Translation, cultural adaptation, validity and reliability of the Turkish ASES questionnaire

Effects of Different Frequencies of Physical Therapy Visits on Shoulder Function After Arthroscopic Rotator Cuff Repair

OBJECTIVE

There is no consensus about the optimal frequency of patient visits during the rehabilitation program after arthroscopic rotator cuff repair (ARCR). This study aimed to investigate the short- and long-term effects of high-frequency (HF) and low-frequency (LF) visits of the patients in the first 12 weeks of rehabilitation after ARCR.

METHODS

This was a quasi-randomized study with 2 parallel groups. Forty-seven patients with ARCR were included in 2 different patient visit frequency protocols (HF = 23, LF = 24) in 12 weeks of postoperative rehabilitation. Patients in the HF group visited the clinic twice a week, whereas patients in the LF group visited once every 2 weeks for the first 6 weeks and once a week for the following 6 weeks. Both groups performed the same exercise protocol. Outcome measurements were pain and range of motion measured at baseline; at the 3rd, 5th, 8th, 12th, and 24th weeks; and at 1-year follow-up. Shoulder function was assessed at the 12th and 24th weeks and at 1-year follow-up with an American Shoulder and Elbow Surgeons score.

RESULTS

There was a significant group × time interaction in pain intensity during the activity between the groups. The activity pain intensity was higher in the LF group (4.2 points) at 8 weeks post surgery than in the HF group (2.7 points) (mean difference: 1.5 points, P < .05), whereas it was similar in both groups at other time periods. The interaction term was not significant between the groups for pain intensity during rest and night through the 1-year follow-up. No group × time interactions were observed in shoulder range of motion and American Shoulder and Elbow Surgeons score over the postoperative period.

CONCLUSION

Both rehabilitation programs at different visit frequencies after ARCR showed similar clinical results in the long term. A supervised, controlled rehabilitation program with LF visits in the first 12 weeks after surgery can be sufficient to achieve optimal clinical results and reduce rehabilitation-related costs after ARCR.

IMPACT

This study highlights that LF treatment protocols under the supervision of the therapist can be adopted after the arthroscopic rotator cuff repair to achieve successful results while decreasing the treatment costs. Physical therapists should plan the treatment sessions efficiently for the compliance of the patients to the exercise treatment.

LAY SUMMARY

If you are a patient with arthroscopic rotator cuff repair, a supervised, controlled rehabilitation program with low-frequency visits in the first 12 weeks after surgery could help you achieve the best outcome and help lower the costs of rehabilitation. A total of 3 visits in the first 6 weeks might be sufficient (once every 2 weeks). More frequent visits (1-2 visits a week) should happen 6 to 12 weeks after the surgery.

Effectiveness of Exercises With Electromyographic Biofeedback in Conservative Treatment of Massive Rotator Cuff Tears: A Randomized Controlled Study

OBJECTIVE

The aim of the study is to investigate the effectiveness of a rehabilitation program with electromyographic biofeedback compared with the control group on patients with massive rotator cuff tear.

DESIGN

Forty-six adults with massive rotator cuff tears, randomly assigned to 2 groups (23 electromyographic biofeedback group vs. 23 control group). The electromyographic biofeedback group (experimental group) performed the exercises under the guidance of electromyographic biofeedback, unlike the control group. All patients underwent a 45-minute training session a day, 3 times a week over a 6-wk duration, and followed up until 1-year. The outcome measures were American Shoulder and Elbow score, shoulder flexion strength, shoulder range of motion, Numeric Pain Rating Scale, and Global Rating of Change Scale.

RESULTS

Compared with the control group, the electromyographic biofeedback group demonstrated a significant change in shoulder flexion strength and patient satisfaction from baseline to 6 wks (posttraining) and from baseline to 12-mo follow-up ( F = 4.671, P = 0.005). There were significant improvements in within groups statistics for American Shoulder and Elbow score, shoulder flexion strength, shoulder range of motion, and Numeric Pain Rating Scale in both groups ( P < 0.05).

CONCLUSIONS

The results demonstrate that deltoid-focused structured rehabilitation program combined with electromyographic biofeedback can be used to increase shoulder flexion strength and patient satisfaction in conservative treatment of massive rotator cuff tear.

Is shoulder joint position sense affected in partial and full-thickness supraspinatus tears?

