific outcome measure assessing activity limitation and symptoms. The Arabic version of QuickDASH is available in the official outcome measure website, but no prior studies have examined its psychometric properties. OBJECTIVE To examine the psychometric properties of the Arabic QuickDASH in patients with upper extremity musculoskeletal disorders. METHODS Participants with upper extremity musculoskeletal disorders were recruited (N = 109) using convenience sampling and completed the Arabic QuickDASH, Numeric Pain Rating Scale, Global Assessment of Function, and RAND 36-item Health Survey in two testing sessions (2-7 days apart). The Arabic QuickDASH structural validity, internal consistency, floor and ceiling effect, test-retest reliability, measurement error, and construct validity were examined. RESULTS Exploratory factor analysis indicated a one factor underlying the Arabic QuickDASH. The Arabic QuickDASH had Cronbach's alpha of 0.90 and ICC2.1 of 0.91 indicating excellent internal consistency and test-retest reliability. None of the participant reached the minimum or the maximum score. The scale's standard error of measurement and minimal detectable change were 7.0 and 16.3. Five out of the six construct validity predefined hypotheses were supported by the results. CONCLUSION The Arabic QuickDASH is a unidimensional scale with excellent internal consistency, test-retest reliability and acceptable measurement error. The Arabic Quick DASH is a valid and reliable outcome measure that can be used in Arabic speaking countries with Arabic patients suffering from various upper extremity activity limitations and symptoms.
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Affiliation(s)
- Ali H Alnahdi
- Rehabilitation Sciences Department, College of Applied Medical, Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia.
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17
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Amako M, Tsuda Y, Chiba K. Comparison of reliability, validity and responsiveness of the Japanese Orthopaedic Association Shoulder 36 Ver. 1.3 among different diagnoses of shoulder lesions. J Orthop Sci 2021; 26:375-380. [PMID: 32487355 DOI: 10.1016/j.jos.2020.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/04/2020] [Accepted: 03/18/2020] [Indexed: 02/09/2023]
Abstract
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.
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Affiliation(s)
- Masatoshi Amako
- Department of Orthopaedic Surgery, National Defense Medical College, Saitama, Japan; Department of Orthopaedic Surgery, Japan Self-Defense Forces Central Hospital, Tokyo, Japan; Department of Rehabilitation Medicine, National Defense Medical College Hospital, Saitama, Japan.
| | - Yoshifumi Tsuda
- Department of Orthopaedic Surgery, Japan Self-Defense Forces Central Hospital, Tokyo, Japan; Department of Orthopaedic Surgery, Minamitama Hospital, Tokyo, Japan
| | - Kazuhiro Chiba
- Department of Orthopaedic Surgery, National Defense Medical College, Saitama, Japan
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Christiansen DH, Hjort J. Group-based exercise, individually supervised exercise and home-based exercise have similar clinical effects and cost-effectiveness in people with subacromial pain: a randomised trial. J Physiother 2021; 67:124-131. [PMID: 33744191 DOI: 10.1016/j.jphys.2021.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 12/11/2022] Open
Abstract
QUESTION What are the relative effects of group-based exercise, individual exercise and home-based exercise on clinical outcomes and costs in patients with subacromial pain? DESIGN Multicentre, three-arm, randomised controlled trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS A total of 208 patients referred to municipal rehabilitation for management of subacromial pain in six municipalities in the Central Denmark Region. INTERVENTIONS Patients were randomly allocated to group-based exercise rehabilitation (GE), individual exercise rehabilitation (IE) or home exercise rehabilitation (HE) for a period of 8 weeks. OUTCOME MEASURES The primary outcome measure was the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH). The secondary outcome measures included the EQ-5D-5L index, pain intensity, fear avoidance, psychological wellbeing, and the participant's perception of improvement and satisfaction. Healthcare and productivity costs were extracted from national health and social registers. RESULTS There was no important between-group difference in Quick-DASH scores at 6 months: adjusted mean differences GE minus IE -2 (95% CI -9 to 5), GE minus HE -2 (95% CI -9 to 5) and HE minus IE 1 (95% CI -6 to 7). The estimates of the between-group differences were able to exclude any clinically important differences in the three regimens' effects on health benefits according to the EQ-5D-5L index and other secondary outcomes. The total average costs were highest for the IE group and lowest for the HE, but not statistically different across groups. CONCLUSION In people with subacromial pain, group-based exercise, individually supervised exercise and home-based supervised exercise regimens have similar benefits. The home exercise intervention was associated with lowest costs. TRIAL REGISTRATION ClinicalTrials.gov: NCT03055117.
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Affiliation(s)
- David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre Regional Hospital Gødstrup, Herning, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
| | - Jakob Hjort
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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Comparison of patient reported outcomes following clavicle operative fixation using supraclavicular nerve sparing and supraclavicular nerve sacrificing techniques- A cohort study. Injury 2021; 52:501-505. [PMID: 33131791 DOI: 10.1016/j.injury.2020.10.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Supraclavicular nerve injury is one of the common complications after clavicle open reduction internal fixation (ORIF) affecting up to 55% of patients. There is debate about whether sparing supraclavicular nerves improves functional outcomes and patient satisfaction. The purpose of this study was to compare numbness, patient-reported outcomes and surgical time in patients undergoing clavicle ORIF using supraclavicular nerve sparing and supraclavicular nerve sacrificing techniques. PATIENTS AND METHODS We conducted a retrospective cohort study with prospective survey of 108 patients with clavicular fractures treated with ORIF at a level 1 trauma centre. Patients were divided into two groups: 1) ORIF with supraclavicular nerve sparing techniques and 2) ORIF with supraclavicular nerve sacrificing techniques. Questionnaires were conducted and subjective numbness around supraclavicular nerve distribution was our primary outcome measure. Secondary outcome measures included the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score, a numeric rating scale for pain and satisfaction with treatment and surgical time. RESULTS An overall response rate of 92% was achieved with an average follow-up of 16 months. There were 20 patients in the supraclavicular nerve sparing group and 79 patients in the supraclavicular nerve sacrificing group. 76% of all patients experienced numbness post-operatively and 91% of these patients experienced persistent numbness at final follow-up. There was no significant difference between the groups for age, gender, time to follow-up and mechanism of injury. Patients in the supraclavicular nerve sparing group had significantly less numbness at final follow-up (35% vs 86%, P < 0.001; OR=0.21 95%CI 0.11-0.40). There was no significant difference in the QuickDASH score nor the NRS for pain and function. Sparing supraclavicular nerves did not result in a significantly longer operation. CONCLUSIONS Our study demonstrates that identification and protection of the supraclavicular nerves result in significantly less numbness following clavicle ORIF but does not affect patient reported functional outcomes.
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Abhimanyu V, Ritika P, Osama N, Srishti N, Gita H. Lateral epicondylitis: Are we missing out on radial nerve involvement? A cross-sectional study. J Bodyw Mov Ther 2021; 27:352-357. [PMID: 34391257 DOI: 10.1016/j.jbmt.2021.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/27/2020] [Accepted: 01/23/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lateral epicondylitis (LE) is a common ailment causing pain and functional limitations. There is an inadequate understanding of its etiopathogenesis. Involvement of the radial nerve (RN) as the primary causative factor for this condition remains debatable. The aim of the present study was to assess the RN thickness in patients with LE and compare it with the unaffected side. METHODS The study included seventy eligible patients (M:F, 22:48) in the age group of 30-60 years with a clinical diagnosis of LE. The cross-sectional area of RN was measured at the spiral groove (SG) and around the antecubital fossa (AF) using ultrasound and compared with the unaffected side. Numeric Pain Rating Scale (NPRS) and the QuickDASH scale were used to assess pain and functional impairment. RESULTS Thickness of RN at the AF (p = 0.026) and the SG (p = 0.0117) on the affected were statistically significant compared to the unaffected side in the cohort comprising of all the 70 patients. Out of 70 patients, increased thickness was seen in 23 at the SG and 19 at the AF. QuickDASH was statistically significant in patients who had thickened nerves compared to the unaffected side at the SG (p = 0.04) but not at the AF (p = 0.16). NPRS was not statistically significant at either the AF (p = 0.34) or the SG (p = 0.71) in patients with thickened nerves. CONCLUSION Tennis elbow needs to be no longer acknowledged only as tendinopathy. It also requires consideration of the involvement of the RN.
