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Broholm D, Andersen TE, Skov O, Juul-Kristensen B, Søgaard K, Ris I. High level of post-traumatic stress symptoms in patients with chronic neck pain is associated with poor mental health but does not moderate the outcome of a multimodal physiotherapy programme. Physiother Theory Pract 2024; 40:1150-1163. [PMID: 36310517 DOI: 10.1080/09593985.2022.2138730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/25/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Chronic traumatic neck pain has a high prevalence of post-traumatic stress symptoms (PTSS). However, whether PTSS moderates treatment effects is unknown. This study investigated: 1) whether PTSS was associated with patient-reported outcomes and clinical test results at baseline; 2) whether PTSS moderated the effect of a multimodal physiotherapy intervention of exercise therapy and patient education; and 3) whether adherence to the intervention differed across PTSS groups. METHODS Secondary data analysis from a randomized controlled trial on chronic neck pain with 12-month follow-up was conducted. Patients were divided into three groups (NT = non-traumatic, LT = traumatic low PTSS, HT = traumatic high PTSS) based on self-reported onset of pain and the Impact of Event Scale. The baseline data were used to analyze the association of PTSS with patient demographics and scores of physical and mental health-related quality of life, depression, neck-related disability, kinesiophobia, and clinical tests. Baseline, 4-month and 12-month follow-up data were analyzed to investigate possible moderating effects on outcomes. Data on adherence were collected at four months. RESULTS 115 participants were included (NT n = 45; LT n = 46; HT n = 24). The HT group reported lower mental health scores and more depressive symptoms at baseline. PTSS did not significantly moderate the treatment effect on any outcomes. The HT group tended to have lower adherence to the multimodal physiotherapy intervention than the LT group. CONCLUSION For patients with traumatic neck pain, high levels of PTSS are associated with poorer psychological outcomes but do not affect the outcomes of multimodal physiotherapy intervention.
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Affiliation(s)
- Daniel Broholm
- Department of Anaesthesiology and Intensive Care, Multidisciplinary Pain Centre, Vejle and Middelfart Hospitals, University Hospital of Southern Denmark, Denmark, UK
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Ole Skov
- Department of Psychology, University of Southern Denmark, Campusvej 55, Odense
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- UCL University College, Odense, Denmark
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Dubé MO, Ingwersen KG, Roy JS, Desmeules F, Lewis J, Juul-Kristensen B, Vobbe J, Lund Jensen S, McCreesh K. Do therapeutic exercises impact supraspinatus tendon thickness? Secondary analyses of the combined dataset from two randomised controlled trials in patients with rotator cuff-related shoulder pain. J Shoulder Elbow Surg 2024:S1058-2746(24)00354-9. [PMID: 38762149 DOI: 10.1016/j.jse.2024.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The mechanistic response of rotator cuff tendons to exercises within the context of rotator cuff-related shoulder pain (RCRSP) remains a significant gap in current research. A greater understanding of this response can shed light on why individuals exhibit varying responses to exercise interventions. It can also provide information on the influence of certain types of exercise on tendons. The primary aim of this article is to explore if changes in supraspinatus tendon thickness (SSTT) ratio differ between exercise interventions (high load vs. low load). The secondary aims are to explore if changes in SSTT ratio differ between ultrasonographic tendinopathy subgroups (reactive vs. degenerative) and if there are associations between tendinopathy subgroups, changes in tendon thickness ratio, and clinical outcomes (disability). METHODS This study comprises secondary analyses of the combined dataset from two randomized controlled trials that compared high and low-load exercises in patients with RCRSP. In those trials, different exercise interventions were compared: 1) progressive high-load strengthening exercises, and 2) low-load strengthening with or without motor control exercises. In one trial, there was also a third group that was not allocated to exercises (education only). Ultrasound-assessed SSTT ratio, derived from comparing symptomatic and asymptomatic sides, served as the primary measure in categorizing participants into tendinopathy subgroups (reactive, normal and degenerative) at baseline. RESULTS Data from 159 participants were analyzed. Two-way repeated measures ANOVAs revealed significant Group (p<0.001) and Group X Time interaction (p<0.001) effects for the SSTT ratio in different tendinopathy subgroups, but no Time effect (p=0.63). Following the interventions, SSTT ratio increased in the "Degenerative" subgroup (0.14 [95% CI: 0.09 to 0.19]), decreased in the "Reactive" subgroup (-0.11 [95% CI: -0.16 to -0.06]), and remained unchanged in the "Normal" subgroup (-0.01 [95% CI: -0.04 to 0.02]). There was no Time (p=0.21), Group (p=0.61), or Group X Time interaction (p=0.66) effect for the SSTT ratio based on intervention allocation. Results of the linear regression did not highlight any significant association between the tendinopathy subgroup (p=0.25) or change in SSTT ratio (p=0.40) and change in disability score. CONCLUSION Findings from this study suggest that, over time, SSTT in individuals with RCRSP tends to normalize, compared to the contralateral side, regardless of the exercise intervention. Different subgroups of symptomatic tendons behave differently, emphasizing the need to potentially consider tendinopathy subtypes in RCRSP research. Future adequately powered studies should investigate how those different tendinopathy subgroups may predict long-term clinical outcomes.
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Affiliation(s)
- Marc-Olivier Dubé
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada G1M 2S8; School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada G1R 1P5; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.
| | - Kim Gordon Ingwersen
- Research Unit in Physio - and Occupational Therapy, Department of Physio- and Occupational Therapy, Lillebaelt Hospital - Vejle, Kabbeltoft 25, DK-7100 Vejle, Denmark
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada G1M 2S8; School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada G1R 1P5
| | - François Desmeules
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, Finchley Memorial Hospital, London N12 0JE, United Kingdom; School of Health Sciences, University of Nottingham, Nottingham, United Kingdom; School of Life and Health Sciences, University of Nicosia, Cyprus; Clinical Therapies, University of Limerick, Ireland
| | - Birgit Juul-Kristensen
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Jette Vobbe
- Orthopaedic Department, Shoulder Unit, Lillebaelt Hospital, Vejle Hospital, Denmark
| | - Steen Lund Jensen
- Orthopaedic Department, Shoulder Unit, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Denmark
| | - Karen McCreesh
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Ageing Research Centre, Health Research Institute, University of Limerick, Ireland
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Liaghat B, Juul-Kristensen B, Faber DA, Christensen EO, Søgaard K, Skou ST, Søndergaard J, Juhl CB. One-year effectiveness of high-load compared with low-load strengthening exercise on self-reported function in patients with hypermobile shoulders: a secondary analysis from a randomised controlled trial. Br J Sports Med 2024; 58:373-381. [PMID: 38253436 PMCID: PMC10982631 DOI: 10.1136/bjsports-2023-107563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To investigate the long-term effectiveness of high-load versus low-load strengthening exercise on self-reported function in patients with hypermobility spectrum disorder (HSD) and shoulder symptoms. METHODS A secondary analysis of a superiority, parallel-group, randomised trial (balanced block randomisation 1:1, electronic concealment) including adult patients (n=100) from primary care with HSD and shoulder pain and/or instability ≥3 months. Patients received 16 weeks of shoulder exercises (three sessions/week): HEAVY (n=50, full-range, high-load, supervised twice/week) or LIGHT (n=50, neutral/mid-range, low-load, supervised three times in total). The 1-year between-group difference in change in self-reported function was measured using the Western Ontario Shoulder Instability Index (WOSI, scale 0-2100, 0=best). Secondary outcomes were self-reported measures including changes in shoulder-related symptoms, function, emotions and lifestyle, quality of life, patient-perceived effect, treatment utility and adverse events. A blinded analyst conducted the analyses using linear mixed model repeated measurements analysis. RESULTS One-year data were available in 86 out of 100 participants (79% women, mean age 37.8 years) (LIGHT 84%, HEAVY 88%). The mean WOSI score between-group difference favoured HEAVY (-92.9, 95% CI -257.4 to 71.5, p=0.268) but was not statistically significant. The secondary outcomes were mostly inconclusive, but patients in HEAVY had larger improvement in the WOSI emotions subdomain (-36.3; 95% CI -65.4 to -7.3, p=0.014). Patient-perceived effect favoured HEAVY anchored in WOSI-emotions (55% vs 31%, p=0.027) and WOSI-lifestyle (50% vs 29%, p=0.042). CONCLUSION High-load shoulder strengthening exercise was not superior to low-load strengthening exercise in improving self-reported function at 1 year. High-load strengthening exercise may be more effective in improving patient emotions about shoulder pain and function, but more robust data are needed to support these findings. TRIAL REGISTRATION NUMBER NCT03869307.
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Affiliation(s)
- Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Evidence-Based Orthopaedics (CEBO), Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Daniel A Faber
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Emil O Christensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carsten B Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
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Cavaggion C, Juul-Kristensen B, Luque-Suarez A, Voogt L, Wollants G, Ó Conaire E, Struyf F. Exercise into pain in chronic rotator cuff related shoulder pain: a prospective single-group feasibility study. BMJ Open 2023; 13:e070698. [PMID: 37802620 PMCID: PMC10565173 DOI: 10.1136/bmjopen-2022-070698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES This study evaluated the feasibility of exercising into pain in rotator cuff related shoulder pain (RCRSP), data collection procedures, feedback from physiotherapists and patients, and clinically important changes in patient-reported outcome measures (PROMs). DESIGN Unblinded non-randomised single-group study. SETTING Physiotherapy clinic in Belgium. PARTICIPANTS Twelve patients with unilateral RCRSP for minimum 3 months, aged 18-65 years. INTERVENTIONS Twelve weeks of four individualised exercises, with nine physiotherapist-led sessions with pain ratings 4-7 out of 10 on a verbal Numeric Pain Rating Scale for 9 weeks and then pain ratings 0-2 for 3 weeks. Every physiotherapy session included 15 min of manual therapy. Non-supervised exercises were: 2×/week in weeks with physiotherapy session, 3×/week in weeks without physiotherapy session. OUTCOME MEASURES Primary: adherence, where patients were considered adherent with 78% (7/9 sessions) attendance for supervised sessions and 81% (22/27 sessions) completion for non-supervised exercises, and Shoulder Pain and Disability Index (SPADI); secondary: fear-avoidance behaviour, fear of pain, physical outcomes (strength, range of motion, scapular dyskinesis); others: ultrasound (US) imaging outcomes (acromionhumeral distance, supraspinatus tendon thickness, occupation ratio), global perceived effect (GPE). PROMs were collected via online survey, except for the GPE (via closed envelope). US measures were taken after physical measures. RESULTS Adherence and adverse effects were analysed in patients who had the possibility to attend minimum seven supervised sessions (n=8): 88% of them adhered to supervised sessions, 50% to non-supervised exercises; none of them withdrew from the study, three of them obtained individual clinically important improvements in SPADI score above 20 points. The measurement protocol of physical and ultrasonographic outcomes took around 60 min. CONCLUSIONS Adherence to supervised sessions was satisfactory, the adherence to non-supervised exercises must be improved. Data collection procedures were feasible to perform, but some changes are recommended. TRIAL REGISTRATION NUMBER NCT04154345.
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Affiliation(s)
- Claudia Cavaggion
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, Universidad de Malaga, Malaga, Spain
- Universidad de Malaga, Instituto de Investigacion Biomedica de Malaga, Malaga, Spain
| | - Lennard Voogt
- Department of Physical Therapy Studies and Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium
| | | | - Eoin Ó Conaire
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Evidence-Based Therapy Centre, Galway, Ireland
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
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Cavaggion C, Navarro-Ledesma S, Luque-Suarez A, Juul-Kristensen B, Voogt L, Struyf F. Subacromial space measured by ultrasound imaging in asymptomatic subjects and patients with subacromial shoulder pain: an inter-rater reliability study. Physiother Theory Pract 2023; 39:2196-2207. [PMID: 35505639 DOI: 10.1080/09593985.2022.2072251] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT) measured by ultrasound (US) can be combined in the occupation ratio (OR). Inter-rater reliability on these subacromial measures depends on the US experience of raters and on the subject status, differing between asymptomatic or patients with subacromial shoulder pain (SSP). OBJECTIVE To evaluate inter-rater reliability between two raters with different US experience (experienced examiner and novice examiner). METHODS In total, 20 asymptomatic subjects (controls) and 21 patients with SSP were examined on one shoulder. Inter-rater reliability was evaluated with intraclass correlation coefficient (ICC). RESULTS ICC for controls was good for AHD at rest and at 60° (0.76-0.77), moderate for STT and AHD at 60° with weights (0.53-0.72), while OR was poorly reliable (below 0.44). ICC for SSP was moderate for AHD at rest and at 60°, STT, OR at rest and at 60° (0.52-0.74) and poor for AHD at 60° with weights and OR at 60° with weights (0.33-0.36). Bland-Altman plots showed systematic bias. CONCLUSION Inter-rater reliability varied largely from poor to good between two examiners with different US experience. Clinicians might use the US as additional tool for detecting the subacromial structures, but a structured training including also symptomatic subjects is suggested. Researchers may further investigate the OR in matched case-control studies, and an overall agreement phase is recommended before starting the inter-rater reliability phase.
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Affiliation(s)
- Claudia Cavaggion
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Santiago Navarro-Ledesma
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, University of Malaga, Malaga, Spain
- Instituto de Investigacion Biomedica de Malaga (IBIMA), Malaga, Spain
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lennard Voogt
- Department of Physical Therapy Studies and Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Dolsø M, Juul-Kristensen B, Skou ST, Søgaard K, Søndergaard J, Juhl CB, Liaghat B. Psychological factors and symptom duration are associated with exercise-based treatment effect in people with hypermobile shoulders: A secondary analysis of a randomised controlled trial. Musculoskelet Sci Pract 2023; 66:102798. [PMID: 37331257 DOI: 10.1016/j.msksp.2023.102798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Shoulder symptoms are common in patients with hypermobility spectrum disorders (HSD), but few studies focus on identifying factors associated with treatment effects. AIM To identify baseline and clinical characteristics associated with a better outcome 16 weeks after starting an exercise-based treatment in patients with HSD and shoulder symptoms. DESIGN Exploratory secondary analysis of data from a randomised controlled trial. METHOD Self-reported treatment outcome was reported as change between baseline and follow-up after 16 weeks of high-load or low-load shoulder strengthening. Multiple linear and logistic regressions were used to investigate associations of patient expectations of treatment effect, self-efficacy, fear of movement, and symptom duration with change in shoulder function, shoulder pain, quality of life, and patient reported health change. All regression models were performed firstly with adjustments for covariates (age, sex, body mass index, hand dominance, treatment group, and baseline score of the outcome variable) and secondly with additional adjustments for exposure variables. RESULTS Expectations of complete recovery were associated with an increased odds of perceiving an important improvement in physical symptoms after a 16-week exercise-based treatment program. Higher self-efficacy at baseline seemed to be associated with improved shoulder function, shoulder pain and quality of life. A higher fear of movement seemed to be associated with increased shoulder pain and decreased quality of life. A longer symptom duration was associated with decreased quality of life. CONCLUSION Expectations of complete recovery, higher self-efficacy, lower fear of movement and shorter symptom duration seem to be important for better treatment outcomes.