PURPOSE

Neuromuscular control is important for joint stabilization. Supraspinatus muscle plays an essential role in the perception of proprioceptive sense. The aim of this study is to investigate active joint position sense (AJPS) both in patients with partial and full-thickness supraspinatus tears and in healthy participants.

METHODS

Twenty patients with partial supraspinatus tears, 20 patients with full-thickness supraspinatus tears, and 20 healthy participants, aged 40-65 years, were included in the study. Proprioceptive sense was assessed with AJPS measurement. Absolute error was calculated to evaluate joint position sense.

RESULTS

Active joint position sense was decreased in partial and full-thickness tears on both in affected and contralateral shoulders compared to control group (p < 0.05). There was no difference between groups with partial and full-thickness tears on the affected and contralateral shoulders at 40° and 100° elevation (p > 0.05).

CONCLUSION

AJPS was affected after supraspinatus injury. It was seen as proprioceptive deficit in patients with partial and full-thickness tears in both affected and contralateral shoulders.

The effect of postoperative sling immobilization and early mobilization on clinical and functional outcomes after arthroscopic rotator cuff repair: A propensity score-matched analysis

BACKROUND

Optimal postoperative management is controversial after arthroscopic rotator cuff repair (ARCR).

OBJECTIVE

The aim of the study was to evaluate outcomes of patients with and without postoperative sling immobilization after undergoing arthroscopic RCR rotator cuff repair.

METHOD

369 arthroscopic full thickness superior rotator cuff tears (RCT) with a minimum follow-up of 6 months were included in this study. Propensity score matching was performed for age, sex, BMI, and tear size. Pain (VAS score), shoulder range of motion (ROM), functional outcome (ASES, Constant-Murley [CM] and Oxford shoulder score [OSS]), and health related quality of life (SF-36) scores were compared between patients with and without sling immobilization.

RESULTS

According to the propensity match score, 92 patients (50 sling immobilization and 42 no sling immobilization) were matched to be almost identical in age (62.5 ± 8.0 vs. 61.8 ± 5.9), sex (female 78% vs. 76.2%), BMI (28.1 ± 2.8 vs. 27.8 ± 2.6), and tear size (2.7 ± 1.1 vs. 2.9 ± 0.8). The postoperative physical functioning domain of SF-36 scores was found to be significantly higher in the no sling group (p= 0.034).

CONCLUSION

Early mobilization after arthroscopic small and medium sized full thickness superior rotator cuff repair is associated with improved ROM and quality of life scores.

Validity and Reliability of the Turkish Version of Western Ontario Osteoarthritis of the Shoulder Index

Objectives

This study aims to adapt the Western Ontario Osteoarthritis of the Shoulder (WOOS) index specific to shoulder osteoarthritis into Turkish and to evaluate its validity and reliability.

Patients and methods

The WOOS index was translated and culturally adapted into Turkish, systematically. It was applied to a total of 68 patients (17 males, 51 females; mean age: 61.5±8.7 years; range, 45 to 80 years) with osteoarthritis of the shoulder treated conservatively. The reliability of the scale was checked through internal consistency and test-retest methods. Internal consistency was analyzed with Cronbach alpha value. Test-retest reliability was assessed using an intraclass correlation coefficient (ICC) with 25 patients. The Western Ontario Rotator Cuff (WORC), the Shoulder Pain and Disability Index (SPADI), and the Society of American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) scores were used to conduct concurrent validity.

Results

The Cronbach alpha value of the scale was found to be excellent as 0.92 (p<0.001). The ICC value was also excellent as 0.97 (p<0.001). There was an excellent positive correlation with WORC (0.847; p<0.001) and a very good positive correlation with SPADI (0.788; p<0.001). It was also negatively very good to correlate with the ASES (-0.754; p<0.001). Additionally, subsections of WOOS had a good correlation with the corresponding subsections of WORC (0.779-0.664; p<0.001).

Conclusion

The Turkish version of the WOOS index is a valid and reliable tool and is recommended for use in the assessment of patients with osteoarthritis of the shoulder.

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

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

Translation, cross-cultural adaptation, reliability, and validity of Turkish version of the university of California Los Angeles (UCLA) shoulder scale into Turkish

PURPOSE

To translate and culturally adapt the University of California Los Angeles (UCLA) shoulder scale into Turkish (T-UCLA) and determine its psychometric properties.