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Affiliation(s)
- Vasudeva Abhimanyu
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Gorakhpur, India.
| | - Parihar Ritika
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India.
| | - Neyaz Osama
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Nanda Srishti
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Handa Gita
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India.
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Razmjou H, Palinkas V, Robarts S, Kennedy D. Psychometric Properties of the OSPRO-YF Screening Tool in Patients with Shoulder Pathology. Physiother Can 2021; 73:26-36. [PMID: 35110821 PMCID: PMC8774952 DOI: 10.3138/ptc-2019-0046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Purpose: The Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) is a screening tool that incorporates many important psychosocial domains into one questionnaire to reduce the burden of completing multiple questionnaires. The objectives of this study were to examine the reliability and validity of the 10-item version of the OSPRO-YF with patients with shoulder conditions. Method: The study group consisted of injured workers with an active compensation claim for a shoulder injury. The control group consisted of patients with a complaint of shoulder pain but without a work-related shoulder injury. We examined reliability (internal consistency, test-retest) and validity (factorial, convergent, known groups). The Hospital Anxiety and Depression Scale; the Quick Disabilities of Arm, Shoulder and Hand; and the short Örebro Musculoskeletal Pain Screening Questionnaire were used for comparison. Results: Eighty patients had an active compensation claim, and 160 were in the control group. The intra-class correlation coefficient values for two observations of the domain scores varied from 0.91 to 0.94. The test-retest reliability of the dichotomous constructs was moderate to perfect for 8 of 11 constructs. The 10-item OSPRO-YF questionnaire had three distinct domains, as conceptualized by the developers: mood, fear avoidance, and positive affect-coping. The Cronbach's a coefficients for these domains were 0.88, 0.94, and 0.94, respectively. The associations between the psychological constructs and domains and the similar theoretically derived scales were moderate to high and in the expected direction. Of the 11 constructs of the OSPRO-YF, 10 differentiated between patients with and without a work-related injury (p-values ranging from 0.028 to < 0.001). Conclusions: The 10-item OSPRO-YF reduces the burden of using multiple questionnaires and has acceptable test-retest and internal consistency reliability and factorial, convergent, and known-groups validity.
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Affiliation(s)
- Helen Razmjou
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre
- Sunnybrook Research Institute
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Veronica Palinkas
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Susan Robarts
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre
- Sunnybrook Research Institute
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
| | - Deborah Kennedy
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto
- School of Rehabilitation Science, McMaster University, Hamilton, Ont
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Neyaz O, Vasudeva A, Parihar R, Bharti A, Handa G. Efficacy of a local corticosteroid injection on pain, disability and radial nerve thickness in patients with lateral epicondylitis. J Family Med Prim Care 2021; 10:4502-4508. [PMID: 35280608 PMCID: PMC8884310 DOI: 10.4103/jfmpc.jfmpc_1173_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction: The aim of this study was to compare the effect of a steroid injection with conservative therapy (CT) versus CT alone on pain, functional limitations and the cross-sectional area (CSA) of the radial nerve (RN) in patients with lateral epicondylitis (LE). Methods: In this clinical trial, seventy subjects in the age group of 30–60 years with a clinical diagnosis of LE were recruited. Patients received an ultrasound-guided steroid injection and CT (Group A, n = 35) or CT alone (Group B, n = 35). Pain intensity (numeric pain rating scale), functional limitations (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire) and the CSA of RN (mm2) using ultrasound were assessed at baseline, 4 and 12 weeks. Results: There was a significant difference in pain intensity (P < 0.05) at 4 weeks in favour of Group A but not at 12 weeks. A statistically significant difference was not present favouring either group concerning disability at both the follow-ups. The difference in CSA of the RN at the affected side in both groups A and B was not statistically significant at either the spiral groove or the antecubital fossa at baseline or the subsequent follow-ups. Conclusions: The CT with a steroid injection proved to be more efficacious in the short term concerning pain intensity and functional limitations. The RN thickness is not increased in patients with LE, thereby refuting its role to some extent in the pathogenesis of LE.
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Jia S, Shi X, Liu G, Wang L, Zhang X, Ma X, Li J, Shao X. Determinants of anxiety and depression in patients with cubital tunnel syndrome. BMC Psychiatry 2020; 20:540. [PMID: 33203413 PMCID: PMC7673081 DOI: 10.1186/s12888-020-02934-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/27/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The aim of this cross-sectional study to assess the proportions of anxiety and depression in patients with CuTS, and to explore the associated demographic and clinical features. METHODS From May 2011 to January 2017, 246 patients diagnosed with CuTS were recruited. The Hospital Anxiety and Depression Scale was used to assess the proportions of depression and anxiety. Patient demographic and clinical data were collected. Univariate analysis and multivariate regression were carried out to identify the variables that were independently associated with anxiety and depression. RESULTS The proportions of depression and anxiety were 17.9% (n = 44) and 14.2% (n = 35), respectively. Five patients had both possible/probable anxiety and depression. Logistic regression analysis revealed that diabetes mellitus was independently associated with depression; and the modified McGowan grade was independently associated with anxiety. CONCLUSIONS In patients with CuTS, the proportions of depression and anxiety were 17.9% and 14.2%, respectively. Early screening for anxiety and depression is beneficial for patients with CuTS.
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Affiliation(s)
- Siming Jia
- grid.452209.8Department of Hand Surgery, The Third hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei China ,grid.256883.20000 0004 1760 8442Graduate School, Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Xiaoying Shi
- grid.256883.20000 0004 1760 8442Graduate School, Hebei Medical University, Shijiazhuang, 050000 Hebei China ,grid.440208.aDepartment of Neurology, Hebei General Hospital, Shijiazhuang, 050000 Hebei China
| | - Guanglian Liu
- Department of Bone Surgery, Hebei Pingshan General Hospital, Shijiazhuang, 050000 Hebei China
| | - Li Wang
- grid.452209.8Department of Hand Surgery, The Third hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Xiaoran Zhang
- grid.452209.8Department of Hand Surgery, The Third hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Xuelin Ma
- grid.452209.8Department of Hand Surgery, The Third hospital of Hebei Medical University, Shijiazhuang, 050000 Hebei China
| | - Jia Li
- Department of Hand Surgery, Xuzhou Renci Hospital, Xuzhou, 221000 Jiangsu China
| | - Xinzhong Shao
- Department of Hand Surgery, The Third hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
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Reproducibility: reliability and agreement parameters of the Revised Short McGill Pain Questionnaire Version-2 for use in patients with musculoskeletal shoulder pain. Health Qual Life Outcomes 2020; 18:365. [PMID: 33176784 PMCID: PMC7661222 DOI: 10.1186/s12955-020-01617-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/03/2020] [Indexed: 12/03/2022] Open
Abstract
Background The Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) is a multidimensional outcome measure designed to capture, evaluate and discriminate pain from neuropathic and non-neuropathic sources. A recent systematic review found insufficient psychometric data with respect to musculoskeletal (MSK) health conditions. This study aimed to describe the reproducibility (test–retest reliability and agreement) and internal consistency of the SF-MPQ-2 for use among patients with musculoskeletal shoulder pain. Methods Eligible patients with shoulder pain from MSK sources completed the SF-MPQ-2: at baseline (n = 195), and a subset did so again after 3–7 days (n = 48), if their response to the Global Rating of Change (GROC) scale remained unchanged. Cronbach alpha (α) and intraclass correlation coefficient (ICC2,1), and their related 95% CI were calculated. Standard error of measurement (SEM), group and individual minimal detectable change (MDC90), and Bland–Altman (BA) plots were used to assess agreement. Results Cronbach α ranged from 0.83 to 0.95 suggesting very satisfactory internal consistency across the SF-MPQ-2 domains. Excellent ICC2,1 scores were found in support of the total scale (0.95) and continuous subscale (0.92) scores; the remaining subscales displayed good ICC2,1 scores (0.78–0.88). Bland–Altman analysis revealed no systematic bias between the test and retest scores (mean difference = 0.13–0.19). While the best agreement coefficients were seen on the total scale (SEM = 0.5; MDC90individual = 1.2 and MDC90group = 0.3), they were acceptable for the SF-MPQ-2 subscales (SEM: range 0.7–1; MDC90individual: range 1.7–2.3; MDC90group: range 0.4–0.5). Conclusion Good reproducibility supports the SF-MPQ-2 domains for augmented or independent use in MSK-related shoulder pain assessment, with the total scale displaying the best reproducibility coefficients. Additional research on the validity and responsiveness of the SF-MPQ-2 is still required in this population.