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Affiliation(s)
- Morten Dolsø
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Centre for Evidence-Based Orthopaedics (CEBO), Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
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Henriksen P, Junge T, Bojsen-Møller J, Juul-Kristensen B, Thorlund JB. Supervised, Heavy Resistance Training Is Tolerated and Potentially Beneficial in Women with Knee Pain and Knee Joint Hypermobility: A Case Series. Transl Sports Med 2022; 2022:8367134. [PMID: 38655168 PMCID: PMC11022762 DOI: 10.1155/2022/8367134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 04/26/2024]
Abstract
Introduction Adults with generalised joint hypermobility including knee joint hypermobility (GJHk) report more knee joint symptoms when compared to adults without GJHk. There is no consensus on best practice for symptom management. For instance, controversy exists regarding the appropriateness and safety of heavy resistance training as an intervention for this specific group. This case series aims to describe a supervised, progressive heavy resistance training program in adults with GJHk and knee pain, the tolerability of the intervention, and the outcomes of knee pain, knee-related quality of life, muscle strength, proprioception, and patellar tendon stiffness through a 12-week period. Materials and Methods Adults with GJHk and knee pain were recruited to perform supervised, progressive heavy resistance training twice a week for 12 weeks. The main outcome was the tolerability of the intervention. Secondary outcomes were knee pain during a self-nominated activity (VASNA); Knee injury and Osteoarthritis Outcome Score (KOOS); Tampa Scale of Kinesiophobia (TSK); maximal quadriceps voluntary isometric contraction and rate of torque development; 5 repetition maximum strength in five different leg exercises; single leg hop for distance; knee proprioception and patellar tendon stiffness. Results In total, 16 women (24.2 years, SD 2.5) completed at least 21/24 training sessions. No major adverse events were observed. On average, VASNA decreased by 32.5 mm (95% CI 21.4-43.6), in addition to improvements in KOOS and TSK scores. These improvements were supported by an increase in all measures of lower extremity muscle strength, knee proprioception, and patellar tendon stiffness. Conclusion Supervised heavy resistance training seems to be well tolerated and potentially beneficial in young women with GJHk and knee pain.
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Affiliation(s)
- Peter Henriksen
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Tina Junge
- Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Jens Bojsen-Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Nikolajsen H, Larsen CM, Holsgaard-Larsen A, Juul-Kristensen B, Hestbaek L. Physical impairments among adults in Denmark: a register-based study. BMC Public Health 2022; 22:2416. [PMID: 36550538 PMCID: PMC9783972 DOI: 10.1186/s12889-022-14747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Knowledge of the prevalence and socio-demographic characteristics of physical impairments is limited. This study aimed to determine the prevalence of physical impairments among adults in Denmark, both in total and according to nine common diagnostic subgroups, describe the socio-demographic and socio-economic profile, and compare the data with those of the general adult population. METHODS This descriptive, cross-sectional, register-based study evaluated the general socio-demographic and socio-economic variables, including sex, age, geographical region, origin, educational level, occupation, marital status, and disability level, of adults with physical impairments extracted by diagnosis from the Danish National Patient Register and Statistics Denmark by 31 December 2018. These data were compared with those of the general adult population in Denmark extracted from Statistics Denmark by January 2019. RESULTS In total, 606,857 adults with physical impairments were identified. Of the nine selected diagnoses, osteoarthritis (69.4%) was the most prevalent, followed by acquired brain injury (29.0%), rheumatoid arthritis (6.7%), multiple sclerosis (2.6%), spinal cord injury (1.5%), cerebral palsy (1.2%), amputation (0.7%), muscular dystrophy (0.5%), and poliomyelitis (< 0.1%). There were large variations in the socio-demographic and socio-economic profile between the nine diagnostic subgroups. The adults with physical impairments were more often women, were older, were less often immigrants and employed adults, had a lower educational level, and were more commonly married than the general adult population. Only the geographical region did not differ. CONCLUSION The nine subgroups with diagnoses related to the musculoskeletal system represent 13% of the adult Danish population. The socio-demographic and socio-economic profile varied largely between the nine diagnostic subgroups, and almost all variables differed significantly between adults with physical impairments and the general adult population in Denmark. These findings reveal patterns and trends on socio-demographic and socio-economic variables essential for future planning at a societal level, including the healthcare and social sectors.
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Affiliation(s)
- Helene Nikolajsen
- grid.10825.3e0000 0001 0728 0170Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ,grid.470076.20000 0004 0607 7033Department of Physiotherapy, Institute of Health Studies, University College South Denmark, Esbjerg-Haderslev, Denmark
| | - Camilla Marie Larsen
- grid.10825.3e0000 0001 0728 0170Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ,grid.460785.80000 0004 0432 5638Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Anders Holsgaard-Larsen
- grid.10825.3e0000 0001 0728 0170Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
| | - Birgit Juul-Kristensen
- grid.10825.3e0000 0001 0728 0170Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lise Hestbaek
- grid.10825.3e0000 0001 0728 0170Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Kjærbæk F, Juul-Kristensen B, Skou ST, Søndergaard J, Boyle E, Søgaard K, Liaghat B. The association between number of shoulder diagnoses and positive clinical tests with self-reported function and pain: A cross-sectional study of patients with hypermobile joints and shoulder complaints. Musculoskelet Sci Pract 2022; 62:102624. [PMID: 35944447 DOI: 10.1016/j.msksp.2022.102624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with hypermobility spectrum disorder (HSD) and shoulder complaints may suffer from symptoms related to shoulder instability, laxity, and hypermobility. It is currently unknown whether having a more complex clinical status with several diagnoses (i.e., anterior instability (AI), multidirectional instability (MDI), and/or symptomatic localised shoulder hypermobility (LSH), relates to higher functional impairments and pain. OBJECTIVES To investigate the associations between either ≤1, 2, or 3 clinical shoulder diagnoses (AI, MDI, and LSH) or the number (0-10) of positive clinical shoulder tests with shoulder function using the western Ontario shoulder instability index (WOSI, 0-2100, 0 = best) and pain intensity using numerical pain rating scale (NPRS, 0-10, 10 = worse). DESIGN Exploratory cross-sectional study. METHOD From a randomised controlled trial, baseline data from 100 participants with HSD and shoulder complaints for at least three months were included. Associations were investigated using linear regression models, adjusted for age, sex, body mass index, and hand dominance. RESULTS Compared with having ≤1 diagnosis, neither participants with two (WOSI 76.9, 95% CI -136.3, 290.0; NPRS 0.3, 95% CI -0.9, 1.5) nor three (WOSI 35.5, 95% CI -178.5, 249.6; NPRS 0.1, 95% CI -1.1, 1.3) clinical shoulder diagnoses had significantly worse shoulder function or pain. Likewise, the number of positive clinical shoulder tests was not associated with function (WOSI -20.8 95%CI (-55.3, 13.7)) or pain (NPRS -0.1 95%CI (-0.2, 0.1)). CONCLUSIONS In participants with HSD and shoulder complaints, having more additional shoulder diagnoses or increased number of positive shoulder tests were not related to functional impairments or pain intensities.
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Affiliation(s)
- Frederik Kjærbæk
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
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Kristiansen L, Magnussen LH, Wilhelmsen KT, Maeland S, Nordahl SHG, Hovland A, Clendaniel R, Boyle E, Juul-Kristensen B. Self-Reported Measures Have a Stronger Association With Dizziness-Related Handicap Compared With Physical Tests in Persons With Persistent Dizziness. Front Neurol 2022; 13:850986. [PMID: 35911903 PMCID: PMC9334819 DOI: 10.3389/fneur.2022.850986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAssociations between dizziness-related handicap and a variety of self-reported measures have been reported. However, research regarding associations between dizziness-related handicap and aspects of functioning that includes both physical tests and self-reported measures is scarce.ObjectiveThe purpose of the study was to describe the variations in signs and symptoms in people with persistent dizziness using physical tests and self-reported outcomes across three severity levels of the Dizziness Handicap Inventory (DHI) and investigate their associations with the DHI.MethodParticipants with persistent dizziness (n = 107) were included in this cross-sectional study. The participants underwent (1) physical tests (gait tests, grip strength, body flexibility, and movement-induced dizziness) and completed questionnaires regarding (2) psychological measures (Mobility Inventory of Agoraphobia, Body Sensation Questionnaire, Agoraphobic Cognitions Questionnaire, and Hospital Depression and Anxiety Questionnaire), and (3) fatigue, dizziness severity, and quality of life (Chalders Fatigue Scale, Vertigo Symptom Scale-Short Form, and EQ visual analog scale), in addition to the DHI. Data were presented by descriptive statistics for three DHI severity levels (mild, moderate, and severe). A multiple linear backward regression analysis was conducted for each group of measures in relation to the DHI total score, with additional analyses adjusting for age and sex. Based on these results, significant associations were tested in a final regression model.ResultsWith increasing severity levels of DHI, the participants demonstrated worse performance on most of the physical tests (preferred and fast gait velocity, dizziness intensity after head movements), presented with worse scores on the self-reported measures (avoidance behavior, fear of bodily sensation, fear of fear itself, psychological distress, fatigue, dizziness severity, quality of life). After adjusting for age and sex, significant associations were found between total DHI and avoidance behavior, psychological distress, dizziness severity, and quality of life, but not with any of the physical tests, explaining almost 56% of the variance of the DHI total score.ConclusionThere was a trend toward worse scores on physical tests and self-reported measurements with increasing DHI severity level. The DHI seems to be a valuable tool in relation to several self-reported outcomes; however, several signs and symptoms may not be detected by the DHI, and thus, a combination of outcomes should be utilized when examining patients with persistent dizziness.
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Affiliation(s)
- Lene Kristiansen
- Department of Health and Function, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngol and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- *Correspondence: Lene Kristiansen
| | - Liv H. Magnussen
- Department of Health and Function, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Kjersti T. Wilhelmsen
- Department of Health and Function, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Silje Maeland
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Research Unit for General Practice in Bergen, The Norwegian Research Center, Bergen, Norway
| | - Stein Helge G. Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngol and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anders Hovland
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Solli District Psychiatric Centre, Bergen, Norway
| | - Richard Clendaniel
- Physical Therapy Division, Department of Orthopaedics and Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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11
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Liaghat B, Skou ST, Søndergaard J, Boyle E, Søgaard K, Juul-Kristensen B. Short-term effectiveness of high-load compared with low-load strengthening exercise on self-reported function in patients with hypermobile shoulders: a randomised controlled trial. Br J Sports Med 2022; 56:bjsports-2021-105223. [PMID: 35649707 PMCID: PMC9626913 DOI: 10.1136/bjsports-2021-105223] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate the short-term effectiveness of high-load versus low-load strengthening exercise on self-reported function in patients with hypermobility spectrum disorder (HSD) and shoulder symptoms. METHODS A superiority, parallel-group, randomised trial (balanced block randomisation, electronic concealment) including adult patients (n=100) from primary care with HSD and shoulder pain and/or shoulder instability ≥3 months. Patients received 16 weeks of shoulder exercises (three sessions/week): HEAVY (n=50, full-range, high-load, supervised twice/week) or LIGHT (n=50, neutral/mid-range, low-load, supervised three times). The primary outcome was the 16-week between-group difference in self-reported function measured with the Western Ontario Shoulder Instability Index (WOSI, scale 0-2100, 0=best, minimal important difference 252 points). Secondary outcomes were self-reported measures including quality of life and clinical tests including shoulder muscle strength and range of motion. An intention-to-treat analysis with multiple imputation was conducted by a blinded biostatistician using linear regression. RESULTS 93 of 100 patients (93%) completed the 16-week evaluation. The mean WOSI score between-group difference significantly favoured HEAVY (-174.5 points, 95% CI -341.4 to -7.7, adjusted for age, sex, baseline score, clustering around clinic). The secondary outcomes were inconclusive, but patients in HEAVY were less likely to have a positive shoulder rotation test >180°, and more likely to rate an important improvement in physical symptoms. There were no serious adverse events, but HEAVY was associated with more transient muscle soreness (56% vs 37%) and headaches (40% vs 20%). CONCLUSION High-load shoulder strengthening exercise was statistically superior to low-load strengthening exercise for self-reported function at 16 weeks and may be used in primary care to treat patients with HSD and shoulder pain and/or instability to improve shoulder function in the short term. Further studies are needed to confirm the clinical relevance, and patients should be supported to manage associated minor adverse events. TRIAL REGISTRATION NUMBER NCT03869307.
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Affiliation(s)
- Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Jens Søndergaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Torabi TP, Juul-Kristensen B, Dam M, Zebis MK, van den Tillaar R, Bencke J. Comparison of Shoulder Kinematics and Muscle Activation of Female Elite Handball Players With and Without Pain—An Explorative Cross-Sectional Study. Front Sports Act Living 2022; 4:868263. [PMID: 35685684 PMCID: PMC9172249 DOI: 10.3389/fspor.2022.868263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Non-traumatic shoulder injuries are common in team handball. However, many athletes continue to throw, despite pain in the shoulder. This study investigated upper body kinematics and muscle activation while throwing in female elite handball players with and without shoulder pain. Thirty female elite team handball players, 15 with pain (age 22.2 ± 2.9 yrs.) and 15 without pain (age 20.4 ± 2.6 yrs.) performed five standing throws in which joint kinematics and muscle activity were measured in the following muscles: pectoralis major, infraspinatus, serratus anterior, latissimus dorsi, and upper-, middle-, and lower trapezius. The main findings revealed that peak joint angles and angular velocities were not different between groups; however, group differences were observed in earlier timing of position and longer time spent in maximal shoulder extension and external shoulder rotation in the pain group compared with the no pain group. The pain group also revealed a significant lower muscle peak activity in the serratus anterior during the cocking phase compared to the no pain group. After the cocking phase and at ball release, the groups had similar activation. In conclusion, the present study showed group differences in appearance and time spent in maximal humerus extension and external rotation and a different serratus anterior muscle peak activity between elite handball players playing with and without shoulder pain, which are identified as possible mechanisms of adaptation to avoid pain.