MATERIAL AND METHODS

The UCLA scale was translated into Turkish using Beaton guidelines. Ninety-one patients (46 male; mean age: 46.0 ± 13.7 years) with shoulder disorders completed T-UCLA and American Shoulder and Elbow Score (ASES), Simple Shoulder Test (SST) and 36-Item Short Form (SF-36). Test-retest reliability was tested in 50 patients at a mean of 5.2 ± 2.2 days after initial assessment. Validity was evaluated in 91 patients, and correlations between ASES, SST and SF-36 were analyzed. Responsiveness was assessed in 33 patients who underwent arthroscopic rotator cuff repair with a mean follow-up of 12.8 ± 0.5 months.

RESULTS

Test-retest reliability of overall T-UCLA, pain and function subscales were 0.96, 0.94 and 0.86, respectively. The correlation coefficients between T-UCLA and SST and ASES were r = 0.752 and r = 0.783, respectively (p < 0.001). The highest correlations between T-UCLA and SF-36 were observed in physical functioning (r = 0.64) and bodily pain subscales (r = 0.66). No ceiling or floor effect observed. Overall and subscales of T-UCLA were highly responsive (ES = 3.22-4.31).

CONCLUSION

T-UCLA has sufficient reliability and validity similar to original and translated versions. T-UCLA is responsive in patients who underwent rotator cuff repair.Implications for rehabilitationIn this study, Turkish version of the UCLA was found to be a reliable and valid outcome measure in patients with various shoulder pathologies.Turkish version of the UCLA is a very responsive tool in patients with who underwent arthroscopic repair of rotator cuff tears.

The Chinese version of the American shoulder and elbow surgeons standardized shoulder assessment form questionnaire, patient self-report section: a cross-cultural adaptation and validation study

Background

The patient self-report section of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASESp) is one of the most validated and reliable assessment tools. This study aimed to establish a validated Chinese version of ASESp (ASESp-CH).

Methods

A clinical prospective study was performed (ClinicalTrials.gov Identifier: NCT04755049; registered on 2021/02/11). Following the guidelines of forward-backward translation and cross-cultural adaptation, a Chinese version of ASESp was established. Patients older than 18 years with shoulder disorders were included. Patients who could not complete test-retest questionnaires within the interval of 7–30 days and patients who received interventions were excluded. Intraclass correlation (ICC) was calculated for test- retest reliability, whereas internal consistency was determined by Cronbach value. Construct validity was evaluated by comparing the corresponding domains between the ASESp-CH and a validated Chinese version of 36-Item Short Form Health Survey (SF-36).

Results

A total of 86 patients were included with a mean test-retest interval of 12 ± 5.4 days. Test-retest reliability was excellent with an ICC of 0.94. Good internal consistency was found, with a Cronbach alpha of 0.86. Construct validity of the ASESp-CH questionnaire was good. The major domains of the ASESp-CH were significantly correlated with the respective domains in the SF-36 (p <  0.01), except for the domain of stability of ASESp-CH.

Conclusions

The Chinese version of ASESp questionnaire is a highly validated and reliable tool for shoulder disorder assessment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04255-z.

Spanish translation and cross-language validation of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form

BACKGROUND

The American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form is one of the most frequently used outcomes score for shoulder pathology. The patient report section of the ASES questionnaire (p-ASES) is easy to complete, can be quickly administered, and is applicable to a wide range of shoulder pathologies, yet a validated Spanish translation of this questionnaire does not currently exist for diverse Spanish-speaking populations. The purpose of this study was to translate and culturally adapt the patient report section of the ASES to Spanish and to assess its validity and reliability among a culturally diverse group of Spanish-speaking patients, typically seen in the United States.

METHODS

The p-ASES Standardized Shoulder Assessment Form was translated into Spanish using a universal approach for translation and cultural adaptation of instruments. A total of 127 Spanish-speaking patients with shoulder pain were included in the study and asked to complete the Spanish translated p-ASES form, the Patient-Reported Outcomes Measurement Information System (PROMIS) v1.2 Physical Function SF 20a in Spanish and a demographics questionnaire. Construct validity was tested using correlational analysis between the Spanish translation of the p-ASES to the Spanish translation of the PROMIS v1.2 Physical Function Short Form 20a. Reliability was measured using both test-retest reliability and internal consistency (Cronbach α) in a subgroup of 27 patients who completed both surveys at a separate time point.