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QVIST AH, VÆSEL MT, MOSS C, JAKOBSEN T, JENSEN SL. No need to use both Disabilities of the Arm, Shoulder and Hand and Constant-Murley score in studies of midshaft clavicular fractures. Acta Orthop 2020; 91:789-793. [PMID: 32928045 PMCID: PMC9897629 DOI: 10.1080/17453674.2020.1820274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Most newer randomized studies examining plate fixation and nonoperative treatment of midshaft clavicular fractures utilize both Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley score (CS) in the evaluation of patient outcomes. Compared with DASH, the use of CS requires on-site trained personnel and patient visits to obtain the score. The use of both DASH and CS should provide extra value compared with the use of a single functional outcome score; if this value is not provided, the combined use is not necessary. We evaluated the agreement between DASH and CS in patients with displaced midshaft clavicular fractures.Patients and methods - We used prospectively collected data from 146 patients enrolled in a randomized study comparing operative and nonoperative treatment of midshaft clavicular fractures. We determined correlation between DASH and CS at all follow-up points and calculated mean bias in the Bland-Altman plot.Results - We found moderate to high correlation (from 0.82 at 6 weeks' follow-up to 0.58 at 1-year follow-up) between DASH and CS score, and a small bias (2.21 [95% CI 0.22-4.20]) in the Bland-Altman plot.Interpretation - In patients with displaced midshaft clavicular fractures DASH and CS measures the same degree of disability. Unless specifically studying strength and range of motion, we recommend the sole use of DASH as it would eliminate potential observer-induced bias along with removing the economic and logistic burden of obtaining CS without compromising the value of the collected data.
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Affiliation(s)
| | | | - Carsten MOSS
- Department of Orthopedics, Randers Regional
Hospital
| | - Thomas JAKOBSEN
- Department of Orthopedics, Alborg University
Hospital, Denmark
| | - Steen L JENSEN
- Department of Orthopedics, Alborg University
Hospital, Denmark
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Shubert DJ, Shubert SB. Patient-Reported Outcomes of Shoulder Surgery in a Community Orthopedic Practice: A 5-Year Quality Improvement Project Using the QuickDASH Questionnaire. Orthopedics 2020; 43:e383-e388. [PMID: 32602924 DOI: 10.3928/01477447-20200619-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/01/2019] [Indexed: 02/03/2023]
Abstract
There has been a shift in US health care to a system that emphasizes value. Patient-reported outcomes have become a critical component of that valuation. A 5-year quality improvement project at the community private practice level was undertaken to assess the authors' delivery of care and practice processes for shoulder surgery as compared with established standards. QuickDASH questionnaires were collected from 1304 consecutive shoulder surgery patients, and data were collected at 4 time points. Mean QuickDASH scores for each procedure and scores assessing biceps tenodesis, distal clavicle excision, workers' compensation status, and sex were analyzed for statistical significance. Rotator cuff repair patients who also underwent biceps tenodesis had statistically significant worse function preoperatively and at 3 and 6 months postoperatively but not at 1 year postoperatively (P<.05). Rotator cuff repair patients undergoing concomitant distal clavicle excision had statistically significantly higher pre-operative scores (P<.01). Male shoulder arthroplasty patients had statistically significant higher preoperative scores (P<.02). Non-workers' compensation patients had statistically significant higher scores at 1 year (P<.05), whereas workers' compensation patients were statistically significantly younger (P<.01). Maximum changes in scores that met minimal clinically important differences occurred between surgery and 6 months postoperatively in all procedures. Quality outcome studies can be performed in private practice by a single surgeon and yield helpful results that lead to quality improvement through practice and delivery of care processes. [Orthopedics. 2020;43(5):e383-e388.].
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da Silva NC, Chaves TC, Dos Santos JB, Sugano RMM, Barbosa RI, Marcolino AM, Mazzer N, Fonseca MCR. Reliability, validity and responsiveness of Brazilian version of QuickDASH. Musculoskelet Sci Pract 2020; 48:102163. [PMID: 32560867 DOI: 10.1016/j.msksp.2020.102163] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
| | - Thais Cristina Chaves
- Department of Health Sciences - Post Graduation Program in Rehabilitation and Functional Performance, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil.
| | | | - Raquel Metzker Mendes Sugano
- Rehabilitation Centre, Ribeirao Preto Clinical Hospital, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil.
| | | | | | - Nilton Mazzer
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
| | - Marisa C Registro Fonseca
- Department of Health Sciences - Post Graduation Program in Rehabilitation and Functional Performance, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil.
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Evaluating the reproducibility of the short version of the Western Ontario Rotator Cuff Index (Short-WORC) prospectively. JSES Int 2020; 4:197-201. [PMID: 32544940 PMCID: PMC7075774 DOI: 10.1016/j.jses.2019.10.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Recently, a shorter version of the Western Ontario Rotator Cuff Index (Short-WORC) was created to reduce patient response burden. However, it has yet to be evaluated prospectively for reproducibility (reliability and agreement) and floor and ceiling effects. Methods Patients (N = 162) with rotator cuff disorders completed the Short-WORC at baseline. From this cohort, 47 patients underwent measurement of test-retest reliability within 2 to 7 days. We used the Cronbach α to determine internal consistency and the intraclass correlation coefficient (ICC2,1) to assess test-retest reliability. To evaluate parameters of agreement, the standard error of measurement, minimal detectable change (based on a 90% confidence interval), and Bland-Altman plots were used. Results The Cronbach α was 0.82 at baseline, and the intraclass correlation coefficient (ICC2,1) was 0.87. The agreement parameter was 8.4 for the standard error of measurement of agreement, and the limits of agreement fell within the range of –22.9 to 23.8. The Short-WORC is reliable over time and reflective of a patient’s true score after an intervention. Conclusions The Short-WORC demonstrated strong reproducibility parameters and can be used for patients with rotator cuff disorders. The Short-WORC indicated no systematic bias and was reflective of the true score of both individual patients and groups of patients at 2 time points.
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Young SW, Young TW, MacDonald CW. Conservative management of De Quervain's tendinopathy with an orthopedic manual physical therapy approach emphasizing first CMC manipulation: a retrospective case series. Physiother Theory Pract 2020; 38:587-596. [PMID: 32478626 DOI: 10.1080/09593985.2020.1771800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
De Quervain's tendinopathy (DQT) is a musculoskeletal disorder that limits hand function of affected individuals. Management of DQT can include splinting, activity modification, medications, corticosteroid injections, physical therapist management, and surgery. There is limited evidence to support the combination of manual therapy and exercise interventions within an Orthopedic Manual Physical Therapy (OMPT) approach when managing patients with DQT. Three patients identified with DQT underwent a multi-modal treatment regimen including carpometacarpal (CMC) thrust and non-thrust manipulation, end range radiocarpal mobilization, mobilization with movement (MWM), strengthening exercises, and grip proprioception training. Outcomes were assessed using the numeric pain rating scale (NPRS), Jamar hand dynamometer grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. These measures were administered at baseline and discharge. Each patient demonstrated improvements in all outcome measures and required ten visits or less to reach a satisfactory outcome. The NPRS improved by a mean of 7.1 points on a 0-10 scale, Quick DASH improved by an average of 37.1%, and grip strength improved by a mean of 27.6 pounds. Each patient was able to return to daily tasks without pain and all improvements were maintained at six month follow-up. An impairment based OMPT management approach was effective in managing three patients with DQT. The inclusion of first CMC manipulation within this multi-modal approach may enhance conservative management of patients with DQT. Because a cause and effect relationship cannot be inferred from a case series, further research is recommended to investigate the efficacy of this management approach.