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Affiliation(s)
- Tina Piil Torabi
- Department of Sports Science, Nord University, Levanger, Norway
- Human Movement Analysis Laboratory, Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
- *Correspondence: Tina Piil Torabi
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mogens Dam
- Bülowsvej Physiotheraphy and Training, Frederiksberg, Denmark
| | - Mette K. Zebis
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Jesper Bencke
- Human Movement Analysis Laboratory, Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
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13
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Juul-Kristensen B, Bech C, Liaghat B, Cools AM, Olsen HB, Søgaard K, Larsen CM. Assessment of shoulder rotation strength, muscle co-activation and shoulder pain in tetraplegic wheelchair athletes - A methodological study. J Spinal Cord Med 2022; 45:410-419. [PMID: 32808885 PMCID: PMC9135435 DOI: 10.1080/10790268.2020.1803659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: To develop a feasible protocol for testing maximum shoulder rotation strength in tetraplegic wheelchair athletes, and investigate concurrent validity of maximum isometric handheld dynamometer (HHD) towards maximum isokinetic dynamometer (ID) strength measurements; secondly, to study shoulder muscle activation during maximum shoulder rotation measurements, and the association between shoulder strength and shoulder pain.Design: Descriptive methodological.Setting: Danish Wheelchair Rugby (WCR) association for WCR tetraplegic athletes from local WCR-clubs.Participants: Twelve adult tetraplegics.Interventions: N/A.Outcome measures: Wheelchair User's Shoulder Pain Index (WUSPI) and Visual Analog Scale (VAS) measured shoulder pain, isometric HHD and ID (60°/s) measured maximum internal (IR) and external (ER) shoulder rotation strength. Surface Electromyography normalized to maximum EMG measured muscle activity (mm Infraspinatus and Latissimus Dorsi) during maximum shoulder rotation strength.Results: Concurrent validity of isometric HHD towards ID showed Concordance Correlation Coefficients of left and right arms 0.90 and 0.86 (IR), and 0.89 and 0.91 (ER), with no difference in muscle activity between isometric HHD and ID, but larger co-activation during ER. There was no association between shoulder strength and pain, except for significantly weak negative associations between ID and pain during ER for left and right arms (P = 0.03; P = 0.04).Conclusion: Standardized feasible protocol for tetraplegic wheelchair athletes for measuring maximum shoulder rotation strength was established. Isometric HHD is comparable with ID on normalized peak torques and muscle activity, but with larger co-activation. Strength was not clearly associated with shoulder pain.
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Affiliation(s)
- Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Claus Bech
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ann M. Cools
- Department of Rehabilitation Sciences and Physiotherapy, Gent University, Gent, Belgium
- Department of Occupational and Physical Therapy & Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik B. Olsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Occupational and Environmental Medicine, University Hospital, Odense, Denmark
| | - Camilla M. Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Centre, University College, Odense, Denmark
- Department of Physiotherapy, University College, Odense, Denmark
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14
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Vestergaard M, Jensen K, Juul-Kristensen B. Hybrid high-intensity interval training using functional electrical stimulation leg cycling and arm ski ergometer for people with spinal cord injuries: a feasibility study. Pilot Feasibility Stud 2022; 8:43. [PMID: 35193705 PMCID: PMC8862540 DOI: 10.1186/s40814-022-00997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/31/2022] [Indexed: 11/22/2022] Open
Abstract
Aim The aim was to assess safety and feasibility of Hybrid High-Intensity Interval Training (HIIT) using Functional Electrical Stimulation (FES) leg cycling and arm ski ergometer in people with Spinal Cord Injuries (SCI). Method Eight outpatients (mean age 42.8 years; 7 men) with stable SCI paraplegia (mean 14.5 years since injury) participated in hybrid HIIT (90% peak watts; 4 × 4–min intervals), three times a week (over 8 weeks). Primary outcomes were Adverse Events (AE), participant acceptability, shoulder pain, training intensity (% peak watts), and attendance. Secondary outcomes were effect on peak oxygen uptake (VO2peak) during FES hybrid poling, mean watts, self-reported leisure time physical activity, quality of life, and fatigue. Results No serious AE occurred; acceptability with the training modality was high, while shoulder pain increased by 9% (SD 95.2). During training, 50% of the participants reached > 90% peak watts during the intervals, three with the legs (FES cycle) and one with the arms (Ski-Erg). Overall, mean training intensity (% peak watts) was 92% (SD 18.9) for legs and 82% (SD 10.3) for arms. Proportion of fulfilled training minutes was 82% (range 36–100%); one participant dropped out after 6 weeks due to back pain. Mean VO2peak increased by 17% (SD 17.5). Participants reported increased leisure time physical activity and health-related quality of life, besides reduced fatigue. Conclusion Hybrid HIIT was safe for people with SCI paraplegia. The majority of the criteria for feasibility were met with acceptable attendance rate, limited drop out, participants enjoyed training, and increased VO2peak and mean watts. However, the intensity of 90% peak watts was reached by < 60% of the participants despite high RPE ratings during training. The method of measuring and calculating intensity needs to be studied further before a study using this HIIT protocol is undertaken. Trial registration Clinicaltrials.gov, NCT04211311, registered 12 December 2019 retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-00997-2.
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15
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Henriksen P, Brage K, Junge T, Juul-Kristensen B, Bojsen-Møller J, Thorlund JB. Concurrent validity and intrarater reliability of two ultrasound-based methods for assessing patellar tendon stiffness. Ultrasound 2022; 30:18-27. [PMID: 35173775 PMCID: PMC8841948 DOI: 10.1177/1742271x21994609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022]
Abstract
Introduction Assessment of tendon stiffness in vivo traditionally involves maximal muscle contractions, which can be challenging in pain populations. Alternative methods are suggested, although the clinimetric properties are sparse. This study investigated the concurrent validity and the intrarater reliability of two ultrasound-based methods for assessing patellar tendon stiffness. Methods Patellar tendon stiffness was assessed in 17 healthy adults with (a) the dynamometer and B-mode ultrasonography method (DBUS) and (b) the strain elastography method. Correlations between the two methods were analysed using Kendall’s Tau-b. The relative reliability of both methods was evaluated using intraclass correlation coefficient (ICC). The absolute reliability was presented by Bland–Altman plots, standard error of measurement (SEM) and minimum detectable change (MDC). Results No correlation was found between the two methods, irrespective of reference tissue in strain elastography (Kendall’s Tau-b Hoffa = –0.01 (p = 1.00), Kendall’s Tau-b subcutis = 0.04 (p = 0.87)). Tracking of the tendon elongation in the DBUS method had good to excellent relative reliability (ICC = 0.95 (95% confidence interval – CI: 0.85–0.98)) and high absolute reliability (SEM = 0.04 mm (1%), MDC = 0.11 mm (3%)). The strain elastography method had good to excellent relative reliability, regardless of reference tissue (ICC Hoffa = 0.95 (95% CI: 0.86–0.98), ICC subcutis = 0.94 (95% CI: 0.82–0.98)), but low absolute reliability (SEM Hoffa = 0.06 (20%), MDC Hoffa = 0.18 (60%), SEM subcutis = 0.12 (41%), MDC subcutis = 0.32 (110%)). Conclusions No concurrent validity existed for DBUS and strain elastography, suggesting that the two methods measure different tendon properties. The overall reliability for the DBUS method was high, but the absolute reliability was low for strain elastography stiffness ratios. Therefore, the strain elastography method may not be recommended for tracking differences in patellar tendon stiffness in healthy adults.
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Affiliation(s)
- P Henriksen
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - K Brage
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - T Junge
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - B Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - J Bojsen-Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Institute for Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - JB Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Anker-Petersen C, Juul-Kristensen B, Antflick J, Aagaard H, Myers C, Boesen AP, Boyle E, Hölmich P, Thorborg K. Six weeks of intensive rehearsals for the Swan Lake ballet shows ultrasound tissue characterization changes of the Achilles tendons in dancers. Scand J Med Sci Sports 2021; 31:2133-2143. [PMID: 34407248 DOI: 10.1111/sms.14034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
The objective was to investigate, first, whether six weeks of intensive ballet dance exposure is associated with structural and clinical changes in the Achilles tendon; second, the importance of demographics, self-reported Achilles pain, and generalized joint hypermobility (GJH). Data were collected at baseline and at six weeks' follow-up, using Achilles tendon ultrasound tissue characteristics (UTC) as primary outcome (percentage distribution of echo-type I-IV: type I = intact and aligned bundles, type II = discontinuous/wavy bundles, type III = fibrillar, and type IV = amorphous cells/fluid). Secondary outcomes included clinical signs of Achilles tendinopathy, Achilles tendon pain during single-leg heel raise, self-reported symptoms (VISA-A questionnaire), and GJH. Sixty-three ballet dancers (aged 18-41) participated. From baseline to follow-up, UTC echo-type I decreased significantly (β = -3.6, p = 0.001; 95% CI: -5.8;-1.4), whereas echo-type II increased significantly (β = 3.2, p < 0.0001, 95% CI: 1.6;4.8). Furthermore, a significant effect of limb (left limb showed decreased echo-type I and increased echo-type III + IV) and sex (women showed decreased echo-type I and increased in type II) was found. No significant changes in the remaining secondary outcomes were found. Ballet dancers showed structural changes in UTC, corresponding to a decreased echo-type I distribution after six weeks of rehearsing for Swan Lake ballet. No changes in self-reported symptoms, clinical signs of Achilles tendinopathy, and single-leg heel raise test were seen from pre- to post-rehearsal. Thus, UTC changes in the Achilles tendon seem to appear earlier than clinical signs of tendinopathy.
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Affiliation(s)
- Charlotte Anker-Petersen
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Henrik Aagaard
- Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Anders Ploug Boesen
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Kristian Thorborg
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
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Nikolajsen H, Richardson EV, Sandal LF, Juul-Kristensen B, Troelsen J. Fitness for all: how do non-disabled people respond to inclusive fitness centres? BMC Sports Sci Med Rehabil 2021; 13:81. [PMID: 34330328 PMCID: PMC8325230 DOI: 10.1186/s13102-021-00303-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 07/01/2021] [Indexed: 11/17/2022]
Abstract
Background Representation of people with disabilities in fitness centres is lacking, despite initiatives to promote inclusion mainly in the UK and USA. Success creating these inclusive spaces is mixed and few were crafted taking into account attitudes and biases of non-disabled co-members. Inclusive fitness centres have not gained much attention in Denmark, and the campaign ‘Fitness for All - fitness for people with physical disabilities’ was initiated. The aim of this study was shaped by two key questions; 1) what is the ideal fitness space from the perception of non-disabled fitness users? and 2) how might their dis/ableist attitudes negate inclusion in three future pilot inclusive fitness centres across Denmark? Method Three focus groups involving 5–7 (total n = 18) adult non-disabled participants were conducted. Aged ranged between 19 and 75 years, both men and women were involved, with fitness centre experiences ranging from 0 to 20+ years. Interviews were transcribed and analysed using Malterud’s four-step method of systematic text condensation. Results Of most importance was a pleasant atmosphere which should make them feel welcome and comfortable. Good social relations within the space were also highly valued. Participants welcomed people with physical disabilities but predicted many challenges with an inclusive fitness centre and expressed unconscious ableist attitudes. Conclusion The current study adds essential knowledge regarding how non-disabled people perceive the ideal inclusive fitness centre. A welcoming and inviting atmosphere is essential whereas social skills, ableism, ignorance, and preconceptions are important barriers that may hinder inclusion of participants with disabilities in inclusive fitness centres. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00303-2.
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Affiliation(s)
- Helene Nikolajsen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark. .,Department of Physiotherapy, Institute of Health Studies, University College South Denmark, Esbjerg-Haderslev, Denmark.
| | | | - Louise Fleng Sandal
- Research Unit for Physical Activity and Health in Work Life, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark
| | - Jens Troelsen
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Nikolajsen H, Sandal LF, Juhl CB, Troelsen J, Juul-Kristensen B. Barriers to, and Facilitators of, Exercising in Fitness Centres among Adults with and without Physical Disabilities: A Scoping Review. Int J Environ Res Public Health 2021; 18:ijerph18147341. [PMID: 34299792 PMCID: PMC8304633 DOI: 10.3390/ijerph18147341] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022]
Abstract
Fitness centres are an obvious arena for performing physical activity for the general population but representation of adults with physical disabilities (AwPD) is lacking. To increase possibilities for AwPD to exercise in fitness centres together with adults without physical disabilities (AwoPD), the aim of this study was to identify, synthesise, and compare barriers to, and facilitators of, exercising in fitness centres for each group. A scoping review was conducted and data extraction of the barriers and facilitators was performed independently by two researchers on six categories of contextual factors based on the framework of Di Blasi: (1) The fitness centre setting; (2) The fitness centre user characteristics; (3) The fitness instructor/staff characteristics; (4) The fitness centre user–instructor/management relationship; and (5) The fitness/exercise characteristics. An extra category, (6) Other relationships, was added. The PRISMA Extension for Scoping Reviews was used for reporting. Of the 102 included papers, only 26 (25%) of the papers were on AwPD, which focused mainly on physical barriers (category 1: inaccessible settings). In contrast, the remaining 76 papers involving AwoPD focused primarily on facilitators (category 2: motivational factors and exercising effects). In categories 3–6, the two groups had similar results, as both groups preferred skilled instructors, a welcoming and comfortable fitness centre environment, an ability to exercise at their preferred type and level, and good social connections. Since most data were based on AwoPD, more studies on actual experiences from AwPD are needed, to reveal the facilitators/motivational factors for fitness centre use.
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Affiliation(s)
- Helene Nikolajsen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark; (C.B.J.); (B.J.-K.)
- Department of Physiotherapy, Institute of Health Studies, University College South Denmark, 6705 Esbjerg Ø, Denmark
- Correspondence:
| | - Louise Fleng Sandal
- Research Unit for Physical Activity and Health in Work Life, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark;
| | - Carsten Bogh Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark; (C.B.J.); (B.J.-K.)
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, 2900 Hellerup, Denmark
| | - Jens Troelsen
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark;
| | - Birgit Juul-Kristensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark; (C.B.J.); (B.J.-K.)