RESULTS

The p-ASES demonstrated desirable convergent validity with the validated Spanish version of the PROMIS v1.2 Physical Function Short Form 20a with a strong correlation (r = 0.82, P < .04) for Spanish speakers. The Spanish translation of the p-ASES proved to be a reliable tool with a high degree of internal consistency across question items (α = 0.90). The Spanish p-ASES also demonstrated excellent test-retest reliability with a strong correlation (r = 0.87, P < .001) between time 1 and time 2.

CONCLUSION

The Spanish p-ASES is both a valid and reliable tool for assessing shoulder function in Spanish-speaking patients from diverse cultural backgrounds and it demonstrates psychometric properties equivalent to those of the English-language version.

Comparison of mobilization with supervised exercise for patients with subacromial impingement syndrome

Objectives

This study aims to investigate the effects of joint mobilization with supervised exercise in patients with subacromial impingement syndrome (SAIS).

Patients and methods

This prospective, randomized-controlled study included a total of 40 patients (18 males, 22 females; mean age 43.52 years; range, 27 to 67 years) with SAIS of more than six weeks between June 2014 and June 2015. The patients were randomly allocated into two groups: Group 1 (n=20) received joint mobilization and neuromuscular electrical stimulation and Group 2 (n=20) received a supervised exercise program and neuromuscular electrical stimulation. The outcome measures included the range of motion, pain intensity, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form-patient self-report section, Short Form-36, and Global Rating of Change Questionnaire. Pain was evaluated using the visual analog scale (VAS).

Results

In both groups, the mean VAS scores significantly decreased and the range of motion significantly increased after treatment (p<0.05). Both joint mobilization and supervised exercise combined with neuromuscular electrical stimulation led to a significant improvement in function in patients with SAIS (p<0.05), although it did not significantly differ between the groups (p>0.05). Patient satisfaction with treatment was similar in both groups (p=0.28).

Conclusion

Based on our study results, mobilization and supervised exercise yield comparable outcomes in patients with SAIS.

Validation of a Mobile Version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form: An Observational Randomized Crossover Trial

Background

The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) questionnaire is an effective tool for evaluating shoulder joint function. The development and usage of a mobile version of the ASES questionnaire has the potential to save time, money, and effort.

Objective

The aim of this study is to assess the equivalence between the paper and mobile versions of the ASES questionnaire and their acceptability among patients.

Methods

The paper and mobile versions of the ASES questionnaire were used to evaluate the shoulder joint function of 50 patients with shoulder pain. This study included patients from the shoulder clinic of Sun Yat-sen Memorial Hospital. The intraclass correlation coefficient (ICC) and Bland-Altman method were used to evaluate the agreement (reliability) of the scores obtained by the two methods (paper versus mobile).

Results

Of the 50 patients recruited from March 2018 to May 2019, 46 (92%) completed the study. There was a high agreement between the paper and mobile versions of the ASES questionnaire (ICC=0.979, 95% CI 0.943-0.987; P<.001). The mean difference between the scores of the mobile and paper versions was 1.0, and only 1/46 (2%) had a difference greater than the minimal clinically important difference of 12 points. About 75% of patients preferred the mobile version to the paper version.

Conclusions

Our study shows that the mobile version of the ASES questionnaire is comparable to the paper version, and has a higher patient preference. This could prove to be a useful tool for epidemiological studies and patient follow-up over longer periods of time.

Validity and Reliability of the Turkish Version of LHB Score

INTRODUCTION

Long head of biceps (LHB) pathologies are an important cause of pain and dysfunction. As LHB pathologies have specific components from other underlying or related pathologies, the LHB score is designed for an accurate assessment. The aim of this study was to adapt the LHB score into Turkish and to assess its validity and reliability.

MATERIALS AND METHODS

LHB score was translated and culturally adapted from English to Turkish, and then it was applied to 62 patients with biceps long head pathology. The reliability of the scale was checked through internal consistency and test-retest methods. Internal consistency was computed with Cronbach alpha value. Test-retest reliability was assessed using an intraclass correlation coefficient. American Shoulder and Elbow Surgeons Standard Shoulder Assessment Form and modified Constant-Murley score were used to analyze concurrent validity.