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Affiliation(s)
- Scott W Young
- Rueckert-Hartman College for Health Professions, School of Physical Therapy, Regis University, Denver, Colorada, USA
| | - Thomas W Young
- Rueckert-Hartman College for Health Professions, School of Physical Therapy, Regis University, Denver, Colorada, USA
| | - Cameron W MacDonald
- Rueckert-Hartman College for Health Professions, School of Physical Therapy, Regis University, Denver, Colorada, USA
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Furtado R, MacDermid JC, Nazari G, Bryant DM, Faber KJ, Athwal GS. Cross-cultural adaptions and measurement properties of the WORC (Western Ontario rotator cuff index): a systematic review. Health Qual Life Outcomes 2020; 18:17. [PMID: 31996226 PMCID: PMC6988228 DOI: 10.1186/s12955-020-1276-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the translations, cross-cultural adaptation procedures and measurement properties of the Western Ontario Rotator Cuff Index (WORC), when it is adapted for different cultures. Methods A systematic review was performed, considering different cultural adaptions of the WORC accessible through MEDLINE, CINAHL, EMBASE and/or Google Scholar. Included were prospective cohort studies that used an adapted version of the WORC to measure QoL in patients with rotator cuff disorders. All studies were evaluated according to the current guidelines for cross-cultural adaptations and measurement properties. Results The search retrieved 14 studies that met the inclusion criteria. According to the recommended guidelines for cross-cultural adaptations, 8 studies performed 100% of the steps, 2 studies performed 80% of the steps and 4 studies used previously translated measures. When evaluating the studies’ psychometric properties based on the quality criteria, none of the studies reported all recommended measurement properties. All of the studies reported the measurement property of reliability, but none of the studies reported agreement. Internal consistency was fully reported by 15% of studies. Construct validity was reported by 43% of studies. Only one study reported 100% of the cross-cultural adaption guidelines and 83% of the quality criteria. Conclusions Although the majority of studies demonstrated proper adaptation procedures, testing of the measurement properties were inadequate. It is recommended that the current adapted versions of the WORC undergo further testing before use in clinical practise, and researchers continue to adapt the WORC for different cultures as it proves to be an appropriate instrument for assessing rotator cuff pathology.
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Affiliation(s)
- Rochelle Furtado
- Physiotherapy, Health and Rehabilitation Science, Western University, London, ON, Canada. .,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.
| | - Joy C MacDermid
- Physiotherapy, Health and Rehabilitation Science, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Goris Nazari
- Physiotherapy, Health and Rehabilitation Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Dianne M Bryant
- Physiotherapy, Health and Rehabilitation Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Kenneth J Faber
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - George S Athwal
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
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Boljanovic D, Razmjou H, Elmaraghy A. Psychosocial flag signs: impact on work status following a compensable shoulder injury. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1682036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Dragana Boljanovic
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Helen Razmjou
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada
| | - Amr Elmaraghy
- Department of Surgery, Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Surgery, Division of Orthopaedic Surgery, St. Joseph's Health Centre, Toronto, Canada
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
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Humeral head resurfacing is associated with less pain and clinically equivalent functional outcomes compared with stemmed hemiarthroplasty at mid-term follow-up. Knee Surg Sports Traumatol Arthrosc 2019; 27:3203-3211. [PMID: 30915512 DOI: 10.1007/s00167-019-05382-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/25/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Humeral head resurfacing (HHR) is a less invasive, anatomic alternative to the conventional stemmed hemiarthroplasty in patients in whom isolated humeral head replacement is preferred. It was hypothesized that, in a mid-term cross-sectional subjective outcome analysis, HHR would have equivalent patient-reported and functional outcomes to stemmed hemiarthroplasty (HA). METHODS A total of 213 HHR and 153 HA procedures were performed at a single academic institution from 2000 to 2014. Of these, 106 HHR and 47 HA patients corresponding with 120 HHR and 55 HA shoulders responded to a survey that collected patient demographics, surgical outcomes, patient satisfaction, and self-reported range of motion scores using both bespoke and validated metrics. RESULTS Follow-up was longer in the HA group (9.4 ± 3.4 vs. 5.2 ± 1.8 years, p < 0.0001). Self-reported range of motion was equivalent between groups. Surgery was perceived as helpful following 76.7% of HHRs and 78.2% of HAs (p > 0.99). The ASES pain subscore was significantly worse in the HA group (25.2 ± 29.5 vs. 38.5 ± 12.7 after HHR, p < 0.0001), which translated into worse ASES total scores (45.1 ± 14.8 HA vs. 52.2 ± 23.7 HHR, p < 0.05). These findings were equivocal in responses received 2-8 years vs. ≥ 8 years after surgery. CONCLUSIONS Indications should be equivocal; humeral head resurfacing is a viable alternative to hemiarthroplasty, with equivalent patient satisfaction and reduced pain in the mid-term post-operative period. LEVEL OF EVIDENCE III.
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Singh G, Mann H, Razmjou H. Outcomes of expedited rotator cuff surgery in injured workers: Impact of pathology on readiness for return to work. J Orthop Surg (Hong Kong) 2019; 26:2309499018808362. [PMID: 30415603 DOI: 10.1177/2309499018808362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The objectives of this study were to (1) examine the overall recovery and satisfaction following an expedited rotator cuff (RC) decompression or repair at 3-6 months and (2) explore group differences (repair vs. decompression) in demographics, clinical, disability, and psychosocial factors. METHODS This was a prospective longitudinal study of injured workers whose surgery was expedited. The outcome measures were Quick disabilities of the arm, shoulder, and hand ( QuickDASH), the Hospital Anxiety and Depression Scale (HADS), the readiness for return to work (RRTW) scale, and satisfaction with surgery and overall recovery. RESULTS Of 118 patients participated in the study, 106 patients, age: 51 (9), 71 males (67%) completed the study. Sixty-four (60%) patients underwent a RC repair and 42 (40%) had RC decompression. Patients improved on average in QuickDASH ( p = 0.004), anxiety ( p = 0.003), and depression scores ( p = 0.004). The majority of patients (75%) were satisfied with surgery. In the decompression group, the pre-contemplation (PC) stage of the RRTW which documents the absence of desire or planning for return to work in the non-working sample ( r = 0.81, p = 0.008) and the uncertain maintenance (UM) stage of the RRTW which explores the worker's struggle to stay at work in the working sample correlated with physical disability as measured by the QuickDASH scores ( r = 0.62, p = 0.0001). In the repair group, the above domains correlated with the depression HADS scores (PC: r = 0.64, p = 0.001 and UM: r = 0.57, p < 0.0001). CONCLUSION Expedited RC surgery improved physical disability and mental well-being and was associated with a relatively high satisfaction at a maximum of 6 months. The poorer report of readiness for return to work was associated with higher physical disability in the decompression group and higher report of depression in the repair group. These differential associations may emphasize the importance of physical versus psychological management in patients with different levels of pathology.