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19
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Liaghat B, Pedersen JR, Young JJ, Thorlund JB, Juul-Kristensen B, Juhl CB. Joint hypermobility in athletes is associated with shoulder injuries: a systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:389. [PMID: 33902511 PMCID: PMC8077913 DOI: 10.1186/s12891-021-04249-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Joint hypermobility in athletes is associated with increased risk of knee injuries, but its role in relation to shoulder injuries has not been scrutinized. Therefore, our aim was to synthesize the evidence on the association between joint hypermobility and shoulder injuries in athletes. METHODS Data sources were MEDLINE, CINAHL, EMBASE, and SPORTDiscus from inception to 27th February 2021. Eligibility criteria were observational studies of athletes (including military personnel), mean age ≥ 16 years, and with a transparent grouping of those with and without joint hypermobility. A broad definition of joint hypermobility as the exposure was accepted (i.e., generalised joint hypermobility (GJH), shoulder joint hypermobility including joint instability). Shoulder injuries included acute and overuse injuries, and self-reported pain was accepted as a proxy for shoulder injuries. The Odds Ratios (OR) for having shoulder injuries in exposed compared with non-exposed athletes were estimated using a random effects meta-analysis. Subgroup analyses were performed to explore the effect of sex, activity type, sports level, study type, risk of bias, and exposure definition. Risk of bias and the overall quality of evidence were assessed using, respectively, the Newcastle-Ottawa Scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Among 6207 records, six studies were included with 2335 (range 118-718) participants (34.1% females; athlete mean age 19.9 years). Athletes with joint hypermobility were more likely to have shoulder injuries compared with athletes without joint hypermobility (OR = 3.25, 95% CI 1.64, 6.43, I2 = 75.3%; p = 0.001). Exposure definition (GJH, OR = 1.97, 95% CI 1.32, 2.94; shoulder joint hypermobility, OR = 8.23, 95% CI 3.63, 18.66; p = 0.002) and risk of bias (low, OR = 5.25, 95% CI 2.56, 10.8; high, OR = 1.6, 95% CI 0.78, 3.29; p = 0.024) had large impacts on estimates, while the remaining subgroup analyses showed no differences. The overall quality of evidence was low. CONCLUSION Joint hypermobility in athletes is associated with a threefold higher odds of having shoulder injuries, highlighting the need for prevention strategies in this population. However, due to low quality of evidence, future research will likely change the estimated strength of the association. PROTOCOL REGISTRATION Open Science Framework registration osf.io/3wrn9.
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Affiliation(s)
- Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Odense, Denmark.
| | - Julie Rønne Pedersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Odense, Denmark
| | - James J Young
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Odense, Denmark
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Odense, Denmark
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
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20
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Nikolajsen H, Juul-Kristensen B, Hendriksen PF, Jensen BR. No difference in knee muscle activation and kinematics during treadmill walking between adolescent girls with and without asymptomatic Generalised Joint Hypermobility. BMC Musculoskelet Disord 2021; 22:170. [PMID: 33573624 PMCID: PMC7879627 DOI: 10.1186/s12891-021-04018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background Altered knee muscle activity in children with asymptomatic Generalized Joint Hypermobility (GJH) is reported during isometric contraction, static and dynamic balance tasks and jumping, but has not been studied during gait. Therefore, the aim was to investigate group differences in knee muscle activity simultaneously with knee joint kinematics during treadmill walking between children with and without GJH. Methods Girls 14–15 years of age with GJH (inclusion criteria: Beighton score ≥6 of 9 and positive hyperextension ≥10° (one/both knees)) and a matched control group without GJH (inclusion criteria: Beighton score ≤5 and no knee hyperextension ≥10° ) were recruited. In total 16 participants with GJH and 10 non-GJH participants were included in the study. Surface electromyography (sEMG) was measured from the quadriceps, hamstrings and gastrocnemius muscles of the dominant leg during treadmill walking. Maximal voluntary isometric contractions while sitting were used for normalisation of sEMG to % of Maximum Voluntary EMG (%MVE). Knee joint angles during treadmill walking were measured by electrogoniometer. Furthermore, co-contraction index (CCI) was calculated, and presented for muscle groups of hamstrings-quadriceps (HQ) and gastrocnemius-quadriceps (GQ). CCI of medial and lateral sides of the knee, including ratio of the medial and lateral CCI for HQ and GQ were calculated. Results No group differences were found in demographics, muscle activation level, nor CCI and CCI ratios. However, participants with GJH displayed significantly decreased knee joint angle, mean (153º vs. 156º; p =0.03) and minimum (105º vs. 111º; p=0.01), during treadmill walking compared with controls. Conclusion Muscle activity during gait was not different between participants with GJH and non-GJH participants. However, participants with GJH displayed minor but statistically significant increased knee flexion during gait. Since the clinical consequences of increased knee joint flexion during gait are unknown, future studies should follow a larger cohort longitudinally during overground walking for development of clinical complications in this group.
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Affiliation(s)
- Helene Nikolajsen
- Research Unit of Applied Health Science, University College South Denmark, Lembckesvej 7, DK-6100, Haderslev, Denmark.,Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
| | - Birgit Juul-Kristensen
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark.
| | | | - Bente Rona Jensen
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Sdr. Boulevard 29, 5000, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense, Denmark
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21
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Kjær BH, Magnusson SP, Henriksen M, Warming S, Boyle E, Krogsgaard MR, Al-Hamdani A, Juul-Kristensen B. Effects of 12 Weeks of Progressive Early Active Exercise Therapy After Surgical Rotator Cuff Repair: 12 Weeks and 1-Year Results From the CUT-N-MOVE Randomized Controlled Trial. Am J Sports Med 2021; 49:321-331. [PMID: 33471547 DOI: 10.1177/0363546520983823] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic full-thickness rotator cuff tears are typically managed surgically, followed by rehabilitation, but the load progression to reach an optimal clinical outcome during postoperative rehabilitation is unknown. PURPOSE To evaluate whether there was a superior effect of 12 weeks of progressive active exercise therapy on shoulder function, pain, and quality of life compared with usual care. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients with surgically repaired traumatic full-thickness rotator cuff tears were recruited from 2 orthopaedic departments and randomized to progressive active exercise therapy (PR) or limited passive exercise therapy (UC [usual care]). The primary outcome was the change in the Western Ontario Rotator Cuff Index (WORC) score between groups from before surgery to 12 weeks after surgery. Secondary outcomes included changes in the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, pain, range of motion, and strength. Adverse events were registered during the intervention period. RESULTS A total of 82 patients were randomized to the PR (n = 41) or UC (n = 41) group. All 82 patients (100%) participated in the 12-week assessment and 79 in the 1-year follow-up. At 12 weeks, there was no significant difference between the groups in the change in the WORC score from baseline adjusted for age, sex, and center (physical symptoms: P = .834; sports and recreation: P = .723; work: P = .541; lifestyle: P = .508; emotions: P = .568). Additionally, there was no between-group difference for the secondary outcomes including the WORC score at 1 year and the DASH score, pain, range of motion, and strength at 12 weeks and 1 year. Both groups showed significant improvements over time in all outcomes. In total, there were 13 retears (16%) at 1-year follow-up: 6 in the PR group and 7 in the UC group. CONCLUSION PR did not result in superior patient-reported and objective outcomes compared with UC at either short- or long-term follow-up (12 weeks and 1 year). REGISTRATION NCT02969135 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marius Henriksen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark.,The Parker Institute, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark
| | - Susan Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Michael Rindom Krogsgaard
- Section for Sports Traumatology, Department of Orthopaedic Surgery, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark
| | - Ali Al-Hamdani
- Shoulder-Elbow Unit, Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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22
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Brage K, Juul-Kristensen B, Hjarbaek J, Boyle E, Kjaer P, Ingwersen KG. Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study. Orthop J Sports Med 2021; 8:2325967120965185. [PMID: 33403207 PMCID: PMC7747122 DOI: 10.1177/2325967120965185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background Shoulder pain is common, with a lifetime prevalence of up to 67%. Evidence is conflicting in relation to imaging findings and pain in the shoulder. Sonoelastography can be used to estimate tissue stiffness and may be a clinically relevant technique for diagnosing and monitoring tendon healing. Purpose To evaluate changes in supraspinatus tendon stiffness using strain elastography (SEL) and associations with changes in patient-reported outcomes, supraspinatus tendon thickness, and grade of tendinopathy after 12 weeks of unilateral shoulder exercises in patients with supraspinatus tendinopathy. Study Design Controlled laboratory study. Methods A total of 23 patients with unilateral clinical supraspinatus tendinopathy performed 12 weeks of "standard care" exercises. At baseline and follow-up, supraspinatus tendon stiffness was measured bilaterally using SEL and compared with tendinopathy grading on magnetic resonance imaging scans and tendon thickness measured using conventional ultrasound. Patient-reported outcome measures included physical function and symptoms from the Disabilities of the Arm, Shoulder and Hand questionnaire and pain rating (visual analog scale). Results No significant changes in SEL within or between groups (asymptomatic vs symptomatic tendon) were seen. All patient-reported outcomes showed significant improvement from baseline to follow-up, but with no change in tendinopathy grading and tendon thickness. No significant differences in the proportion of patients changing above the minimal detectable change in SEL and PROM were seen, except for discomfort while sleeping. Conclusion Despite no significant within-group or between-group changes in SEL, significant improvements were found in patient-reported outcomes. An acceptable agreement between patients changing above the minimal detectable change in SEL and patient-reported outcome measure was seen. Further studies should explore the use of SEL to detect changes after tendon repair and long-term training potentially in subgroups of different tendinopathy phases. Clinical Relevance In the short term, structural changes in supraspinatus tendons could not be visualized using SEL, indicating that a longer time span should be expected in order to observe structural changes, which should be considered before return to sports. Subgrouping based on stage of tendinopathy may also be important in order to evaluate changes over time with SEL among patients with supraspinatus tendinopathy. Registration NCT03425357 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Karen Brage
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - John Hjarbaek
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Kim Gordon Ingwersen
- Research Unit in Physio- and Occupational Therapy, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Science, University of Southern Denmark, Odense, Denmark
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23
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Larsen CM, Juul-Kristensen B, Kasch H, Hartvigsen J, Frich LH, Boyle E, Østengaard L, Biering-Sørensen F. The Danish Spinal Cord Injury Shoulder (DanSCIS) cohort: methodology and primary results. Spinal Cord 2020; 59:821-831. [PMID: 33323964 DOI: 10.1038/s41393-020-00594-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 01/27/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To describe the socio-demographics, injury characteristics, prevalence of shoulder and neck symptoms, weekly participation in leisure time physical activity (LTPA) and quality of life (QoL) of individuals with spinal cord injury in Denmark (SCI). SETTING Nation-wide community survey, Denmark. METHODS Individuals with SCI for >2 years were included from three SCI rehabilitation departments. Questionnaire data regarding socio-demographic details, SCI injury characteristics, medical history, shoulder and neck symptoms, LTPA and QoL were collected. RESULTS Of 2454 potential participants, 1517 (62%) responded to the survey (mean age = 56.2, SD 16.1, 37% female, 42% tetraplegia, 23% complete SCI, mean time since injury = 16.9, SD 13.5). 75% used some form of assistive mobility device. Responders and non-responders showed no sex or injury type/severity differences. Shoulder and neck symptoms within the past 3 months were reported by 63 and 67% respectively, with 51% reporting shoulder symptoms within the past week. Among those with symptoms, 61% had experienced shoulder symptoms and 56% neck symptoms, for more than 30 days during the previous 3 months. Symptoms often prevented participants from performing their usual activities (due to shoulder symptoms 46%, neck symptoms 41%). CONCLUSIONS A high prevalence of self-reported shoulder and neck symptoms was found, which may limit physical function and social activities. We succeeded in generating the Danish Spinal Cord Injury Shoulder (DanSCIS) dataset, which comprised a substantial proportion of Danish adults with SCI. Future studies using data from this cohort will investigate patterns and associations between shoulder/neck symptoms, use of assistive mobility devices, LTPA and QoL.
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Affiliation(s)
- Camilla M Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. .,Health Sciences Research Centre, UCL University College, Odense, Denmark. .,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Helge Kasch
- Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Hospital, Viborg, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Lars H Frich
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lasse Østengaard
- University Library of Southern Denmark, University of Southern Denmark, Odense, Denmark.,Centre for Evidence-Based Medicine Odense, University of Southern Denmark, Odense, Denmark
| | - Fin Biering-Sørensen
- Department for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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24
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Liaghat B, Skou ST, Søndergaard J, Boyle E, Søgaard K, Juul-Kristensen B. A randomised controlled trial of heavy shoulder strengthening exercise in patients with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome and long-lasting shoulder complaints: study protocol for the Shoulder-MOBILEX study. Trials 2020; 21:992. [PMID: 33261635 PMCID: PMC7705859 DOI: 10.1186/s13063-020-04892-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Four out of five patients with hypermobility spectrum disorder (HSD) or hypermobile Ehlers-Danlos syndrome (hEDS) experience shoulder complaints including persistent pain and instability. Evidence suggests that patients with HSD/hEDS who experience knee and back complaints improve with exercise-based therapy. However, no study has focused on exercise-based treatment for the shoulder in this patient group. The potential benefits of strengthening the shoulder muscles, such as increased muscle-tendon stiffness, may be effective for patients with HSD/hEDS who often display decreased strength and increased shoulder laxity/instability. The primary aim is to investigate the short-term effectiveness of a 16-week progressive heavy shoulder strengthening programme and general advice (HEAVY) compared with low-load training and general advice (LIGHT), on self-reported shoulder symptoms, function, and quality of life. Methods A superiority, parallel group, randomised controlled trial will be conducted with 100 patients from primary care with HSD/hEDS and shoulder complaints (persistent pain and/or instability) for more than 3 months. Participants will be randomised to receive HEAVY (full range of motion, high load) or LIGHT (neutral to midrange of motion, low load) strengthening programme three times weekly with exercises targeting scapular and rotator cuff muscles. HEAVY will be supervised twice weekly, and LIGHT three times during the 16 weeks. The primary outcome will be between-group difference in change from baseline to 16-week follow-up in the Western Ontario Shoulder Instability Index (WOSI, 0-2100 better to worse). Secondary outcomes will include a range of self-reported outcomes covering symptoms, function, and quality of life, besides clinical tests for shoulder strength, laxity/instability, and proprioception. Outcome assessors will be blinded to group allocation. Participants will be kept blind to treatment allocation through minimal information about the intervention content and hypotheses. Primary analyses will be performed by a blinded epidemiologist. Discussion If effective, the current heavy shoulder strengthening programme will challenge the general understanding of prescribing low-load exercise interventions for patients with HSD/hEDS and provide a new treatment strategy. The study will address an important and severe condition using transparent, detailed, and high-quality methods to potentially support a future implementation. Trial registration ClinicalTrials.gov NCT03869307. Registered on 11 March 2019. Supplementary information The online version contains supplementary material available at 10.1186/s13063-020-04892-0.