RESULTS

The Cronbach alpha value of the scale was found as .640. When the subsections of LHB score were computed separately, Cronbach alpha levels of pain/cramps and cosmesis sections were found as .753 and .774, respectively. The intraclass correlation coefficient value of the scale was found to be excellent (.940; P < .001). The total LHB score was determined to have a good positive correlation with the American Shoulder and Elbow Surgeons Standard Shoulder Assessment Form (.527) and Constant-Murley score (.516). But an excellent correlation was revealed between the pain/cramps section of LHB score and other pain sections in American Shoulder and Elbow Surgeons Standard Shoulder Assessment Form (.811) and Constant-Murley score (.816) (P < .001). There was an excellent correlation (.916) between cosmesis section and Popeye sign (P < .001). There was a moderate correlation (.469) between elbow-flexion strength section of LHB score and the digital handheld dynamometer outcomes (P < .001).

CONCLUSION

The Turkish version of the LHB is a valid and reliable tool, especially for biceps pathologies.

Cross-cultural adaptation and validation of the Argentine "American Shoulder and elbow surgeons, patient self-report section" questionnaire

BACKGROUND

American Shoulder and Elbow Surgeons questionnaire (ASES-p) has been translated into Spanish, but it has not been adapted to the Argentine population yet. Although Spain and Argentina speak the same language, linguistic differences between Spanish-speaking countries may affect the interpretation of the different items included in the questionnaire.

OBJECTIVE

To conduct the translation, cross-cultural adaptation and validation of the self-report section of the ASES-p into Argentine Spanish for patients with musculoskeletal shoulder disorders, and to assess its psychometric properties.

DESIGN

Study of diagnostic accuracy/assessment scale.

METHOD

The study was carried out in three consecutive phases: translation, cross-cultural adaptation and validation for its use in Argentina. In the third phase, we used the ASES-p, Short Form 36 (SF-36), EuroQol-5D (EQ-5D), and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, and the Global Rating of Change (GROC) scale.

RESULTS

One hundred three participants completed a set of questionnaires on two occasions and were included in the final analysis. The time taken to answer and score the questionnaire was 118 and 52 s, respectively. Neither a ceiling nor a floor effect was observed. Cronbach's alpha coefficient was 0.85. Intraclass correlation coefficient was 0.83. A significant correlation was found between the DASH, the GROC and various SF-36 subscales. There were strong indices of concurrent-cross validation, longitudinal validity, and construct validity. The ASES-p questionnaire showed a minimal clinically important difference (MCID) value of 7.88 points.

CONCLUSION

Some psychometric properties in reliability and validity were acceptable in the Argentine version of the ASES-p questionnaire.

The Dutch version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form is a reliable and valid questionnaire for shoulder problems

Background

The self-assessment section of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASESq) is one of the most used patient-reported outcome measures for general shoulder problems. This study was performed to establish a valid Dutch version of the ASESq (ASESq-NL).

Materials and Methods

A clinical prospective, nonrandomized study was performed. Translation of the ASESq into Dutch was done following the guidelines of cross-cultural adaptation. Patients older than 17 years of age with shoulder problems were included. Patients who declined to participate or insufficiently completed questionnaires were excluded. For test-retest reliability analysis, the intraclass correlation coefficient (ICC) was calculated and an interval of 7-28 days between test and retest was set. Cronbach alpha was used to determine internal consistency. Dutch validated versions of the Shoulder Pain and Disability Index (SPADI) and 36-Item Short Form Health Survey (SF-36) were completed and compared with the ASESq-NL to evaluate construct validity using a Spearman rank correlation coefficient calculation.

Results

A total of 92 patients were included. Test-retest reliability was excellent with an ICC of 0.82. The mean test-retest interval was 13 days (standard deviation 4.4). Internal consistency was good, with a Cronbach alpha of 0.83. Construct validity of the ASES questionnaire was good. All domains of the ASESq-NL had significant (P < .05) correlations with the domains of the SPADI and the SF-36, except for the SF-36 domains stability with “physical function and energy" and "emotional well-being.”

Conclusion

The Dutch ASES questionnaire is a valid and reliable tool for the evaluation of shoulder problems and is permissible for implementation into the Dutch health care system.

The effectiveness of trigger point treatment in rotator cuff pathology: A randomized controlled double-blind study

BACKGROUND

Studies have emphasized the importance of the presence of myofascial trigger points (MTrPs) in patients with rotator cuff pathologies and the high frequency of MTrPs in rotator cuff muscles.

OBJECTIVE

Evaluate the effectiveness of the treatment of active MTrPs in patients with rotator cuff pathologies.

