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Pantouveris M, Kotsifaki R, Whiteley R. Inclinometers and Apps Are Better than Goniometers, Measuring Knee Extension Range of Motion in Anterior Cruciate Ligament Patients: Reliability and Minimal Detectable Change for the Three Devices. J Knee Surg 2024; 37:821-827. [PMID: 38714213 DOI: 10.1055/a-2321-0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
Knee extension range of motion (ROM) measurement is important in patients with anterior cruciate ligament (ACL) injury. The main objective is to evaluate the reliability and the minimal detectable change (MDC) of three methods of measuring knee extension ROM in ACL patients. The three common goniometric devices were a universal goniometer, an inclinometer, and a smartphone app. During a single-visit, knee extension ROM was measured in both knees of 92 ACL-injured or -reconstructed patients by two testers blinded to the other's measures. Intrarater, interrater, and test-retest intraclass correlation coefficients (ICC2,1) were calculated. Intrarater ICC2,1 was excellent for the three devices ranging from 0.92 to 0.94, with the inclinometer yielding the best results (ICC2,1 = 0.94 [95% confidence interval, CI: 0.91-0.96]). Interrater ICC2,1, however, varied from 0.36 to 0.80. The inclinometer and the smartphone app yielded similar results 0.80 (95% CI: 0.71-0.86) and 0.79 (95% CI: 0.70-0.86), respectively, whereas the universal goniometer was 0.36 (95% CI: 0.17-0.53). Test-retest ICC2,1 for the inclinometer was 0.89 (95% CI: 0.84-0.93), 0.86 (95% CI: 0.79-0.91) for the app, and 0.83 (95% CI:0.74-0.89) for the goniometer. The intrarater, interrater, and test-retest MDC95 values ranged from 2.0 to 3.5, 3.7 to 10.4, and 2.6 to 5.4 degrees, respectively. The goniometer was the least reliable. The inclinometer is the recommended device due to its highest ICC scores among the three devices and ease of use.
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Affiliation(s)
- Michail Pantouveris
- Rehabilitation Department, Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Roula Kotsifaki
- Rehabilitation Department, Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Rodney Whiteley
- Rehabilitation Department, Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Ucero-Lozano R, Pérez-Llanes R, Cuesta-Barriuso R, Donoso-Úbeda E. Immersive visualization of movement in patients with hemophilic ankle arthropathy. Multicenter, single-blind, randomized clinical trial. J Rehabil Med 2024; 56:jrm40775. [PMID: 39347694 DOI: 10.2340/jrm.v56.40775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 09/08/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy of immersive movement observation in adult patients with haemophilic ankle arthropathy. DESIGN Multicentre, single-blind, randomized clinical trial. SUBJECTS 48 patients with haemophilia. METHODS Patients were randomly allocated to 2 groups (180º immersive video-based visualization of movement and a control group with no intervention). Twenty-eight consecutive 15-min home sessions, 1 per day, of immersive visualization of ankle flexion-extension movement were carried out. Three evaluations were performed: pretreatment (T0), post-intervention (T1), and at 16 weeks' follow-up (T2). The primary variable was joint-pain intensity (visual analogue scale). The secondary variables were conditioned pain modulation (Conditioned Pain Modulation Index), pressure pain threshold (pressure algometer), range of motion (goniometry) and kinesiophobia (Tampa Scale of Kinesiophophia). RESULTS There were intergroup differences in pain intensity (F = 37.14; p < 0.001), conditioned pain modulation (F = 5.40; p = 0.006), and dorsal (F = 19.17; p < 0.001) and plantar (F = 9.27; p<0.001) ankle flexion. More than 50% of experimental group patients exhibited changes exceeding the minimum detectable change in pain intensity (MDC = 0.43), and the pressure pain threshold in the extensor carpi radialis longus muscle (MDC = 1.34) and malleolus (MDC = 4.93). CONCLUSIONS 180º immersive video-based visualization of movement can improve the intensity of pain, conditioned pain modulation, and ankle range of motion in patients with haemophilic ankle arthropathy.