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Affiliation(s)
- Behnam Liaghat
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Karen Søgaard
- Research Unit of Physical Activity and Health in Work Life, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
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25
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Hagesæter AN, Løvold T, Juul-Kristensen B, Blomquist J, Hole R, Eshoj H, Magnussen LH. Feasibility of the SINEX program for patients with traumatic anterior shoulder instability. Pilot Feasibility Stud 2020; 6:148. [PMID: 33042568 PMCID: PMC7541274 DOI: 10.1186/s40814-020-00679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 09/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background An optimal treatment for traumatic anterior shoulder instability (TASI) remains to be identified. A shoulder instability neuromuscular exercise (SINEX) program has been designed for patients with TASI, but has not yet been tested in patients eligible for surgery. The purpose of this study was to investigate and evaluate the feasibility and safety of the SINEX program for patients diagnosed with TASI and eligible for surgery. Methods A feasibility study with an experimental, longitudinal design using both quantitative and qualitative research methods. A total of seven participants underwent the SINEX program, a 12-week exercise program including physiotherapist-supervised sessions. Feasibility data on recruitment, retention, compliance, acceptability and safety was collected through observation and individual semi-structured interviews. Clinical tests and self-report questionnaires were completed at baseline and 12 weeks follow-up. Clinical assessments included apprehension and relocation tests, shoulder joint position sense (SJPS), shoulder sensorimotor control measured by center of pressure path length (COPL) on a force platform, isometric strength measured by Constant Score-Isometric Maximal Voluntary Contraction (CS-iMVC), self-report questionnaires including Western Ontario Shoulder Instability Index (WOSI), Tampa Scale of Kinesiophobia (TSK) and Global Perceived Effect questionnaire (GPE). Results With one participant recruited every 2 weeks, the recruitment rate was 50% lower than expected. Two of seven participants achieved compliance, defined as at least 66% completion of the scheduled home exercises and at least 50% attendance for the physiotherapist supervised sessions. Barriers for successful compliance were (1) inability to take along exercise equipment when travelling, (2) sick leave, (3) holidays and (4) lack of time/busy days. Four adverse events occurred, one of which was related to the intervention (patellar redislocation). All participants expressed satisfaction with the intervention and felt safe during the exercises. All participants improved in the GPE. Change greater than minimal detectable change (MDC) was reported in four participants in some of the outcome assessments. One of the seven participants declined surgery. Conclusion Further assessment is required on several areas before performing an RCT evaluating the efficacy of the SINEX program for patients with TASI considered eligible for surgery. No adverse events suggest that the program is safe, but patients with general hypermobility may need additional adjustments to prevent adverse events in other areas of the body. Trial registration ClinicalTrials.gov: NCT04152304, retrospectively registered
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Affiliation(s)
- Amalie Nilssen Hagesæter
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tonje Løvold
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jesper Blomquist
- Department of Orthopedic Surgery, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Randi Hole
- Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Henrik Eshoj
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Liv Heide Magnussen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Liaghat B, Skou ST, Jørgensen U, Sondergaard J, Søgaard K, Juul-Kristensen B. Heavy shoulder strengthening exercise in people with hypermobility spectrum disorder (HSD) and long-lasting shoulder symptoms: a feasibility study. Pilot Feasibility Stud 2020; 6:97. [PMID: 32670599 PMCID: PMC7350677 DOI: 10.1186/s40814-020-00632-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/12/2020] [Indexed: 12/18/2022] Open
Abstract
Background People with hypermobility spectrum disorder (HSD) are in great risk of experiencing shoulder symptoms, but evidence for treatment is sparse. Therefore, the objective was to evaluate the feasibility of 16-week shoulder strengthening programme for improving shoulder strength and function in people with HSD and shoulder symptoms for more than 3 months to inform a future randomised controlled trial (RCT). Methods Twelve participants (11 females, 39.3 ± 13.9 years) with HSD and shoulder instability and/or pain for more than 3 months underwent a 16-week heavy shoulder strengthening exercise programme three times weekly using exercises targeting scapular and rotator cuff muscles. Primary outcomes were pre-defined research progression criteria including recruitment rate (acceptable, 6 participants/month), assessment duration (acceptable: < 120 min), participant retention (acceptable: > 80% complete intervention), training adherence (acceptable: > 75% adhere to > 36 training sessions) and adverse events (acceptable: minor events with no participants discontinuing the study), besides participant and physiotherapist feedback. Secondary treatment outcomes were assessed using the Western Ontario Shoulder Instability Index (WOSI, 0–2100 better to worse), self-reported pain, kinesiophobia and fatigue, isometric shoulder strength, besides clinical tests for instability, hypermobility, laxity, and proprioception. Results Recruitment rate was 5.6/month, assessment duration (mean ± SD) 105 ± 9 min, retention 100%, adherence 83%, and four participants experienced short-lasting soreness or pain. Participant feedback was positive, and physiotherapists found the intervention relevant and applicable to the population. The WOSI total score showed an improvement by 51% (mean ± SD, points: baseline 1037 ± 215; Follow up 509 ± 365; mean change (95% CI), − 528 (− 738, − 318)), and participants reported reduced pain, kinesiophobia and fatigue. Shoulder strength measurements improved by 28–31% (mean change (95% CI), Nm/kg: scaption 0.51 (0.23, 0.78); internal rotation 1.32 (0.70, 1.95) and external rotation 0.89 (0.37, 1.40)), and clinical tests indicated decreased shoulder laxity/instability. Conclusions The shoulder strengthening exercise programme was feasible and safe for people with HSD and long-lasting shoulder symptoms. A future RCT, with an improved recruitment strategy, will demonstrate whether the exercise programme is also effective in improving symptoms and muscle-tendon function in this population. Trial registration ClinicalTrials.gov: NCT03547570. Registered on May 3, 2018.
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Affiliation(s)
- Behnam Liaghat
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Uffe Jørgensen
- Orthopedic Research Unit, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jens Sondergaard
- Research Unit of General Practice, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Research Unit of Physical Activity and Health in Work Life, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Brage K, Hjarbaek J, Boyle E, Ingwersen KG, Kjaer P, Juul-Kristensen B. Discriminative and convergent validity of strain elastography for detecting tendinopathy within the supraspinatus tendon: a cross-sectional study. JSES Int 2020; 4:310-317. [PMID: 32490419 PMCID: PMC7256788 DOI: 10.1016/j.jseint.2019.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background We aimed to explore the discriminative validity of ultrasound strain elastography (SEL) between patients with painful supraspinatus tendinopathy and healthy control shoulders, as well as the associations between SEL and magnetic resonance imaging (MRI), conventional ultrasound (tendon thickness), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Methods Thirty patients with shoulder pain and MRI-verified supraspinatus tendinopathy and 30 healthy control shoulders (no pain) were examined using SEL, MRI, and conventional ultrasound of the supraspinatus tendon. SEL variables included raw data, ratios between the deltoid muscle and supraspinatus tendon (deltoid ratio), color rating, and presence of red/yellow lesions (middle, worst part, and total tendon). Results Statistically significant increases in odds ratios for being symptomatic (increased softening) were seen for all raw data variables, corresponding to 3.978 (95% confidence interval [CI], 1.414-11.197) for middle, 4.602 (95% CI, 1.536-13.788) for worst, and 4.865 (95% CI, 1.406-16.836) for total tendon, and 1.260 (95% CI, 1.027-1.545) for the deltoid ratio (worst), adjusted for sex and body mass index (BMI). Tendon thickness was not associated with SEL; however, significantly positive associations were found between raw data variables and MRI (β ≥ 0.58, P < .01), and positive associations were found between raw data variables and the DASH score (β = 0.01, P ≤ .04), adjusted for sex and BMI. Conclusions Raw data variables and the deltoid ratio (worst) discriminated between patients with painful supraspinatus tendinopathy and healthy control shoulders when adjusted for sex and BMI. Associations were statistically significant for raw data variables and MRI or DASH score when adjusted for sex and BMI. Further studies are needed to understand SEL and the role of sex and BMI, including the responsiveness of SEL.
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Affiliation(s)
- Karen Brage
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - John Hjarbaek
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kim Gordon Ingwersen
- Research Unit in Physiotherapy and Occupational Therapy, Hospital Lillebaelt, Vejle, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Liaghat B, Eshoj H, Juul-Kristensen B, Arendt-Nielsen L, Skou ST. Pressure pain sensitivity in patients with traumatic first-time and recurrent anterior shoulder dislocation: a cross-sectional analysis. Scand J Pain 2020; 20:387-395. [PMID: 31586969 DOI: 10.1515/sjpain-2019-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022]
Abstract
Background and aims Traumatic anterior shoulder dislocation (ASD) is frequent in active populations and associated with a 39% higher risk of recurrent dislocation, which may cause persistent shoulder problems, pain, and impaired shoulder-related quality of life. While local and distant pressure pain sensitivity has been demonstrated in other shoulder conditions, little is known about the link between pressure pain sensitivity and ASD. The interesting aspect is whether recurrent dislocation - resulting in symptoms of longer duration - is associated with more pronounced pressure pain sensitivity, or if presence of pressure pain sensitivity may be part of the reasons why patients develop recurrent dislocation. Therefore, this study aimed at evaluating whether patients with recurrent ASD display greater pressure pain sensitivity and more painful body sites than patients with first-time ASD. Methods This was a cross-sectional analysis of baseline data from a randomized controlled trial including 34 patients with first-time ASD [82% male, mean (SD) age 26 (7) years] and 22 patients with recurrent ASD [96% male, mean (SD) age 25 (5) years]. Patients were assessed as follows: (1) assessment of local and distant pressure pain sensitivity evaluated by pressure pain thresholds (PPTs) using a handheld algometer on mm. trapezius superior, levator scapula, pectorales major, deltoideus, and tibialis anterior, (2) pain intensity at rest during the previous 24 h, (3) number of ASD, and (4) number of painful body sites on a region-divided body chart. Results The PPTs were not significantly different between first-time and recurrent ASD [mean (SD) kPa for m. trapezius superior 264 (110) vs. 261 (88), m. levator scapula 301 (157) vs. 325 (163), m. pectorales major 234 (163) vs. 269 (130), m. deltoideus 290 (166) vs. 352 (173), m. tibialis anterior 420 (202) vs. 449 (184)], two-way ANCOVA, adjusted for sex and age, F (4,263) = 0.29, p = 0.88. For both groups, the PPTs were lower at the shoulder sites than at m. tibialis anterior (difference 117-184 kPa, 95% CI range 33-267). Females had lower PPTs than males (difference 124 kPa, 95% CI 64-183). The number (SD) of painful body sites were 2.2 (1.9) for first-time ASD and 2.6 (5.4) for recurrent ASD, with no between-group differences, one-way ANCOVA, adjusted for sex and age, F (1, 52) = 0.24, p = 0.63. There was a strong correlation between PPTs at the shoulder and lower leg, r = 0.84, p < 0.01. Conclusions This study demonstrated no differences in local and distant pressure pain sensitivity or number of painful body sites between patients with first-time and recurrent ASD. Females had lower PPTs than males, and a strong correlation was found between PPTs at the shoulder and lower leg. Implications Patients with first-time and recurrent ASD seem to have similar pressure pain sensitivity, but lower PPTs compared to existing normative data, suggesting that it is relevant to evaluate the status of the pain system in these patients to prevent triggering or worsening of their symptoms. However, it remains unanswered how these changes affect the patients' ability to undergo rehabilitation, symptom response and long-term shoulder function.
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Affiliation(s)
- Behnam Liaghat
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Eshoj
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Quality of Life Research Center, Odense University Hospital, Department of Haematology, Odense, Denmark
| | - Birgit Juul-Kristensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Eshoj HR, Rasmussen S, Frich LH, Hvass I, Christensen R, Boyle E, Jensen SL, Søndergaard J, Søgaard K, Juul-Kristensen B. Neuromuscular Exercises Improve Shoulder Function More Than Standard Care Exercises in Patients With a Traumatic Anterior Shoulder Dislocation: A Randomized Controlled Trial. Orthop J Sports Med 2020; 8:2325967119896102. [PMID: 32064291 PMCID: PMC6993151 DOI: 10.1177/2325967119896102] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background: There is an important gap in knowledge about the effectiveness of nonoperative treatment (exercise) for patients with traumatic primary and recurrent anterior shoulder dislocations (ASDs). Purpose/Hypothesis: The purpose of this study was to assess the efficacy and safety of physical therapist–supervised, shoulder instability neuromuscular exercise (SINEX) versus self-managed, home-based, standard care shoulder exercise (HOMEX) in patients with traumatic ASDs. The hypothesis was that SINEX would have a larger effect and fewer adverse events compared with HOMEX. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 56 participants with radiographically verified, trauma-initiated primary or recurrent ASDs and self-reported decreased shoulder function were randomized to 12 weeks of either SINEX or HOMEX. The SINEX program consisted of 7 exercises, individually progressing from basic (2 × 20 repetitions each day) to elite (2 × 10 repetitions, 3 times weekly). The HOMEX program included 5 shoulder exercises performed 3 times weekly (2 × 10 repetitions). The primary outcome was the Western Ontario Shoulder Instability Index (WOSI) score, ranging from 0 (best possible) to 2100. The between-group minimal clinically important difference at 12 weeks was 250 points. Secondary outcomes included WOSI subdomain scores, patient-reported ratings of kinesiophobia and pain, objective shoulder function, patient satisfaction, and number of adverse events. Results: The between-group mean difference in the WOSI total score at 12 weeks significantly favored SINEX over HOMEX (–228.1 [95% CI, –430.5 to –25.6]). SINEX was furthermore superior to HOMEX in most of the secondary outcomes (3/4 subdomains of the WOSI and pain level during the past 7 days as well as clinical signs of anterior shoulder instability). Also, although not statistically significant, less than half the proportion of the SINEX patients compared with the HOMEX patients (3/27 [11%] vs 6/24 [25%], respectively; P = .204) underwent or were referred for shoulder stabilizing surgery. Satisfaction with both exercise programs was high, and no serious adverse events were reported. Conclusion: Neuromuscular shoulder exercise (SINEX) was superior to standard care exercise (HOMEX) in patients with traumatic ASDs. Further long-term follow-ups on treatment effects are needed. Registration: NCT02371928 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Henrik Rode Eshoj
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Henrik Frich
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Inge Hvass
- Shoulder Section, Department of Orthopaedic Surgery, South-West Jutland Hospital, Esbjerg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Rheumatology Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Steen Lund Jensen
- Shoulder Section, Department of Orthopaedic Surgery, Aalborg University Hospital, Farsoe, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Kjær BH, Juul-Kristensen B, Warming S, Magnusson SP, Krogsgaard MR, Boyle E, Henriksen M. Associations between shoulder symptoms and concomitant pathology in patients with traumatic supraspinatus tears. JSES Int 2020; 4:85-90. [PMID: 32195468 PMCID: PMC7075778 DOI: 10.1016/j.jses.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background The association between concomitant pathologic characteristics and preoperative symptoms in patients identified as eligible for surgical rotator cuff repair has been sparsely evaluated. The purpose was to explore the associations between preoperative shoulder symptoms and additional structural pathology or injuries identified during surgery in patients with traumatic supraspinatus tears. Methods This was a cross-sectional study including patients with traumatic supraspinatus tears. Preoperatively, patients reported pain and disability using a numeric pain rating scale from 0 to 10 and the Western Ontario Rotator Cuff Index. During surgery, the presence of prespecified structural injuries and pathologies including a full-thickness or partial supraspinatus tear, infraspinatus tear, subscapularis tear, hooked acromion, acromioclavicular joint osteoarthritis, biceps tendon pathology, labral tear, and cartilage lesion was recorded. Linear regression and analysis of covariance were used to assess associations. Results A total of 87 patients (52 male patients, 60%) were included (mean age, 60 years; standard deviation, 9.2 years). Of these patients, 69 (79%) had a full-thickness supraspinatus tear and 18 (21%) had a partial-thickness tear. Concomitant structural pathology was found in 79 patients (91%). No association was found between the number of structural shoulder pathologies and preoperative numeric pain rating scale or Western Ontario Rotator Cuff Index score, and no particular concomitant pathology was associated with worse patient-reported symptoms. Conclusion Pathology of the infraspinatus and subscapularis and other structural joint pathologies concomitant with supraspinatus tears were not correlated with preoperative self-reported pain and disability in patients scheduled to undergo rotator cuff surgery, suggesting that concomitant pathology adds little to the symptoms in patients with a traumatic supraspinatus tear.