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Affiliation(s)
- Gargi Singh
- 1 Holland Orthopaedic and Arthritic Centre, Working Condition Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Helen Mann
- 1 Holland Orthopaedic and Arthritic Centre, Working Condition Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Helen Razmjou
- 1 Holland Orthopaedic and Arthritic Centre, Working Condition Program, Sunnybrook Health Sciences Centre, Toronto, Canada.,2 Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,3 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
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Dabija DI, Pennings JS, Archer KR, Ayers GD, Higgins LD, Kuhn JE, Baumgarten KM, Matzkin E, Jain NB. Which Is the Best Outcome Measure for Rotator Cuff Tears? Clin Orthop Relat Res 2019; 477:1869-1878. [PMID: 31335605 PMCID: PMC7000030 DOI: 10.1097/corr.0000000000000800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/11/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The American Shoulder and Elbow Surgeons Standardized Shoulder Form (ASES), the Shoulder Pain and Disability Index (SPADI), and the shortened Disability of the Arm, Shoulder, and Hand (quickDASH) are patient-reported upper extremity-specific outcome scales currently used to evaluate patients with rotator cuff tears. This heterogeneity does not allow for a uniform metric for research and patient care. QUESTIONS/PURPOSES Our objective was to determine psychometric properties (reliability, convergent and discriminant validity, and responsiveness) of five commonly used outcome instruments (the ASES, the SPADI, the quickDASH, the SF-12, and the EuroQol-5D) in a longitudinal study of patients undergoing treatment for rotator cuff tears. METHODS From February 2011 through June 2015, 120 patients completed a standardized history, the five outcome scales under study, a physical examination, and an MRI. Of these, 47 (39%) were lost to followup before 18 months, and another 24 (20%) were accounted for at 18 months but had missing data at one or more of the earlier prespecified followup intervals (3, 6, or 12 months). Reliability (the reproducibility of an outcome instrument between subjects; tested by Cronbach's alpha), convergent and discriminant validity (determining which outcome measures correlate most strongly with others; tested by Spearman's correlation coefficients), and responsiveness (the change in outcome scales over time based on percent improvement in shoulder functionality using the minimal clinically important difference [MCID] and the subjective shoulder value) were calculated. RESULTS All outcomes measures had a Cronbach's alpha above 0.70 (range, 0.74-0.94) and therefore were considered reliable. Convergent validity was demonstrated as the upper extremity-specific measures (SPADI, ASES, and quickDASH) were more strongly correlated with each other (rho = 0.74-0.81; p < 0.001) than with any of the other measures. Discriminant validity was demonstrated because the Spearman's correlation coefficients were stronger for the relationships between upper extremity measures compared with the correlations between upper extremity measures and general health measures for 53 of the 54 correlations that were compared. Both internal and external responsiveness of the measures was supported. Patients who achieved the MCID and at least a 30% change on the subjective shoulder value had more positive change in scores over time compared with those who did not. Mixed model linear regressions revealed that all three upper extremity-specific measures had a group by time interaction for the MCID, indicating that patients who achieved the MCID had greater change over time compared with those who did not achieve the MCID. Results showed that the measure with the best discrimination between groups, or best internal responsiveness, was the ASES (beta = -8.26, 95% confidence interval [CI], -11.39 to -5.14; p < 0.001; η = 0.089) followed by the SPADI (beta = 6.88, 95% CI, 3.78-9.97; p < 0.001; η = 0.088) then the quickDASH (beta = 3.43, 95% CI, 0.86-6.01; p = 0.009, η = 0.027). Measures with the best external responsiveness followed the same pattern of results. CONCLUSIONS All the upper extremity-specific scales had acceptable psychometric properties. Correlations were high and thus only one upper extremity-specific instrument is needed for outcome assessment. Given the overall psychometric assessment, we recommend SPADI be the shoulder-specific instrument used to assess outcomes in patients with rotator cuff tears. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Dominique I Dabija
- D. I. Dabija, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN, USA J. S. Pennings, K. R. Archer, J. E. Kuhn, N. B. Jain, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA K. R. Archer, N. B. Jain, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA G. D. Ayers, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA L. D. Higgins, E. Matzkin, Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA K. M. Baumgarten, Orthopedic Institute, Sioux Falls, SD, USA
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Garcia AN, Thigpen CA, Lake AD, Martinez C, Myers H, Cook C. Do older adults with shoulder disorders who meet the minimal clinically important difference also present low disability at discharge? An observational study. Braz J Phys Ther 2019; 24:152-160. [PMID: 30885628 DOI: 10.1016/j.bjpt.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/05/2019] [Accepted: 02/13/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The choice of outcome success thresholds may influence clinical management, pay-for-performance, and assessment of value-based care. OBJECTIVE To evaluate outcomes success thresholds in older adults using two different methods: 1) Minimal clinically important differences (MCIDs) of the Quick-DASH and 2) Dichotomization of the Quick-DASH based on low disability rating at discharge DESIGN: An observational design (retrospective database study). SETTING Dataset of 1109 patients with shoulder disorders. PARTICIPANTS 297 older adults patients who were diagnosed with rotator cuff related shoulder disorders and were managed through physical therapy treatment. MAIN OUTCOME MEASURES We categorized and calculated how many patients met 8.0 and 16.0 point changes on the Quick-DASH. To evaluate outcomes success thresholds using dichotomization, patients who discharge score of ≤20 on the Quick-DASH were considered positive responders with successful outcomes. RESULTS The percentage of positive responders who met the MCID thresholds for the Quick-DASH were 63.3% using MCID of 8.0 points, 39.7% using the MCID of 16.0 points, and 46.12% who met discharge score of ≤ 20 on the Quick-DASH. 39.0% met both MCID of 8.0 points and discharge score of ≤ 20 on the Quick-DASH. Only 28% met both MCID of 16.0 points and discharge score of = 20 on the Quick-DASH. CONCLUSION Three different success threshold derivations classified patients into three very different assessments of success. Quick-DASH scores of ≤ 20 represent low levels of self-report disability at discharge and can be a stable clinical option for a measure of success to capture whether a treatment results in meaningful improvement.
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Affiliation(s)
- Alessandra Narciso Garcia
- Post-Doctorate, Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University, 2200 W. Main St. Durham, NC, USA 27708.
| | - Charles A Thigpen
- Sr. Director of Practice Innovation & Analytics, ATI Physical Therapy; Director, Program in Observational Clinical Research in Orthopedics, Center for Effectiveness in Orthopedic Research, Arnold School of Public Health, University of South Carolina, Greenville SC USA 29681
| | - Ashley Davis Lake
- Senior Physical Therapist, Department of Physical Therapy and Occupational Therapy, Duke University Health System, 3475 Erwin Road, Durham, NC 27710
| | - Corina Martinez
- Senior Physical Therapist, Department of Physical Therapy and Occupational Therapy, Duke University Health System, 3475 Erwin Road, Durham, NC 27710
| | - Heather Myers
- Senior Physical Therapist, Department of Physical Therapy and Occupational Therapy, Duke University Health System, 3475 Erwin Road, Durham, NC 27710
| | - Chad Cook
- Professor and program director, Doctor of Physical Therapy Division, Duke Clinical Research Institute, Duke University, 2200 W. Main St. Durham, NC, USA 27708
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Beck A, Lee H, Fourman M, Giugale J, Zlotnicki J, Rodosky M, Lin A. Preoperative Comorbidities and Postoperative Complications Do Not Influence Patient-Reported Satisfaction Following Humeral Head Resurfacing: Mid- to Long-term Follow-up of 106 Patients. J Shoulder Elb Arthroplast 2019; 3:2471549219830284. [PMID: 34497944 PMCID: PMC8282149 DOI: 10.1177/2471549219830284] [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] [Received: 08/07/2018] [Revised: 12/10/2018] [Accepted: 01/13/2019] [Indexed: 11/30/2022] Open
Abstract
Background Humeral head resurfacing (HHR) has emerged as an alternative treatment for glenohumeral osteoarthritis. We investigated the outcomes of HHR using validated patient-reported outcome (PRO) measures. Methods A retrospective review was performed on 213 patients who underwent HHR. A PRO follow-up was performed by administering a questionnaire including the American Shoulder and Elbow Society (ASES) score, Brophy activity survey, short form of the Disabilities of the Arm, Shoulder and Hand (quickDASH) survey, and general shoulder function. PRO scores were stratified by comorbidities and complications. Results Survey responses were received from 106 patients (51%), with a mean follow-up of 5.6 ± 1.8 years (range: 9 months to 6.1 years). Preoperative comorbidities were associated with significantly higher quickDASH scores. Postoperative complications were associated with significantly higher rates of current pain, higher visual analog scale scores, night pain, lower subjective shoulder values, and lower ASES pain and total scores. No differences in patient satisfaction were identified between the cohorts with and without preoperative comorbidities and between the cohorts with and without postoperative complications. Conclusion In our cross-sectional analysis of mid- to long-term outcomes following HHR, preoperative comorbidities, or postoperative complications had no impact on patient-perceived postoperative satisfaction or most PROs. HHR is clinically viable in a wide variety of patients. Future work is necessary to compare the efficacy of HHR compared with more traditional total shoulder arthroplasty and stemmed hemiarthroplasty regarding long-term outcomes and appropriate indications.