METHODS

Fifty-three patients with rotator cuff tear were randomized into two groups. All patients received the same standard conservative treatment twice a week for 6 weeks. Patients in Group 1 additionally received ischemic compression (IC) of MTrPs. Pain, range of motion (ROM), function, and anxiety and depression were assessed. MTrPs in rotator cuff muscles were assessed manually, and the number of MTrPs on the shoulder complex was counted.

RESULTS

There were no significant differences between the groups in terms of changes in resting/activity/night pain, ROM, function, or anxiety and depression (p> 0.05). Pain scores improved only in Group 1. However, the total number of MTrPs was significantly decreased in Group 1 (p= 0.001).

CONCLUSION

A six-week course of IC helps treat active MTrPs. A standard conservative treatment program reduced pain and increased function; the addition of MTrP treatment did not improve clinical outcomes in patients with rotator cuff pathologies.

Test-retest reliability of the ASES-p shoulder scale

INTRODUCTION

Shoulder disorders are common musculoskeletal problems. The self-assessed ASES questionnaire (ASES-p) is one of the most widely used tools for evaluating shoulder function. Its 11 items are divided in a function (10 items) and pain (1 item) dimension, assigned between 0 and 50 points each. Their sum is the scale's total score, with higher values indicating better health status. The current work explores the test-retest reliability of the Spanish version of the ASES-p score values.

MATERIALS AND METHODS

The scale was administered twice to a sample of subjects with various shoulder pathologies, via telephone interviews performed at 3-7 days apart. Exact agreement was calculated on an item and score basis. Score variability was assessed with the 95% limits of agreement method (LoA).

RESULTS

N = 161 subjects were initially contacted, and a total of 82 stable health status subjects provided valid test-retest replies. "Do usual sport" was the only item with missing data. Exact agreement oscillated between 67 and 89% per item. The 95% LoA ranged between -5.9 and 6.9 points for function; -13.2 to 11.9 for pain and -10.3 to 10.1 for the total ASES-p score.

CONCLUSIONS

Test-retest reliability in stable patients was considered acceptable for the function and total scores, but not for pain. This may reflect usual pain behaviour, but it also implies that the pain evaluation should be further studied. The ASES-p pain subscore should not be used as the single measure for monitoring shoulder pain. Revisiting the "do usual sports" item may increase the scale's applicability.

Does the patients' expectations on kinesiotape affect the outcomes of patients with a rotator cuff tear? A randomized controlled clinical trial

OBJECTIVE:

To investigate the effect of setting expectations verbally on the effectiveness of kinesiotape application in patients with a rotator cuff tear.

DESIGN:

Randomized controlled, double-blind study.

SETTING:

Department of Physiotherapy and Rehabilitation.

SUBJECTS:

Eighty-nine patients with rotator cuff tear.

INTERVENTION:

Patients were randomized according to the verbal input given to patients about the effectiveness of kinesiotaping; Group 1 (there is no evidence that kinesiotaping is effective), Group 2 (there is limited evidence that kinesiotaping is effective), and Group 3 (there is evidence that kinesiotaping has an excellent effect).

MAIN MEASURES:

Resting pain, activity pain, and night pain were assessed by visual analog scale. Range of motion was assessed by a universal goniometer. Function was evaluated by the Disabilities of the Arm, Shoulder and Hand Questionnaire and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form before and 24 hours after kinesiotape application. Only resting pain and activity pain were assessed after 30 minutes.

RESULTS:

There were no statistically significant differences (ANOVA) between any groups at the three assessment points. The intragroup assessment showed that in Group 2, only resting pain after 30 minutes improved (3.2 ± 2.9 to 2.6 ± 2.8; P  = 0.02 ). An improvement in resting pain both after 30 minutes and after 24 hours was found in the third group (4.1 ± 2.4 to 2.3 ± 2.3, P  = 0.001; 4.1 ± 2.4 to 2.2 ± 2.3, P  = 0.001, respectively). Activity pain and night pain were improved in all groups after 24 hours.

CONCLUSION:

Setting positive expectations verbally about kinesiotaping might be effective in reducing pain in patients with rotator cuff tear.

Cross-cultural adaptation of Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score: Reliability and validity in Turkish-speaking overhead athletes

OBJECTIVE

Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES) is a subjective assessment tool to measure functional status of the upper extremities in overhead athletes. The aim was to translate and culturally adapt the KJOC-SES and to evaluate the psychometric properties of the Turkish version (KJOC-SES-Tr) in overhead athletes.