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Affiliation(s)
- Birgitte H Kjær
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Susan Warming
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Orthopaedic Surgery, Institute of Sports Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael R Krogsgaard
- Section for Sports Traumatology, Department of Orthopaedic Surgery, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Marius Henriksen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Frederiksberg, Denmark
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31
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Sundemo D, Hamrin Senorski E, Karlsson L, Horvath A, Juul-Kristensen B, Karlsson J, Ayeni OR, Samuelsson K. Generalised joint hypermobility increases ACL injury risk and is associated with inferior outcome after ACL reconstruction: a systematic review. BMJ Open Sport Exerc Med 2019; 5:e000620. [PMID: 31798951 PMCID: PMC6863654 DOI: 10.1136/bmjsem-2019-000620] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 01/02/2023] Open
Abstract
Objectives To investigate the association between generalised joint hypermobility (GJH) and ACL injury risk. Secondary aims involved evaluating associations between GJH and postoperative outcome (including graft-failure risk, knee laxity and patient-reported outcome). Furthermore, we aimed to compare the performance of different grafts in patients with GJH. Methods Databases MEDLINE/PubMed, EMBASE and the Cochrane Library were searched, including 2760 studies. Two reviewers independently screened studies for eligibility. A modified version of the MINORS score was applied for quality appraisal. Studies assessing GJH while reporting the risk of ACL injury and/or postoperative outcome were included. Results Twenty studies were included, using several different methods to determine GJH. There was consistent evidence showing that GJH is a risk factor for unilateral ACL injury in males, while in females, the results were conflicting. There was limited evidence associating GJH with increased knee laxity 5 years postoperatively. There was consistent evidence of inferior postoperative patient-reported outcome in patients with GJH. Moreover, there was limited yet consistent evidence indicating that patellar-tendon autografts are superior to hamstring-tendon autografts in patients with GJH in terms of knee laxity and patient-reported outcome. There was insufficient evidence to draw conclusions regarding the outcomes of bilateral ACL injury and graft failure. Conclusions In men, GJH was associated with an increased risk of unilateral ACL injury. Moreover, GJH was associated with greater postoperative knee laxity and inferior patient-reported outcome. Based on the available evidence, a patellar-tendon autograft appears to be superior to a hamstring-tendon autograft in patients with GJH. However, the included studies were heterogeneous and there is a need for consensus in the assessment of GJH within sports medicine.
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Affiliation(s)
- David Sundemo
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabiltation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Karlsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexandra Horvath
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Denmark
| | - Jon Karlsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kristian Samuelsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Gohlke J, Juul-Kristensen B, Brunner I. Are changes in upper extremity use during sub-acute rehabilitation after stroke associated with physical, cognitive, and social activities? An observational cohort pilot study. Physiother Res Int 2019; 25:e1818. [PMID: 31680404 DOI: 10.1002/pri.1818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/24/2019] [Accepted: 10/03/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate how changes in physical, social, and cognitive activity levels are associated with the use of the affected upper extremity at different time points during inpatient rehabilitation after stroke. METHODS In an observational longitudinal cohort pilot study activity of 14 patients with subacute stroke was registered 2-4 times during their inpatient rehabilitation from 2 p.m. to 8 p.m. At the same time, patients wore accelerometers on both wrists to register amount of use and use ratio of the affected to the unaffected upper extremity. Before and after the observation period, patients were assessed with action research arm test, Box and Blocks Test, and Functional Independence Measure. Linear regression models were used to examine the influence of different categories of activities and motor function levels on affected upper extremity use. RESULTS Increasing physical activity levels during rehabilitation and improvement in upper extremity motor function were associated with increased use of the affected upper extremity. Cognitive and social activity levels did not change and were not associated with affected upper extremity use. CONCLUSION Our findings suggest that the use of the affected upper extremity and a general increase in activity are associated. Facilitating both general physical activity and specific upper extremity use at a rehabilitation ward may benefit overall recovery.
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Affiliation(s)
- Jacob Gohlke
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Iris Brunner
- Department of Clinical Medicine, Hammel Neurocenter, Aarhus University, Denmark
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Kristiansen L, Magnussen LH, Wilhelmsen KT, Mæland S, Nordahl SHG, Clendaniel R, Hovland A, Juul-Kristensen B. Efficacy of intergrating vestibular rehabilitation and cognitive behaviour therapy in persons with persistent dizziness in primary care- a study protocol for a randomised controlled trial. Trials 2019; 20:575. [PMID: 31590692 PMCID: PMC6781377 DOI: 10.1186/s13063-019-3660-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/14/2019] [Indexed: 01/13/2023] Open
Abstract
Background Dizziness is a common complaint, and the symptom often persists, together with additional complaints. A treatment combining Vestibular Rehabilitation (VR) and Cognitive Behaviour Therapy (CBT) is suggested. However, further research is necessary to evaluate the efficacy of such an intervention. The objective of this paper is to present the design of a randomised controlled trial aiming at evaluating the efficacy of an integrated treatment of VR and CBT on dizziness, physical function, psychological complaints and quality of life in persons with persistent dizziness. Methods/design The randomised controlled trial is an assessor-blinded, block-randomised, parallel-group design, with a 6- and 12-month follow-up. The study includes 125 participants from Bergen (Norway) and surrounding areas. Included participants present with persistent dizziness lasting for at least 3 months, triggered or exacerbated by movement. All participants receive a one-session treatment (Brief Intervention Vestibular Rehabilitation; BI-VR) with VR before being randomised into a control group or an intervention group. The intervention group will further be offered an eight-session treatment integrating VR and CBT. The primary outcomes in the study are the Dizziness Handicap Inventory and preferred gait velocity. Discussion Previous studies combining these treatments have been of varying methodological quality, with small samples, and long-term effects have not been maintained. In addition, only the CBT has been administered in supervised sessions, with VR offered as home exercises. The current study focusses on the integrated treatment, a sufficiently powered sample size, and a standardised treatment programme evaluated by validated outcomes using a standardised assessment protocol. Trial registration www.clinicaltrials.gov, ID: NCT02655575. Registered on 14 January 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3660-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lene Kristiansen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - L H Magnussen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - K T Wilhelmsen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - S Mæland
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - S H G Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R Clendaniel
- Doctor of Physical Therapy Division, Department of Orthopedics, Duke University School of Medicine, Durham, NC, USA
| | - A Hovland
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Solli District Psychiatric Centre (DPS), Nesttun, Norway
| | - B Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Juul-Kristensen B, Larsen CM, Eshoj H, Clemmensen T, Hansen A, Bo Jensen P, Boyle E, Søgaard K. Positive effects of neuromuscular shoulder exercises with or without EMG-biofeedback, on pain and function in participants with subacromial pain syndrome - A randomised controlled trial. J Electromyogr Kinesiol 2019; 48:161-168. [PMID: 31394380 DOI: 10.1016/j.jelekin.2019.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/18/2019] [Accepted: 07/18/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim was to investigate the effect of Electromyography (EMG)-biofeedback guided exercises (BIONEX) on shoulder pain and function in participants with subacromial pain syndrome (SPS). METHODS Twenty-five women and 24 men (19-67 years), diagnosed with SPS, were randomised to BIONEX or the same exercises without EMG-biofeedback (NEX). Primary outcome was shoulder pain during the past 7 days (Numeric Pain Rating Scale (NPRS)). Secondary outcomes included self-reported (Disability of Arm Shoulder and Hand (DASH), Oxford Shoulder Score (OSS)), and measured shoulder function (surface EMG from upper trapezius, lower trapezius and serratus anterior) in mean and ratios of % of maximum voluntary EMG (%MVE) and onset time (msec), during arm tasks with 0, 1 and 3 kg. RESULTS There was no group difference (BIONEX versus NEX) in changed shoulder pain (NPRS, mean difference 0.18 (95% CI. -1.56; 1.19)), self-reported or measured shoulder function. Both groups, however, showed significant within-group improvements on self-reported outcomes (NPRS, DASH, OSS), only clinically relevant on NPRS (BIONEX 2.23 (SD 2.47); NEX 2.04 (SD 2.29)). CONCLUSION BIONEX and NEX were both effective in reducing pain to a clinically relevant level, while EMG-biofeedback did not make a difference. The current neuromuscular shoulder exercise protocol is recommended.
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Affiliation(s)
- Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Camilla Marie Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Health Sciences Research Center, University College Lillebaelt, Odense, Denmark
| | - Henrik Eshoj
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Trine Clemmensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Health Sciences Research Center, University College Lillebaelt, Odense, Denmark
| | - Anders Hansen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Research Unit for Rehabilitation, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Peter Bo Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Kristiansen L, Magnussen LH, Juul-Kristensen B, Mæland S, Nordahl SHG, Hovland A, Sjøbø T, Wilhelmsen KT. Feasibility of integrating vestibular rehabilitation and cognitive behaviour therapy for people with persistent dizziness. Pilot Feasibility Stud 2019; 5:69. [PMID: 31139431 PMCID: PMC6528375 DOI: 10.1186/s40814-019-0452-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 05/06/2019] [Indexed: 01/16/2023] Open
Abstract
Purpose To evaluate the feasibility of integrating vestibular rehabilitation and cognitive behaviour therapy (VR-CBT) for people with persistent dizziness in primary care. Design Prospective single-group pre- and post-test study. Participants Adults (aged 18–70) with acute onset of dizziness and symptoms lasting a minimum 3 months, recruited from Bergen municipality. Methods Participants attended eight weekly group sessions of VR-CBT intervention. Feasibility outcomes consisted of recruitment and testing procedures, intervention adherence, and participant feedback, besides change in primary outcomes. The primary outcomes were Dizziness Handicap Inventory (DHI) and preferred gait velocity. Results Seven participants were recruited for the study. All participants completed the pre-treatment tests, five participants completed the intervention and answered post-treatment questionnaires, and three completed post-treatment testing. Of the five participants, three attended at least 75% of the VR-CBT sessions, and two 50% of the sessions. Participants reported that the VR-CBT was relevant and led to improvement in function. DHI scores improved beyond minimal important change in two out of five participants, and preferred gait velocity increased beyond minimal important change in two out of three participants. Conclusion The current tests and VR-CBT treatment protocols were feasible. Some changes are suggested to optimise the protocols, before conducting a randomised controlled trial. Trial registration NCT02655575. Registered 14 January 2016—retrospectively registered
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Affiliation(s)
- Lene Kristiansen
- 1Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, P.O. box 7030, 5020 Bergen, Norway
| | - L H Magnussen
- 1Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, P.O. box 7030, 5020 Bergen, Norway
| | - B Juul-Kristensen
- 2Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - S Mæland
- 1Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, P.O. box 7030, 5020 Bergen, Norway
| | - S H G Nordahl
- 3Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngol and Head Neck Surgery, Haukeland University Hospital, Bergen, Norway.,4Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A Hovland
- Solli District Psychiatric Centre (DPS), Nesttun, Norway.,6Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - T Sjøbø
- Solli District Psychiatric Centre (DPS), Nesttun, Norway
| | - K T Wilhelmsen
- 1Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, P.O. box 7030, 5020 Bergen, Norway
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Brage K, Hjarbaek J, Kjaer P, Ingwersen KG, Juul-Kristensen B. Ultrasonic strain elastography for detecting abnormalities in the supraspinatus tendon: an intra- and inter-rater reliability study. BMJ Open 2019; 9:e027725. [PMID: 31072860 PMCID: PMC6527995 DOI: 10.1136/bmjopen-2018-027725] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The reliability of ultrasonic strain elastography (SEL) used to detect abnormalities in the supraspinatus tendon is unclear. Thus, the aim of this study was to investigate the reliability of SEL in the supraspinatus tendon. DESIGN An intra-rater and inter-rater reliability study. SETTING A single-centre study conducted at the University of Southern Denmark. PARTICIPANTS Twenty participants with shoulder pain and MRI-verified supraspinatus tendinosis and 20 asymptomatic participants (no MRI). PRIMARY AND SECONDARY OUTCOME MEASURES Raw values (RAW) and ratios (deltoid muscle (DELT) and gel pad (GEL) as reference tissues) were calculated and mean values of measurements from three regions of the supraspinatus tendon were reported. Colour scale ratings and number of yellow/red lesions from the three areas were also included. RESULTS Intra-rater reliability showed intraclass correlation coefficients (ICCs) for RAW, DELT and GEL: 0.97 (minimal detectable change (MDC): 0.28 (6.36% of the mean)), 0.89 (MDC: 2.91 (20.37%)) and 0.73 (MDC: 1.61 (58.82%)), respectively. The ICCs for inter-rater reliability were 0.89 (MDC: 0.47 (10.53%)), 0.78 (MDC: 3.69 (25.51%)) and 0.70 (MDC: 1.75 (62.63%)), respectively.For colour scale ratings, intra-rater reliability (linear weighted kappa) ranged from 0.76 to 0.79, with the inter-rater reliability from 0.71 to 0.81. For the number of lesions, intra-rater reliability ranged from 0.40 to 0.82 and inter-rater reliability from 0.24 to 0.67. CONCLUSIONS Intra-rater and inter-rater reliability were excellent for raw values and for ratios with deltoid muscle as the reference tissue, and good for ratios with gel pad as the reference tissue. The reliability of colour scale ratings was substantial-to-almost perfect, and for the number of lesions fair-to-almost perfect.Although high reliability was found, validity and responsiveness of these elastographic methods needs further investigation. ETHICS APPROVAL The study protocol was approved by the Ethics Committee for the Region of South Denmark (S-20160115) and reported to the Danish Data Protection Agency (2014-41-3266).