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Affiliation(s)
- Andrea Beck
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Hannah Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mitchell Fourman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan Giugale
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason Zlotnicki
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mark Rodosky
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Launonen AP, Fjalestad T, Laitinen MK, Lähdeoja T, Ekholm C, Wagle T, Mattila VM. Nordic Innovative Trials to Evaluate osteoPorotic Fractures (NITEP) Collaboration: The Nordic DeltaCon Trial protocol-non-operative treatment versus reversed total shoulder arthroplasty in patients 65 years of age and older with a displaced proximal humerus fracture: a prospective, randomised controlled trial. BMJ Open 2019; 9:e024916. [PMID: 30700485 PMCID: PMC6352806 DOI: 10.1136/bmjopen-2018-024916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The proximal humerus fracture (PHF) is one of the most common fractures in the elderly. The majority of PHFs are treated non-operatively, while 15%-33% of patients undergo surgical treatment. Recent randomised controlled trial (RCT) and meta-analyses have shown that there is no difference in outcome between non-operative treatment and locking plate or hemi-arthroplasty. During the past decade, reverse total shoulder arthroplasty (RTSA) has gained popularity in the treatment of PHF, although there is a lack of RCTs comparing RTSA to non-operative treatment. METHODS This is a prospective, single-blinded, randomised, controlled, multicentre and multinational trial comparing RTSA with non-operative treatment in displaced proximal humeral fractures in patients 65-85 years. The primary outcome in this study is QuickDASH-score measured at 2 years. Secondary outcomes include visual analogue scale for pain, grip strength, Oxford shoulder score, Constant score and the number of reoperations and complications.The hypothesis of the trial is that operative treatment with RTSA produces better outcome after 2 and 5 years measured with QuickDASH. ETHICS AND DISSEMINATION In this protocol, we describe the design, method and management of the Nordic DeltaCon trial. The ethical approval for the trial has been given by the Regional Committee for Medical and Health Research Ethics, Norway. There have been several examples in orthopaedics of innovations that result in failure after medium-term follow-ups . In order to prevent such failures and to increase our knowledge of RSTA, we feel a large-scale study of the effects of the surgery on the outcome that focuses on the complications and reoperations is warranted. After the trial 2-year follow-up, the results will be disseminated in a major orthopaedic publication. TRIAL REGISTRATION NUMBER NCT03531463; Pre-Results.
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Affiliation(s)
| | | | | | | | - Carl Ekholm
- Sahlgrenska University Hospital, Göteborg, Sweden
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Aceituno-Gómez J, Avendaño-Coy J, Gómez-Soriano J, García-Madero VM, Ávila-Martín G, Serrano-Muñoz D, González-González J, Criado-Álvarez JJ. Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial. Clin Rehabil 2019; 33:894-903. [PMID: 30672303 DOI: 10.1177/0269215518824691] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of high-intensity laser therapy on shoulder pain and function in subacromial impingement syndrome. DESIGN Clinical controlled trial with alternate allocation. SETTING Hospital Department of Rehabilitation. SUBJECTS A total of 46 participants with subacromial impingement syndrome. INTERVENTION Participants were sequence allocated to an intervention group (high-intensity laser therapy + exercise therapy) and control group (sham-laser + exercise therapy) and received 15 sessions (five days a week during three weeks). MAIN MEASURES Patiens were evaluated at baseline, after 15 sessions, and at one month and at three months after completing the intervention. The main outcome variables were pain and functionality as measured by visual analogue scale; pressure pain threshold; Shoulder Pain and Disability Index; Constant-Murley Score; and QuickDASH. Secondary outcomes were number of sessions at discharge and drug use. RESULTS A total of 21 patients in high-intensity laser therapy group (56.7 ± 8.9 years) and 22 patients in sham-laser group (61.3 ± 8.9 years) concluded the study. Visual analogue scale (cm) at baseline, one-month, and three-months were 6.2 ± 0.5, 3 ± 2.6, and 2.6 ± 2.4 for the control group and 5.4 ± 1.5, 3.6 ± 1.3, and 1.8 ± 1.7 for experimental group, respectively. Shoulder Pain and Disability Index (points) at baseline, one-month, and three-monts were 51.8 ± 16.1, 16.3 ± 16.1, and 13.6 ± 17.1 in the control group and 41.8 ± 20.6, 20.5 ± 19.7, 11 ± 14.5 in experimental group, respectively. No differences were found between groups ( P > 0.05). CONCLUSION The effect of high-intensity laser therapy plus exercise is not higher than exercise alone to reduce pain and improve functionality in patients with subacromial syndrome.
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Affiliation(s)
- Javier Aceituno-Gómez
- 1 University General Hospital Nuestra Señora del Prado, Gerencia de Atención Integrada de Talavera de la Reina (SESCAM), Toledo, Spain
| | - Juan Avendaño-Coy
- 2 Toledo Physiotherapy Research Group (GIFTO), E.U. Enfermería y Fisioterapia de Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Julio Gómez-Soriano
- 2 Toledo Physiotherapy Research Group (GIFTO), E.U. Enfermería y Fisioterapia de Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Venancio Miguel García-Madero
- 1 University General Hospital Nuestra Señora del Prado, Gerencia de Atención Integrada de Talavera de la Reina (SESCAM), Toledo, Spain
| | | | - Diego Serrano-Muñoz
- 3 Sensorimotor Function Group, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - Jaime González-González
- 4 Gerencia de Atención Integrada de Talavera de la Reina (SESCAM), Toledo, Spain.,5 Medicine Department, Facultad de Terapia Ocupacional, Logopedia y Enfermería, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Juan José Criado-Álvarez
- 4 Gerencia de Atención Integrada de Talavera de la Reina (SESCAM), Toledo, Spain.,5 Medicine Department, Facultad de Terapia Ocupacional, Logopedia y Enfermería, Universidad de Castilla-La Mancha, Ciudad Real, Spain
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Ataoğlu S, Ankaralı H, Ankaralı S, Pasin Ö. Determination of the Appropriate Quality of Life Scale for Patients with Rheumatoid Arthritis and Osteoarthritis. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.497345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Evaluation of Donor Morbidity following Single-Stage Latissimus Dorsi Neuromuscular Transfer for Facial Reanimation. Plast Reconstr Surg 2018; 143:152e-164e. [PMID: 30325893 DOI: 10.1097/prs.0000000000005168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Single-stage latissimus dorsi neuromuscular transfer has been a valuable option for dynamic smile reanimation. However, there is a paucity of studies evaluating the potential donor morbidity in such cases. The present study aimed to comprehensively analyze the donor morbidity following functional latissimus dorsi muscle transfer. METHODS Patients who underwent single-stage functional latissimus dorsi muscle transfer for smile reanimation between 2002 and 2016 were reviewed. Postoperative complications and functional impairments at the donor sites were evaluated. The Quick-Disabilities of the Arm, Shoulder and Hand questionnaire was used for assessing postoperative donor-site function. RESULTS Sixty patients, including 12 pediatric (18 years or younger) patients, were analyzed. Mean length of a harvested thoracodorsal nerve was 14.9 cm. Fourteen patients were treated with a dual innervation technique, in which both a descending and a transverse branch of the thoracodorsal nerve were harvested. Donor complications were observed in seven cases; all of them were seromas and resolved by simple aspiration. No other complications including scoliosis and sensory and/or motor disturbances in the upper extremities were encountered. Fifty patients responded to the Quick-Disabilities of the Arm, Shoulder and Hand questionnaire at a median follow-up of 51 months. The average score was 2.64, and all but three patients scored less than 10. No variables, including patient age (pediatric versus adult) and the use of a dual-innervation technique, affected the donor morbidities, including the functional deficits. CONCLUSION Single-stage latissimus dorsi neuromuscular transfer for facial reanimation might be associated with a low rate of complications and minimal functional morbidity at the donor site. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Inderhaug E, Kalsvik M, Kollevold KH, Hegna J, Solheim E. Long-term results after surgical treatment of subacromial pain syndrome with or without rotator cuff tear. J Orthop 2018; 15:757-760. [PMID: 29946199 PMCID: PMC6014565 DOI: 10.1016/j.jor.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Some studies suggest a common degenerative path might contribute to a range of shoulder diseases involving subacromial pain syndrome and full-thickness rotator cuff tears. One could therefore theorize arthroscopic subacromial decompression and rotator cuff repair as interventions at different stages of a degenerative shoulder disease. Few studies have compared long-term outcomes after these two procedures. METHOD Matched case-controls undergoing arthroscopic rotator cuff repair combined with subacromial decompression (N = 180) or subacromial decompression only (N = 180) were evaluated pre- and 7.5 years postoperatively using QuickDASH score, VAS of function, VAS of pain and VAS of satisfaction. New surgery and complications were recorded. Baseline characteristics were related to outcomes to investigate predictors of good/poor outcome. RESULTS A general improvement from baseline was seen - from 51 to 14 (QuickDASH) in the combined group and from 53 to 16 in the decompression only group. No differences in outcomes were seen between groups (n.s.). Age above 55 at surgery predicted better VAS of function (P = .04) while acute onset of symptoms predicted better QuickDASH in the combined group (P = 0.03). None in the decompression group had undergone later rotator cuff repair. CONCLUSION Major improvements in pain/function were seen at mid- to long-term after isolated arthroscopic subacromial decompression and combined decompression/rotator cuff repair. Several patient-specific factors predicting worse outcomes were identified.