METHODS

The forward and back-translation method was followed. One hundred and twenty-three overhead athletes completed the KJOC-SES-Tr, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the American Shoulder and Elbow Surgeons Evaluation Form (ASES). Participants were assigned to one of the following subgroups: asymptomatic (playing without pain) or symptomatic (playing with pain, or not playing due to pain). Internal consistency, reliability, construct validity, discriminant validity, and content validity of the KJOC-SES-Tr were tested.

RESULTS

The test-retest reliability of the KJOC-SES-Tr was excellent with an interclass coefficient of 0.93. There was a strong correlation between the KJOC-SES-Tr and the DASH and the ASES, indicating that the construct validity was good for all participants. Results of the KJOC-SES-Tr significantly differed between different subgroups and categories of athletes. The floor and ceiling effects were acceptable for symptomatic athletes.

CONCLUSION

The KJOC-SES-Tr was shown to be valid, reliable tool to monitor the return to sports following injuries in athletes.

Clinical rating systems in elbow research-a systematic review exploring trends and distributions of use

BACKGROUND

Clinical rating systems are used as outcome measures in clinical trials and attempt to gauge the patient's view of his or her own health. The choice of clinical rating system should be supported by its performance against established quality standards.

METHODS

A search strategy was developed to identify all studies that reported the use of clinical rating systems in the elbow literature. The strategy was run from inception in Medline Embase and CINHAL. Data extraction identified the date of publication, country of data collection, pathology assessed, and the outcome measure used.

RESULTS

We identified 980 studies that reported clinical rating system use. Seventy-two separate rating systems were identified. Forty-one percent of studies used ≥2 separate measures. Overall, 54% of studies used the Mayo Elbow Performance Score (MEPS). For arthroplasty, 82% used MEPS, 17% used Disabilities of Arm, Shoulder and Hand (DASH), and 7% used QuickDASH. For trauma, 66.7% used MEPS, 32% used DASH, and 23% used the Morrey Score. For tendinopathy, 31% used DASH, 23% used Patient-Rated Tennis Elbow Evaluation (PRTEE), and 13% used MEPS. Over time, there was an increased proportional use of the MEPS, DASH, QuickDASH, PRTEE, and the Oxford Elbow Score.

CONCLUSIONS

This study identified a wide choice and usage of clinical rating systems in the elbow literature. Numerous studies reported measures without a history of either a specific pathology or cross-cultural validation. Interpretability and comparison of outcomes is dependent on the unification of outcome measure choice. This was not demonstrated currently.

Patient self-report section of the ASES questionnaire: a Spanish validation study using classical test theory and the Rasch model

Background

The aim of the current study was to validate the self-report section of the American Shoulder and Elbow Surgeons questionnaire (ASES-p) into Spanish.

Methods

Shoulder pathology patients were recruited and followed up to 6 months post treatment. The ASES-p, Constant, SF-36 and Barthel scales were filled-in pre and post treatment. Reliability was tested with Cronbach’s alpha, convergent validity with Spearman’s correlations coefficients. Confirmatory factor analysis (CFA) and the Rasch model were implemented for assessing structural validity and unidimensionality of the scale. Models with and without the pain item were considered. Responsiveness to change was explored via standardised effect sizes.

Results

Results were acceptable for both tested models. Cronbach’s alpha was 0.91, total scale correlations with Constant and physical SF-36 dimensions were >0.50. Factor loadings for CFA were >0.40. The Rasch model confirmed unidimensionality of the scale, even though item 10 “do usual sport” was suggested as non-informative. Finally, patients with improved post treatment shoulder function and those receiving surgery had higher standardised effect sizes.

Conclusions

The adapted Spanish ASES-p version is a valid and reliable tool for shoulder evaluation and its unidimensionality is supported by the data.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-016-0552-1) contains supplementary material, which is available to authorized users.

Factors Affecting Functional Outcomes After Clavicle Fracture

INTRODUCTION

This study evaluated the effects that patient demographics, injury, and social characteristics have on functional outcomes after clavicle fracture.

METHODS

After a mean follow-up of 56 months, 214 patients with a mean age of 44.4 years completed the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form. The effects that age, sex, fracture location, open fracture, associated injuries, tobacco use, employment status, and timing of surgery had on functional outcomes were assessed.