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Affiliation(s)
- K Brage
- Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - John Hjarbaek
- Department of Radiology, Musculoskeletal section, Odense Universitetshospital, Odense, Denmark
| | - Per Kjaer
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Birgit Juul-Kristensen
- Institute of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, Odense, Denmark
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Larsen CM, Søgaard K, Eshoj H, Ingwersen K, Juul-Kristensen B. Clinical assessment methods for scapular position and function. An inter-rater reliability study. Physiother Theory Pract 2019; 36:1399-1420. [PMID: 30924383 DOI: 10.1080/09593985.2019.1579284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The aim of this study was to assess the inter-rater reliability of selected static, semi-dynamic, and dynamic test assessment methods for evaluation of scapular positioning and function. Methods: A standardized three-phase (i.e. training, overall agreement, and actual study) protocol for reliability studies was applied on 41 overhead sports participants, aged 18-56 (22 with obvious scapular winging, classified as visibility of the medial or inferior angle border of scapula). Ten scapular test assessment methods (two static, three semi-dynamic, and five dynamic) were evaluated. Results: Bland-Altman plots showed no funnel effects, although systematic bias and significant differences between raters were present in three of the methods. ICC values ranged from 0.71 to 0.80 for the static test assessment methods and from 0.25-0.92 for the semi-dynamic test assessment methods. Three of the five dynamic test assessment methods had ICCs of 0.47-0.68. For the two remaining dynamic test assessment methods, kappa varied between -0.034 and 0.71. Using PABAK, kappa increased to 0.54-0.86. Conclusion: Four scapular test assessment methods (Upper horizontal distance, Lower horizontal distance at max shoulder flexion, Acromial distance, and Winging scapula) showed satisfactory inter-rater reliability. Simple visual observational methods and quantitative distance measurements have better reliability between clinicians than more complex measurements and may be better suited for use in clinical practice.
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Affiliation(s)
- Camilla Marie Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark , Odense, Denmark.,Health Sciences Research Center, UCL University College , Odense, Denmark.,Department of Physiotheraphy, UCL University College , Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark , Odense, Denmark.,Occupational and Environmental Medicine, University Hospital , Odense, Denmark
| | - Henrik Eshoj
- Quality of Life Research Center, Department of Haematology, Odense University Hospital , Odense, Denmark
| | - Kim Ingwersen
- Department of Rehabilitation, Hospital Lillebaelt - Vejle Hospital , Vejle, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark , Odense, Denmark
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Eshoj H, Rasmussen S, Frich LH, Jensen SL, Søgaard K, Juul-Kristensen B. Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study. BMC Musculoskelet Disord 2019; 20:59. [PMID: 30736761 PMCID: PMC6368725 DOI: 10.1186/s12891-019-2444-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/30/2019] [Indexed: 01/16/2023] Open
Abstract
Background Patients with non-operated traumatic primary anterior shoulder dislocation (PASD) are assumed to have less shoulder impairment than patients with recurrent anterior shoulder dislocations (RASD). This may impact treatment decision strategy. The aim was to study whether patients with non-operated traumatic PASD have less shoulder impairment than those with RASD. Methods In a cross-sectional study baseline data from patients with PASD and RASD in a randomised controlled trial of non-operative shoulder exercise treatment were used. Shoulder function was self-reported (Western Ontario Shoulder Instability (WOSI), Tampa Scale of Kinesiophobia (TSK), General Health (EQ-5D-VAS), Numeric Pain Rating Scale (NPRS)), and measured (Constant-Murley shoulder Score (CMS total), CMS - Range of Motion (CMS-ROM, CMS – strength, proprioception, clinical tests). Results In total, 56 patients (34 (28 men) with PASD and 22 (21 men) with RASD) (mean age 26 years) participated. WOSI total was 1064 and 1048, and TSK above 37 (indicating high re-injury fear) was present in 33 (97%) and 21 (96%) of the groups with PASD and RASD, with no group difference. CMS total (66.4 and 70.4), CMS-ROM (28.7 and 31.5), CMS-strength (injured shoulder: 7.6 kg and 9.1 kg), proprioception and clinical tests were the same. Furthermore, 26 (76%) with PASD and 13 (59%) with RASD reported not to have received non-operative shoulder treatment. Conclusions Non-operated patients with PASD and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients RASD and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event.
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Affiliation(s)
- Henrik Eshoj
- Quality of Life Research Center, Department of Hematology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000, Odense, Denmark. .,Department of Sports Science and Clinical Biomechanics, University of Southern, Campusvej 55, DK-5230, Odense, Denmark.
| | - Sten Rasmussen
- Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark, Hobrovej 18-22, DK-9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | - Lars Henrik Frich
- Department of Orthopaedics and Traumatology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark
| | - Steen Lund Jensen
- Department of Clinical Medicine, Aalborg University, Hobrovej 18-22, DK-9000, Aalborg, Denmark.,Shoulder sector, Orthopaedic Department, Aalborg University Hospital, Farsoe, Denmark
| | - Karen Søgaard
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern, Campusvej 55, DK-5230, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern, Campusvej 55, DK-5230, Odense, Denmark
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Kjær BH, Magnusson SP, Warming S, Henriksen M, Krogsgaard MR, Juul-Kristensen B. Progressive early passive and active exercise therapy after surgical rotator cuff repair - study protocol for a randomized controlled trial (the CUT-N-MOVE trial). Trials 2018; 19:470. [PMID: 30176943 PMCID: PMC6122575 DOI: 10.1186/s13063-018-2839-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/04/2018] [Indexed: 01/08/2023] Open
Abstract
Background Rotator cuff tear is a common cause of shoulder disability and results in patients predominantly complaining of pain and loss of motion and strength. Traumatic rotator cuff tears are typically managed surgically followed by ~ 20 weeks of rehabilitation. However, the timing and intensity of the postoperative rehabilitation strategy required to reach an optimal clinical outcome is unknown. Early controlled and gradually increased tendon loading has been suggested to positively influence tendon healing and recovery. The aim of this trial is therefore to examine the effect of a progressive rehabilitation strategy on pain, physical function and quality of life compared to usual care (that limits tendon loading in the early postoperative phase) in patients who have a rotator cuff repair of a traumatic tear. Methods The current study is a randomized, controlled, outcome-assessor blinded, multicenter, superiority trial with a two-group paralleled design. A total of 100 patients with surgically repaired traumatic rotator cuff tears will be recruited from up to three orthopedic departments in Denmark, and randomized to either a progressive early passive and active movement program or a limited early passive movement program (usual care). The primary outcome measure will be the change from pre-surgery to 12 weeks post-surgery in the Western Ontario Rotator Cuff Index questionnaire. Secondary outcomes include the Disabilities Arm, Shoulder and Hand questionnaire (DASH), range of motion, strength and tendon healing characteristics from ultrasound measurements at 12 months follow up. Discussion We hypothesized that patients who receive the progressive rehabilitation strategy will benefit more with respect to pain reduction, physical function and quality of life than those who receive care as usual. If this is confirmed our study can be used clinically to enhance the recovery of patients with traumatic rotator cuff tear. Trial registration ClinicalTrials.gov, NCT02969135. Registered on 15 November 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2839-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark. .,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark.
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark.,Institute of Sports Medicine, Department of Orthopaedic Surgery M, Copenhagen Bispebjerg-Frederiksberg Hospital, and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susan Warming
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark
| | - Marius Henriksen
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark.,The Parker Institute, Bispebjerg-Frederiksberg Hospital, Ndr. Fasanvej 57, DK-2000, Frederiksberg, Copenhagen, Denmark
| | - Michael Rindom Krogsgaard
- Section for Sports Traumatology M51, Department of Orthopaedic Surgery, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark
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Ris I, Barbero M, Falla D, Larsen MH, Kraft MN, Søgaard K, Juul-Kristensen B. Pain extent is more strongly associated with disability, psychological factors, and neck muscle function in people with non-traumatic versus traumatic chronic neck pain: a cross sectional study. Eur J Phys Rehabil Med 2018; 55:71-78. [PMID: 30156084 DOI: 10.23736/s1973-9087.18.04977-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neck pain is presented with a variety of symptoms. Pain drawings are used in the clinical assessment of people with neck pain. Pain extent based upon pain drawings can be associated with different factors. However, the relation between pain extent and function limitations in people with neck pain is unknown. AIM The aim of this study was to explore the associations between pain extent extracted from pain drawings, and self-reported neck pain related disability, quality of life, depression, self-reported neck function, cervical muscle function, and range of motion in a chronic neck pain population and possible differences depending on the onset of pain being traumatic or not. DESIGN Observational cross-sectional study. SETTING Primary and secondary healthcare. POPULATION People with chronic neck pain (N.=200) of traumatic (N.=120) or non-traumatic (N.=80) origin. METHODS Outcome measures: Pain extent, Short Form 36 Health Survey Physical and Mental Component Summary (SF36-PCS/MCS), TAMPA Scale of Kinesiophobia (TSK), Beck Depression Inventory-II (BDI-II), Neck Disability Index (NDI), Craniocervical Flexion Test (CCFT), Cervical Extension Test (CE), and Cervical Range of Motion (ROM). Correlations were calculated using Spearman or Pearson correlation coefficients. Correlation between pain extent and outcomes were calculated for all participants collectively and then separately for those with a traumatic versus non-traumatic neck pain. RESULTS Overall, significant positive correlations were observed between pain extent and NDI (r=0.33; P<0.001), BDI-II (r=0.29; P<0.001), CCFT (r=-0.24; P=0.001) and CE (r=-0.19; P=0.006). No difference was observed in pain extent between patients with traumatic (mean: 7.6±6.7%) and non-traumatic onset (7.4±6.8%). Pain extent correlated moderately with NDI, BDI-II, TSK, CCFT and CE in those with non-traumatic onset, but weakly with NDI, BDI-II, CCFT and CE in those with trauma-induced chronic neck pain. CONCLUSIONS Pain extent is correlated with patient-reported neck function, depression and muscle test performance in people with chronic neck pain. These correlations were strongest in those with non-traumatic neck pain. CLINICAL REHABILITATION IMPACT Patients presenting with larger pain areas show poorer psychological and physical function. Pain drawings can therefore indicate a need for addressing these functions in management of a person with chronic neck pain.
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Affiliation(s)
- Inge Ris
- Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark - .,Metropolitan University College, Copenhagen, Denmark -
| | - Marco Barbero
- 2rLab Rehabilitation Research Laboratory, Department of Business, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland
| | - Deborah Falla
- Center of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Mads H Larsen
- Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Martin N Kraft
- Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Research Unit for Physical Activity and Health in Working Life, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health Sciences, Bergen University College, Bergen, Norway
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Frydendal T, Eshøj H, Liaghat B, Edouard P, Søgaard K, Juul-Kristensen B. Sensorimotor control and neuromuscular activity of the shoulder in adolescent competitive swimmers with generalized joint hypermobility. Gait Posture 2018; 63:221-227. [PMID: 29775909 DOI: 10.1016/j.gaitpost.2018.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Shoulder pain is highly prevalent in competitive swimmers, and generalized joint hypermobility (GJH) is considered a risk factor. Sensorimotor control deficiencies and altered neuromuscular activation of the shoulder may represent underlying factors. RESEARCH QUESTION To investigate whether competitive swimmers with GJH including shoulder hypermobility (GJHS) differ in shoulder sensorimotor control and muscle activity from those without GJH and no shoulder hypermobility (NGJH). METHODS Competitive swimmers (aged 13-17) were recruited. GJHS or NGJH status was determined using the Beighton score (0-9) and Rotès-Quérol test (positive/negative). Inclusion criteria for GJHS were a Beighton score ≥5 and minimum one hypermobile shoulder, while NGJH was defined as a Beighton score ≤3 and no shoulder hypermobility. Three prone lying, upper-extremity weight-bearing shoulder stabilometric tests were performed on a force platform: Bilateral upper-extremity support eyes open (BL-EO) and eyes closed (BL-EC) and unilateral upper-extremity support eyes open (UL-EO). Surface electromyography (SEMG) was measured from the upper trapezius, lower trapezius, serratus anterior, infraspinatus and pectoralis major muscles. SEMG was normalized using maximal voluntary isometric contractions and presented relative to maximal voluntary SEMG (%MVE). Co-contraction index (CCI) was calculated for the following muscle pairs: upper trapezius-lower trapezius, upper trapezius-serratus anterior, and infraspinatus-pectoralis major. Between-group differences in stabilometric parameters, %MVE, and CCI were analyzed with a mixed effects model. RESULTS Thirty-eight swimmers were enrolled as GJHS (n = 19) or NGJH (n = 19). There were no group differences in stabilometric parameters or CCI. GJHS displayed significantly decreased (29%) pectoralis major activity during BL-EO compared to NGJH (5.35 ± 1.77%MVE vs. 7.51 ± 1.96%MVE; p = 0.043). SIGNIFICANCE Adolescent competitive swimmers with GJHS displayed no shoulder sensorimotor control deficiencies and no generally altered shoulder muscle activity pattern, except for decreased pectoralis major activity in BL-EO. Longitudinal studies are needed to investigate whether decreased pectoralis major activation contributes to the development of shoulder pain in swimmers with GJHS.
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Affiliation(s)
- Thomas Frydendal
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy, Lillebaelt Hospital, Vejle Hospital, Vejle, Denmark.
| | - Henrik Eshøj
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department for Health, University of Bath, Bath, United Kingdom
| | - Pascal Edouard
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France; Inter-university Laboratory of Human Movement Science (LIBM EA 7424), University of Lyon, University Jean Monnet, F-42023, Saint Etienne, France
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Eshoj H, Ingwersen KG, Larsen CM, Kjaer BH, Juul-Kristensen B. Intertester reliability of clinical shoulder instability and laxity tests in subjects with and without self-reported shoulder problems. BMJ Open 2018; 8:e018472. [PMID: 29502086 PMCID: PMC5855406 DOI: 10.1136/bmjopen-2017-018472] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE First, to investigate the intertester reliability of clinical shoulder instability and laxity tests, and second, to describe the mutual dependency of each test evaluated by each tester for identifying self-reported shoulder instability and laxity. METHODS A standardised protocol for conducting reliability studies was used to test the intertester reliability of the six clinical shoulder instability and laxity tests: apprehension, relocation, surprise, load-and-shift, sulcus sign and Gagey. Cohen's kappa (κ) with 95% CIs besides prevalence-adjusted and bias-adjusted kappa (PABAK), accounting for insufficient prevalence and bias, were computed to establish the intertester reliability and mutual dependency. RESULTS Forty individuals (13 with self-reported shoulder instability and laxity-related shoulder problems and 27 normal shoulder individuals) aged 18-60 were included. Fair (relocation), moderate (load-and-shift, sulcus sign) and substantial (apprehension, surprise, Gagey) intertester reliability were observed across tests (κ 0.39-0.73; 95% CI 0.00 to 1.00). PABAK improved reliability across tests, resulting in substantial to almost perfect intertester reliability for the apprehension, surprise, load-and-shift and Gagey tests (κ 0.65-0.90). Mutual dependencies between each test and self-reported shoulder problem showed apprehension, relocation and surprise to be the most often used tests to characterise self-reported shoulder instability and laxity conditions. CONCLUSIONS Four tests (apprehension, surprise, load-and-shift and Gagey) out of six were considered intertester reliable for clinical use, while relocation and sulcus sign tests need further standardisation before acceptable evidence. Furthermore, the validity of the tests for shoulder instability and laxity needs to be studied.