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Affiliation(s)
- Eivind Inderhaug
- Surgical Department, Haraldsplass Deaconess Hospital, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Maiken Kalsvik
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Kristin H. Kollevold
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | | | - Eirik Solheim
- Surgical Department, Haraldsplass Deaconess Hospital, Norway
- Aleris Nesttun, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Depreli Ö, Angın E. Review of scapular movement disorders among office workers having ergonomic risk. J Back Musculoskelet Rehabil 2018; 31:371-380. [PMID: 29154262 DOI: 10.3233/bmr-170790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Work-related musculoskeletal disorders are the most common health problems which affect millions of office workers. OBJECTIVE The objective of this study is to determine scapular positioning at rest and different anatomical planes, the assessment of pain, postural changes and the functionality of upper extremity that is caused by the lack of ergonomic principles among office workers of civil servants in TRNC (Turkish Republic of Northern Cyprus). METHODS 183 individuals participated in the study and 2 groups were created by grand scores of Rapid Upper Limb Assessment (RULA) tool. Scapular dyskinesis, pain of upper extremity and back, physical functions and symptoms of upper extremity, the self-rated neck disability, cervical and upper thoracic posture of workers were assessed. RESULTS The difference between pain situation and the results of upper extremity and neck disability scores of the participants among the groups was significant (p< 0.05). No significant difference has been found statistically among the postural angle values of individuals (p> 0.05). A significant statistical difference has been found among the groups when the results of Lateral Scapular Slide Test (LSST) is examined (p< 0.05). CONCLUSIONS Working environment and conditions cause the wrong of working posture and thus, lead individuals to spend more energy together with physical difficulty, and consequently affect general health.
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Fatty infiltration and muscle atrophy of the rotator cuff in stemless total shoulder arthroplasty: a prospective cohort study. J Shoulder Elbow Surg 2018; 27:976-982. [PMID: 29433980 DOI: 10.1016/j.jse.2017.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/04/2017] [Accepted: 12/12/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The influence of preoperative rotator cuff fatty infiltration (FI) and muscle atrophy (MA) on the postoperative outcome of total shoulder arthroplasty (TSA) has only rarely been investigated and reported in the literature. We hypothesized that more FI and MA would be associated with a worse postoperative functional outcome. METHODS This prospective cohort study included 63 patients (31 female and 32 male patients; mean age, 71 years [range, 53-89 years; standard deviation, 7 years]) with primary osteoarthritis of the shoulder operated on with anatomic stemless TSA. Preoperatively and at 3 months and 1 year after the operation, the functional outcome (QuickDASH [short version of Disabilities of the Arm, Shoulder and Hand questionnaire] score) and range of motion (ROM) (goniometer) and strength (dynamometer) for abduction at the scapular plane and for external rotation were measured. The degree of preoperative FI and MA was evaluated using computed tomography scans according to the Goutallier classification and Warner classification, respectively, for the supraspinatus and infraspinatus. RESULTS We found clinically and statistically significant improvements in functional outcome, strength, and ROM at both 3 months and 1 year of follow-up compared with those preoperatively. The Pearson correlation coefficient (r) showed significant correlations between preoperative supraspinatus and infraspinatus FI and MA and preoperative and 1-year postoperative shoulder abduction and external rotation strength but not ROM. However, we found no influence of the rotator cuff FI and MA on the functional outcome after TSA. CONCLUSION We demonstrated a significant correlation between rotator cuff FI and MA and strength but not ROM of the shoulder joint.
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Razmjou H, Boljanovic D, Elmaraghy A, Macritchie I, Roknic C, Medeiros D, Richards RR. Abnormal Pain Response After a Compensable Shoulder Injury. Orthop J Sports Med 2017; 5:2325967117739851. [PMID: 29201928 PMCID: PMC5700789 DOI: 10.1177/2325967117739851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The role of psychosocial factors has been established in patients with shoulder abnormalities. However, the prevalence of exaggerated pain behaviors and their association with the characteristics of injured workers have not been well studied. Purpose: To examine the prevalence of abnormal pain responses (APRs) in workers with active workers’ compensation claims for a shoulder injury and to examine the differences between workers with APRs versus workers without APRs. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An analysis of electronic data files of injured workers was completed. An APR was defined as an exaggerated pain response during a clinical examination, including facial grimacing, shaking, withdrawal, nonanatomic dermatome or myotome disturbances, increased tenderness, regional symptoms, and verbal utterances such as groaning, moaning, or gasping. To control for potential confounders, patients with positive APRs (APR group) were matched with injured workers without APRs (control group) seen in the same clinic and matched for sex, age, and surgical candidacy. Results: Data from 1000 workers who had sustained a shoulder injury at work and who were referred for an early assessment by an orthopaedic surgeon and a physical therapist were reviewed. A total of 86 (9%) injured workers (mean age, 47 ± 11 years; 55 [64%] female) demonstrated APRs and were matched with 86 injured workers without APRs. There were no statistically significant between-group differences in the wait time, mechanism of injury, coexisting comorbidity, type of abnormality, or medication consumption. The APR group reported higher levels of disability (P < .0001) and psychological problems (P < .0001), presented with more inconsistency in range of motion (P = .04), and had more limitations at work (P = .02). Conclusion: The presence of an APR after a compensable shoulder injury was associated with higher reports of disability and psychological problems. Patients with positive APRs were more likely to be off work and less likely to perform full duties.