RESULTS

The mean ASES score for the entire group of 214 patients was 80.5. Seventy-seven patients (36%) were treated surgically and 137 patients (64%) were treated nonsurgically. The mean ASES scores were 84.0 and 78.5, respectively, in the surgical and nonsurgical groups (P = 0.06). Patients with lateral fractures who were treated surgically had better ASES scores than those treated nonsurgically (91.3 versus 72.7, P = 0.011); this was also true of patients with isolated fractures (P = 0.02). Smokers in the surgical and nonsurgical groups had scores of 74.1 and 83.6, respectively (P = 0.003). Patients who were unemployed had the worst ASES scores regardless of surgical or nonsurgical treatment (70.5 and 86.1, respectively; P < 0.001). Surgical timing was not related to outcome; no difference in ASES scores was noted in patients treated surgically within ≤10 weeks versus those treated after 10 weeks after injury and in those treated within <20 weeks versus those treated >20 weeks after injury (both, P > 0.34).

DISCUSSION

We identified factors associated with better functional outcomes, which could aid in developing treatment recommendations. Additionally, initial nonsurgical management of clavicle fractures may be reasonable because patients had similar functional outcomes even when surgery was delayed.

LEVEL OF EVIDENCE

Level III retrospective comparative study.

Reliability and validity of the Finnish version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section

Background

The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) is one of the most widely used shoulder outcome tools in clinical work and in scientific studies. However, it has not been validated in the Finnish language. The aims of this study were to cross-culturally adapt the ASES to the Finnish language and to study the psychometric properties of the self-report section of the ASES.

Methods

A total of 105 patients with shoulder symptoms answered the questionnaires of the ASES, a single disability question, the Simple Shoulder Test (SST), and the Short-Form 36 Health Survey (SF-36). The reliability of the ASES questionnaire was studied using a test-retest procedure at 2-week intervals. Psychometric assessment was performed by testing the construct validity, internal consistency, the criterion validity, and the convergent validity of the ASES.

Results

The reproducibility and internal consistency of the ASES were 0.83 (95% CI 0.70 to 0.90) and 0.88 (95% Cl 0.84 to 0.91). There were no significant differences between the diagnostic groups in the pain scores from the ASES, and the function score was significantly higher in the instability group compared to the other groups. The convergent validity of the ASES correlated with the SST, r = 0.73 (p < 0.001); the single disability question, r = -0.74 (p < 0.001); and the Physical Component Score of the SF-36, r = 0.57 (p < 0.001).

Conclusions

The Finnish version of the ASES proved to be a reliable and valid tool for assessing shoulder disabilities in patients with different shoulder diagnoses, including rotator cuff disease, instability, and osteoarthritis.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-272) contains supplementary material, which is available to authorized users.

Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence

BACKGROUND

The aim of this study was to perform a standardized and systematic evaluation of the available evidence on multi-item shoulder-specific patient-reported outcome measures that are applicable to a wide spectrum of disorders.

MATERIALS AND METHODS

A systematic review was conducted in PubMed to identify articles with information regarding the development process, metric properties, and administration issues of shoulder-specific patient-reported outcome measures. Two experts independently reviewed all the articles identified for one instrument and applied the EMPRO (Evaluating Measures of Patient Reported Outcomes) tool, which was designed to assess the quality of attributes in a standardized way. An overall EMPRO score and 6 attribute-specific scores were calculated (range, 0-100) to describe the quality of instrument performance.

RESULTS

We identified 11 instruments and 112 articles (2-30 articles per instrument). The American Shoulder and Elbow Surgeons (ASES) shoulder assessment, Simple Shoulder Test (SST), and Oxford Shoulder Score (OSS) were the best rated, with overall scores of 77.4 points, 72.6 points, and 69.7 points, respectively. They have been shown to be valid, reliable, and responsive, with a low administration burden. Acceptable results were also found for the Flexilevel Scale of Shoulder Function, Shoulder Pain and Disability Index, and Dutch Shoulder Disability Questionnaire, but some of their attributes need further evaluation.

CONCLUSIONS

Current evidence supports the use of the ASES, SST, or OSS. We recommend the SST for longitudinal studies or clinical trials, the Dutch Shoulder Disability Questionnaire for clinical practice to minimize administration burden, and the ASES or OSS to discriminate among patients' or groups' evaluations at one point of time.