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Affiliation(s)
- Henrik Eshoj
- Department of Haematology, Quality of Life Research Center, Odense University Hospital, Odense, Denmark
| | - Kim Gordon Ingwersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit at Department of Physical Therapy and Occupational Therapy, Hospital Lillebaelt-Vejle Hospital, Vejle, Denmark
| | - Camilla Marie Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Birgitte Hougs Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit at Department of Physical Therapy and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Health Sciences, Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
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Liaghat B, Juul-Kristensen B, Frydendal T, Marie Larsen C, Søgaard K, Ilkka Tapio Salo A. Competitive swimmers with hypermobility have strength and fatigue deficits in shoulder medial rotation. J Electromyogr Kinesiol 2018; 39:1-7. [PMID: 29353138 DOI: 10.1016/j.jelekin.2018.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/08/2017] [Accepted: 01/09/2018] [Indexed: 12/12/2022] Open
Abstract
Generalised Joint Hypermobility including shoulder hypermobility (GJHS) in swimmers is considered an intrinsic risk factor for shoulder injuries. The aim was to investigate the association of GJHS with shoulder strength, fatigue development and muscle activity during swimming-related shoulder rotations. Totally, 38 competitive swimmers (aged 13-17 years) participated, 19 were competitive swimmers with GJHS and 19 were age, sex and club matched swimmers without GJHS. Concentric isokinetic force in medial and lateral rotations were measured at 60°/s (5 repetitions) and 180°/s (10 repetitions). Electromyographic activity was measured from upper trapezius, lower trapezius, serratus anterior, infraspinatus and pectoralis major muscles. Swimmers with GJHS produced significantly lower peak torque (0.53 vs. 0.60 Nm/kg; p = .047) and maximum work (0.62 vs. 0.71 J/kg; p = .031) than controls during medial rotation (60°/s). Swimmers with GJHS showed significantly larger isokinetic fatigue at 180°/s (0.321 J/repetition; p = .010), and tendencies to lower levels of muscle activity in infraspinatus (20%, p = .066) and pectoralis major (34%, p = .092) at 60°/s during medial rotation. Young competitive swimmers with GJHS, despite no formal diagnosis, displayed strength and fatigue deficits in medial rotation, potentially inherent with greater risk of shoulder injury. Whether GJHS swimmers benefit from medial rotation strengthening is an important topic for future studies.
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Affiliation(s)
- Behnam Liaghat
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department for Health, University of Bath, Bath, United Kingdom.
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Thomas Frydendal
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy, Hospital Lillebaelt, Vejle Hospital, Vejle, Denmark
| | - Camilla Marie Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Jørgensen R, Ris I, Juhl C, Falla D, Juul-Kristensen B. Responsiveness of clinical tests for people with neck pain. BMC Musculoskelet Disord 2017; 18:548. [PMID: 29282073 PMCID: PMC5745670 DOI: 10.1186/s12891-017-1918-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Responsiveness of a clinical test is highly relevant in order to evaluate the effect of a given intervention. However, the responsiveness of clinical tests for people with neck pain has not been adequately evaluated. The objective of the present study was to examine the responsiveness of four clinical tests which are low cost and easy to perform in a clinical setting, including the craniocervical flexion test, cervical active range of movement, test for the cervical extensors and pressure pain threshold testing. METHODS This study is a secondary analysis of data collected in a previously published randomised controlled trial. Participants were randomized to either physical training, exercises and pain education combined or pain education only. Participants were tested on the clinical tests at baseline and at 4-month follow-up. An anchor-based approach using Receiver Operator Characteristics (ROC) curves was used to evaluate responsiveness of the clinical tests. The Neck Disability Index was used to discriminate between those who had improved and those who were unchanged at the 4-month follow-up. Minimum Clinically Important Difference (MCID), together with sensitivity, specificity, positive and negative predictive values, in addition to positive and negative likelihood ratios were calculated. RESULTS In total, 164 participants completed the 4 month follow up. One-hundred forty four participants were classified as unchanged whereas 20 patients were considered to be improved. Twenty-six participants didn't complete all of the clinical tests, leaving a total of 138 to be included for analyses. Area Under Curve (AUC) ranged from 0.50-0.62 for the clinical tests, and were all below an acceptable level. MCID was generally large, and the corresponding sensitivity and specificity was low with sensitivity ranging from 20 to 60%, and specificity from 54 to 86%. LR+ (0.8-2.07) and LR- (0.7-1.1) showed low diagnostic value for all variables, with PPV ranging from 12.1 to 26.1 and NPV ranging from 84.7 to 89.2. CONCLUSION Responsiveness of the included clinical tests was generally low when using change in NDI score as the anchor from baseline to the 4-month follow up. Further investigations of responsiveness are warranted, possibly using other anchors, which to a higher degree resemble similar dimensions as the clinical tests.
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Affiliation(s)
- René Jørgensen
- Department of Physiotherapy, University College South, Degnevej 16, 6705, Esbjerg Ø, Denmark.
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Carsten Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Department of Rehabilitation, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Junge T, Henriksen P, Hansen S, Østengaard L, Golightly YM, Juul-Kristensen B. Generalised joint hypermobility and knee joint hypermobility: prevalence, knee joint symptoms and health-related quality of life in a Danish adult population. Int J Rheum Dis 2017; 22:288-296. [DOI: 10.1111/1756-185x.13205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Tina Junge
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
- Health Sciences Research Centre; University College Lillebaelt; Odense Denmark
| | - Peter Henriksen
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
- Health Sciences Research Centre; University College Lillebaelt; Odense Denmark
| | - Sebrina Hansen
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
| | - Lasse Østengaard
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
| | - Yvonne M. Golightly
- Department of Epidemiology; University of North Carolina; Chapel Hill North Carolina USA
- Thurston Arthritis Research Center; University of North Carolina; Chapel Hill North Carolina USA
- Injury Prevention Research Center; University of North Carolina; Chapel Hill North Carolina USA
- Division of Physical Therapy; University of North Carolina; Chapel Hill North Carolina USA
| | - Birgit Juul-Kristensen
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense Denmark
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Juul-Kristensen B, Schmedling K, Rombaut L, Lund H, Engelbert RHH. Measurement properties of clinical assessment methods for classifying generalized joint hypermobility-A systematic review. Am J Med Genet C Semin Med Genet 2017; 175:116-147. [PMID: 28306223 DOI: 10.1002/ajmg.c.31540] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose was to perform a systematic review of clinical assessment methods for classifying Generalized Joint Hypermobility (GJH), evaluate their clinimetric properties, and perform the best evidence synthesis of these methods. Four test assessment methods (Beighton Score [BS], Carter and Wilkinson, Hospital del Mar, Rotes-Querol) and two questionnaire assessment methods (Five-part questionnaire [5PQ], Beighton Score-self reported [BS-self]) were identified on children or adults. Using the Consensus-based Standards for selection of health Measurement Instrument (COSMIN) checklist for evaluating the methodological quality of the identified studies, all included studies were rated "fair" or "poor." Most studies were using BS, and for BS the reliability most of the studies showed limited positive to conflicting evidence, with some shortcomings on studies for the validity. The three other test assessment methods lack satisfactory information on both reliability and validity. For the questionnaire assessment methods, 5PQ was the most frequently used, and reliability showed conflicting evidence, while the validity had limited positive to conflicting evidence compared with test assessment methods. For BS-self, the validity showed unknown evidence compared with test assessment methods. In conclusion, following recommended uniformity of testing procedures, the recommendation for clinical use in adults is BS with cut-point of 5 of 9 including historical information, while in children it is BS with cut-point of at least 6 of 9. However, more studies are needed to conclude on the validity properties of these assessment methods, and before evidence-based recommendations can be made for clinical use on the "best" assessment method for classifying GJH. © 2017 Wiley Periodicals, Inc.
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Engelbert RHH, Juul-Kristensen B, Pacey V, de Wandele I, Smeenk S, Woinarosky N, Sabo S, Scheper MC, Russek L, Simmonds JV. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. Am J Med Genet C Semin Med Genet 2017; 175:158-167. [PMID: 28306230 DOI: 10.1002/ajmg.c.31545] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in management of individuals with hypermobility related disorders. However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management. This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children, adolescents, and adults with JHS/hEDS. Due to the complexity of the symptoms in the profile of JHS/hEDS, the International Classification of Functioning, Disability and Health (ICF) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions, activities and participation, as well as environmental and personal factors. The current evidence-based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions. Multicenter randomized controlled trials are warranted to assess the clinical and cost-effectiveness of interventions for children and adults. Until further multicenter trials are conducted, clinical decision-making should be based on theoretical and the current limited research evidence. For all individuals diagnosed with JHS/hEDS, international consensus and combined efforts to identify risk profiles would create a better understanding of the pathological mechanisms and the potential for optimizing health care for affected individuals. © 2017 Wiley Periodicals, Inc.
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Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, Bloom L, Bowen JM, Brady AF, Burrows NP, Castori M, Cohen H, Colombi M, Demirdas S, De Backer J, De Paepe A, Fournel-Gigleux S, Frank M, Ghali N, Giunta C, Grahame R, Hakim A, Jeunemaitre X, Johnson D, Juul-Kristensen B, Kapferer-Seebacher I, Kazkaz H, Kosho T, Lavallee ME, Levy H, Mendoza-Londono R, Pepin M, Pope FM, Reinstein E, Robert L, Rohrbach M, Sanders L, Sobey GJ, Van Damme T, Vandersteen A, van Mourik C, Voermans N, Wheeldon N, Zschocke J, Tinkle B. The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet 2017; 175:8-26. [PMID: 28306229 DOI: 10.1002/ajmg.c.31552] [Citation(s) in RCA: 939] [Impact Index Per Article: 134.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Ehlers-Danlos syndromes (EDS) are a clinically and genetically heterogeneous group of heritable connective tissue disorders (HCTDs) characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Over the past two decades, the Villefranche Nosology, which delineated six subtypes, has been widely used as the standard for clinical diagnosis of EDS. For most of these subtypes, mutations had been identified in collagen-encoding genes, or in genes encoding collagen-modifying enzymes. Since its publication in 1998, a whole spectrum of novel EDS subtypes has been described, and mutations have been identified in an array of novel genes. The International EDS Consortium proposes a revised EDS classification, which recognizes 13 subtypes. For each of the subtypes, we propose a set of clinical criteria that are suggestive for the diagnosis. However, in view of the vast genetic heterogeneity and phenotypic variability of the EDS subtypes, and the clinical overlap between EDS subtypes, but also with other HCTDs, the definite diagnosis of all EDS subtypes, except for the hypermobile type, relies on molecular confirmation with identification of (a) causative genetic variant(s). We also revised the clinical criteria for hypermobile EDS in order to allow for a better distinction from other joint hypermobility disorders. To satisfy research needs, we also propose a pathogenetic scheme, that regroups EDS subtypes for which the causative proteins function within the same pathway. We hope that the revised International EDS Classification will serve as a new standard for the diagnosis of EDS and will provide a framework for future research purposes. © 2017 Wiley Periodicals, Inc.
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Hope L, Juul-Kristensen B, Løvaas H, Løvvik C, Maeland S. Subjective health complaints and illness perception amongst adults with Joint Hypermobility Syndrome/Ehlers–Danlos Syndrome-HypermobilityType – a cross-sectional study. Disabil Rehabil 2017; 41:333-340. [DOI: 10.1080/09638288.2017.1390695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Lena Hope
- Department of Occupational Therapy, Physiotherapy and Radiography, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Birgit Juul-Kristensen
- Department of Occupational Therapy, Physiotherapy and Radiography, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Sports Sciences and Clinical Biomechanics, Research Unit of Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Helene Løvaas
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Camilla Løvvik
- Uni Research Health, Uni Research, Bergen, Norway
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Silje Maeland
- Department of Occupational Therapy, Physiotherapy and Radiography, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Uni Research Health, Uni Research, Bergen, Norway
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Ingwersen KG, Jensen SL, Sørensen L, Jørgensen HR, Christensen R, Søgaard K, Juul-Kristensen B. Three Months of Progressive High-Load Versus Traditional Low-Load Strength Training Among Patients With Rotator Cuff Tendinopathy: Primary Results From the Double-Blind Randomized Controlled RoCTEx Trial. Orthop J Sports Med 2017; 5:2325967117723292. [PMID: 28875153 PMCID: PMC5576542 DOI: 10.1177/2325967117723292] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Progressive high-load exercise (PHLE) has led to positive clinical results in patients with patellar and Achilles tendinopathy. However, its effects on rotator cuff tendinopathy still need to be investigated. Purpose: To assess the clinical effects of PHLE versus low-load exercise (LLE) among patients with rotator cuff tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients with rotator cuff tendinopathy were recruited and randomized to 12 weeks of PHLE or LLE, stratified for concomitant administration of corticosteroid injection. The primary outcome measure was change from baseline to 12 weeks in the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, assessed in the intention-to-treat population. Results: A total of 100 patients were randomized to PHLE (n = 49) or LLE (n = 51). Mean changes in the DASH questionnaire were 7.11 points (95% CI, 3.07-11.16) and 8.39 points (95% CI, 4.35-12.44) in the PHLE and LLE groups, respectively; this corresponded to a statistically nonsignificant adjusted mean group difference of −1.37 points (95% CI, −6.72 to 3.99; P = .61). Similar nonsignificant results were seen for pain, range of motion, and strength. However, a significant interaction effect was found between the 2 groups and concomitant corticosteroid use (P = .028), with the largest positive change in DASH in favor of PHLE for the group receiving concomitant corticosteroid. Conclusion: The study results showed no superior benefit from PHLE over traditional LLE among patients with rotator cuff tendinopathy. Further investigation of the possible interaction between exercise type and corticosteroid injection is needed to establish optimal and potentially synergistic combinations of these 2 factors. Registration: NCT01984203 (ClinicalTrials.gov identifier): Rotator Cuff Tendinopathy Exercise Trial (RoCTEx).
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Affiliation(s)
- Kim Gordon Ingwersen
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy, Hospital Lillebaelt, Vejle Hospital, Vejle, Denmark
| | - Steen Lund Jensen
- Department of Orthopaedic Surgery, Shoulder Clinic, Aalborg University Hospital, Farsø Hospital, Farsø, Denmark
| | - Lilli Sørensen
- Department of Orthopaedic Surgery, Shoulder Clinic, Hospital Lillebaelt, Vejle Hospital, Vejle, Denmark
| | - Hans Ri Jørgensen
- Department of Orthopaedic Surgery, Shoulder Clinic, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Birgit Juul-Kristensen
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Health Sciences, Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
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