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Affiliation(s)
- Helen Razmjou
- Working Condition Program, Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dragana Boljanovic
- Working Condition Program, Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amr Elmaraghy
- Division of Orthopaedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, St. Joseph's Health Centre, Toronto, Ontario, Canada
| | - Iona Macritchie
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Carolyn Roknic
- Working Condition Program, Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danielle Medeiros
- Central West Community Care Access Centre, Brampton, Ontario, Canada
| | - Robin R Richards
- Working Condition Program, Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Iordens GIT, Den Hartog D, Tuinebreijer WE, Eygendaal D, Schep NWL, Verhofstad MHJ, Van Lieshout EMM. Minimal important change and other measurement properties of the Oxford Elbow Score and the Quick Disabilities of the Arm, Shoulder, and Hand in patients with a simple elbow dislocation; validation study alongside the multicenter FuncSiE trial. PLoS One 2017; 12:e0182557. [PMID: 28886018 PMCID: PMC5590744 DOI: 10.1371/journal.pone.0182557] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 07/19/2017] [Indexed: 11/19/2022] Open
Abstract
Study design Validation study using data from a multicenter, randomized, clinical trial (RCT). Objectives To evaluate the reliability, validity, responsiveness, and minimal important change (MIC) of the Dutch version of the Oxford Elbow Score (OES) and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) in patients with a simple elbow dislocation. Background Patient-reported outcome measures are increasingly important for assessing outcome following elbow injuries, both in daily practice and in clinical research. However measurement properties of the OES and Quick-DASH in these patients are not fully known. Methods OES and Quick-DASH were completed four times until one year after trauma. Mayo Elbow Performance Index, pain (VAS), Short Form-36, and EuroQol-5D were completed for comparison. Data of a multicenter RCT (n = 100) were used. Internal consistency was determined using Cronbach’s alpha. Construct and longitudinal validity were assessed by determining hypothesized strength of correlation between scores or changes in scores, respectively, of (sub)scales. Finally, floor and ceiling effects, MIC, and smallest detectable change (SDC) were determined. Results OES and Quick-DASH demonstrated adequate internal consistency (Cronbach α, 0.882 and 0.886, respectively). Construct validity and longitudinal validity of both scales were supported by >75% correctly hypothesized correlations. MIC and SDC were 8.2 and 12.0 point for OES, respectively. For Quick-DASH, these values were 11.7 and 25.0, respectively. Conclusions OES and Quick-DASH are reliable, valid, and responsive instruments for evaluating elbow-related quality of life. The anchor-based MIC was 8.2 points for OES and 11.7 for Quick-DASH.
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Affiliation(s)
- Gijs I. T. Iordens
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wim E. Tuinebreijer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | - Niels W. L. Schep
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Michael H. J. Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M. M. Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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Delayed union of humeral shaft fractures: comparison of autograft with and without platelet-rich plasma treatment: a randomized, single blinded clinical trial. Arch Orthop Trauma Surg 2017; 137:1247-1252. [PMID: 28667397 DOI: 10.1007/s00402-017-2736-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Despite an adequate orthopedic treatment with functional bracing, some patients develop a delayed union in humeral shaft fractures. The objective of the present study was to determine the bone consolidation time among patients with delayed union of diaphyseal humeral fractures who were managed with locking compression plate (LCP) fixation combined with an iliac crest autograft using platelet-rich plasma (PRP) as a co-adjuvant. MATERIALS AND METHODS This study was a controlled, randomized, experimental, longitudinal, comparative, prospective, blind clinical trial. Patients diagnosed with delayed union of a diaphyseal humeral fracture with at least 4 months of evolution were treated with an open reduction and LCP osteosynthesis combined with an iliac crest autograft. The experimental group also received PRP. The patients were assessed radiographically until 36 weeks of evolution. RESULTS A total of 16 patients were included. Both groups had similar demographic characteristics. The patients treated with PRP had an earlier beginning of bone consolidation. Furthermore, these same patients exhibited bone consolidation at 19.9 weeks, on average, in contrast to 25.4 weeks in the control group. CONCLUSIONS The use of PRP promotes earlier bone consolidation in patients with delayed union of the humeral shaft.
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Inderhaug E, Kollevold KH, Kalsvik M, Hegna J, Solheim E. Preoperative NSAIDs, non-acute onset and long-standing symptoms predict inferior outcome at long-term follow-up after rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2017; 25:2067-2072. [PMID: 26520644 DOI: 10.1007/s00167-015-3845-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/22/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate mid- to long-term results after arthroscopic rotator cuff repair and to explore possible predictors of inferior outcome. METHODS Patients treated for full-thickness supraspinatus and/or infraspinatus tears from 2004 to 2008, using a uniform single-row arthroscopic technique, were included in the study. Pre- and post-operative QuickDASH were used as the primary outcome measure, and VAS of pain, function and satisfaction were also collected. An additional questionnaire explored demographic and preoperative factors like onset and duration of symptoms, preoperative treatment and smoking habits. RESULTS One hundred and forty-seven patients (82 %) were available at 6-9 years after surgery. All outcomes improved significantly from the preoperative values. A total of 8 % of patients had undergone additional surgery to the same shoulder during the follow-up period. Long-standing symptoms (>12 months) (P < 0.01), non-acute onset of symptoms (P < 0.01) and preoperative use of NSAIDs (P = 0.01) were correlated with inferior outcome at follow-up. No other factors investigated (i.e. gender, age, smoking and steroid injections) were found to affect the primary outcome (QuickDASH). CONCLUSION The current study is one of few reports of mid- to long-term outcomes after arthroscopic single-row repair of full-thickness rotator cuff tears. Global improvement in symptoms and function was found between the preoperative and the 6-9 years evaluation, and the technique therefore seems like a viable approach for treating tears of the supra- and the infraspinatus tendon. Several predictors of inferior long-term outcome after rotator cuff repair were, however, identified: preoperative use of NSAIDs, long-standing symptoms before surgery and non-acute onset of shoulder symptoms. In light of the current findings, accurate diagnosis and prompt treatment seem important in optimizing outcomes after rotator cuff surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Eivind Inderhaug
- Surgical Department, Haraldsplass Deaconess Hospital, PB 6165, 5152, Bergen, Norway. .,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
| | - Kristin H Kollevold
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Maiken Kalsvik
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | | | - Eirik Solheim
- Surgical Department, Haraldsplass Deaconess Hospital, PB 6165, 5152, Bergen, Norway.,Teres Bergen, Nesttun, Norway.,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Rysstad T, Røe Y, Haldorsen B, Svege I, Strand LI. 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. BMC Musculoskelet Disord 2017; 18:248. [PMID: 28595612 PMCID: PMC5465524 DOI: 10.1186/s12891-017-1616-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/02/2017] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Tarjei Rysstad
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4, St Olavs Plass, Oslo, Norway.
| | - Yngve Røe
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4, St Olavs Plass, Oslo, Norway
| | | | - Ida Svege
- Norwegian Research Center for Active Rehabilitation, Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Comprehensive Analysis of Donor-Site Morbidity following Free Thoracodorsal Artery Perforator Flap Harvest. Plast Reconstr Surg 2017; 138:899-909. [PMID: 27307340 DOI: 10.1097/prs.0000000000002396] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors evaluated donor-site morbidity following free thoracodorsal artery perforator flap harvest comprehensively and investigated patient-and operation-related factors that might contribute to adverse outcomes. METHODS A retrospective analysis was conducted for all cases of free thoracodorsal artery perforator flap reconstruction performed between January of 2002 and December of 2014. Donor-site morbidity was evaluated in three aspects: postoperative complications, scar-related problems, and functional impairment. The Quick-Disabilities of the Arm, Shoulder and Hand questionnaire was administered postoperatively to assess donor-site function. RESULTS A total of 293 patients were analyzed. The median follow-up period was 19.0 months. Donor-site complications developed in 33 patients (11.3 percent). Wound dehiscence (7.4 percent) and seroma (3.0 percent) were the most common complications. Harvesting thoracodorsal artery perforator flaps on multiple perforators or segmental latissimus dorsi muscle-chimeric flaps increased the rate of seroma formation but did not affect other donor-site morbidities significantly. Patient American Society of Anesthesiologists classification was a significant predictor of wound dehiscence and overall donor-site complications. Thirty-one patients (10.6 percent) had scar-related problems, including 18 hypertrophic and 13 widened scars. A transverse skin paddle design had a significant protective effect on developing scar-related problems, compared with the nontransverse design. The mean Quick-Disabilities of the Arm, Shoulder and Hand questionnaire score was 2.68 (range, 0 to 18.2), and 90 percent of patients scored less than 10. Flap dimensions were positively correlated with the questionnaire score. CONCLUSIONS The present study suggests that the free thoracodorsal artery perforator flap is associated with low donor-site morbidity and minimal dysfunction. Careful consideration of patient condition and thoughtful planning could further minimize donor-site morbidity. CLINICAL QUESTION/LEVEVL OF EVIDENCE Therapeutic, IV.
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