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Affiliation(s)
- Roberto Ucero-Lozano
- Department of Physiotherapy, European University of Madrid, Madrid, Spain; InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
| | - Raúl Pérez-Llanes
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain; Department of Physiotherapy, University of Murcia, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain; Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain.
| | - Elena Donoso-Úbeda
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain; Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
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Ucero-Lozano R, Donoso-Úbeda E, Cuesta-Barriuso R, Pérez-Llanes R. Immersive VR movement visualization in patients with hemophilic knee arthropathy: randomized, multicenter, single-blind clinical trial. Disabil Rehabil 2024:1-8. [PMID: 39244653 DOI: 10.1080/09638288.2024.2401138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 08/30/2024] [Accepted: 08/31/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE To evaluate the efficacy of an immersive movement visualization intervention in patients with hemophilia and hemophilic knee arthropathy. MATERIALS AND METHODS Randomized, single-blind clinical study. Twenty-eight patients with hemophilia were recruited. Patients were randomized to an experimental group (four weeks of immersive movement visualization) and a control group (no intervention). The intensity of pain, pressure pain threshold in the knee, tibialis anterior muscle, lower back level, conditioned pain modulation, range of knee motion, and lower limb functionality were evaluated. RESULTS There were statistically significant differences in the intergroup effect on knee pain intensity (F = 23.71; p < 0.001) and lower limb functionality (F = 7.11; p = 0.003). 42.86% of the patients in the experimental group exhibited changes greater than the minimum detectable change (MDC) in functionality. 39.29% of the patients subject to the intervention experienced changes greater than the MDC in the knee pressure pain threshold. CONCLUSIONS Immersive motion visualization can improve the intensity of joint pain and functionality in patients with hemophilic knee arthropathy. Functionality, pressure pain threshold, and pain intensity improved in those patients who conducted immersive movement visualization.Implications for rehabilitationImmersive visualization of movement significantly improves intensity of joint pain, functionality, pressure pain threshold, joint health, and conditioned pain modulation in patients with hemophilic knee arthropathy.The fact that it is a therapy without potential aversive stimuli makes it a possible access pathway for patients with high levels of kinesiophobia and/or catastrophism.This low-cost, home-based technology allows its use in patients far from hemophilia reference centers or with difficult access to physiotherapy treatments.The immersive visualization of movement influences the democratization of treatment, in accordance with the WHO's Sustainable Development Goal 3 (health and well-being for all).
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Affiliation(s)
- Roberto Ucero-Lozano
- Department of Physiotherapy, European University of Madrid, Madrid, Spain
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
| | - Elena Donoso-Úbeda
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
- Department of Physiotherapy, Catholic University San Antonio-UCAM Murcia, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain
| | - Raúl Pérez-Llanes
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
- Department of Physiotherapy, University of Murcia, Murcia, Spain
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Jacob L, Lasbleiz S, Sanchez K, Morchoisne O, Lefèvre-Colau MM, Nguyen C, Rannou F, Feydy A, Portal JJ, Schnitzler A, Vicaut E, Laredo JD, Richette P, Orcel P, Beaudreuil J. Arthro-distension with early and intensive mobilization for shoulder adhesive capsulitis: A randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101852. [PMID: 38824872 DOI: 10.1016/j.rehab.2024.101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND There are several therapeutic options for the management of shoulder adhesive capsulitis (AC). The superiority of arthro-distension over intra-articular steroid injection (ISI) for AC remains controversial. OBJECTIVES To evaluate the efficacy of a single arthro-distension procedure combined with early and intensive mobilization (ADM) and physiotherapy, versus ISI and physiotherapy, in people with AC lasting ≥3 months. METHODS This was a prospective, 2 parallel-group, 2-center, observer-blind randomized controlled trial conducted in tertiary care settings. Adults with AC were randomly assigned to the treatment or control group. Efficacy was assessed using the self-administered Shoulder Pain and Disability Index (SPADI). Total, pain and disability SPADI scores 15 days, 6 weeks, and 3, 6 and 12 months after the procedure (total SPADI at 15 days: primary outcome; other outcomes were secondary) were compared between groups using analysis of covariance (ANCOVA). A post hoc analysis stratified on the initial range of passive glenohumeral abduction, which had not been pre-specified, was conducted. RESULTS There were 33 participants in each group. Both groups improved over time. Mean (SD) total SPADI score at 15 days was 33.8 (19.6) in the treatment group and 32.8 (17.5) in the control group, p = 0.393. There were no significant differences for any variables in the overall sample. The post hoc analysis found ADM to be associated with a significant decrease in total SPADI score at 15 days compared with ISI (p = 0.049) in individuals with initial passive glenohumeral abduction >45°. CONCLUSIONS The effects of ADM on pain and function were not statistically different from those of ISI. However, ADM may be useful in individuals with initial passive glenohumeral abduction >45°. DATABASE REGISTRATION NCT00724113.
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Affiliation(s)
- Louis Jacob
- Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, Paris, France; Université Paris Cité, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases (EpiAgeing), Paris, France; Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain.
| | - Sandra Lasbleiz
- Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Rheumatology, Paris, France
| | - Katherine Sanchez
- AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014, Paris, France
| | - Odile Morchoisne
- Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Rheumatology, Paris, France
| | - Marie-Martine Lefèvre-Colau
- AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014, Paris, France; AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014, Paris, France
| | - Christelle Nguyen
- Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France; AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014, Paris, France; INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, 75006 Paris, France
| | - François Rannou
- Université Paris Cité, Faculté de Santé, UFR de Médecine, 75006 Paris, France; AP-HP.Centre-Université Paris Cité, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014, Paris, France; INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, 75006 Paris, France
| | - Antoine Feydy
- Université Paris Cité, AP-HP, Cochin Hospital, Department of Musculoskeletal Radiology, Paris, France
| | - Jean-Jacques Portal
- Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Clinical Research, Paris, France
| | - Alexis Schnitzler
- Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, Paris, France; Université Paris Cité, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases (EpiAgeing), Paris, France
| | - Eric Vicaut
- Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Clinical Research, Paris, France
| | - Jean-Denis Laredo
- Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Musculoskeletal Radiology, Paris, France
| | - Pascal Richette
- Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Rheumatology, Paris, France
| | - Philippe Orcel
- Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Rheumatology, Paris, France
| | - Johann Beaudreuil
- Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, Paris, France; Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Rheumatology, Paris, France
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Karimijashni M, Ramsay T, Beaulé PE, Poitras S. Strategies to Manage Poorer Outcomes After Hip or Knee Arthroplasty: A Narrative Review of Current Understanding, Unanswered Questions, and Future Directions. Musculoskeletal Care 2024; 22:e1921. [PMID: 39075675 DOI: 10.1002/msc.1921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Although hip or knee arthroplasty is generally a successful intervention, it is documented that 15%-30% of patients undergoing arthroplasty report suboptimal outcomes. This narrative review aims to provide an overview of the key findings concerning the management of poorer outcomes after hip or knee arthroplasty. METHOD A comprehensive search of articles was conducted up to November 2023 across three electronic databases. Only studies written in English were included, with no limitations applied regarding study design and time. RESULT Efficiently addressing poorer outcomes after arthroplasty necessitates a thorough exploration of appropriate methods for assessing recovery following hip or knee arthroplasty, ensuring accurate identification of patients at risk or experiencing poorer recovery. When selecting appropriate outcome measure tools, various factors should be taken into consideration, including understanding patients' priorities throughout the recovery process, assessing psychometric properties of outcome measure tools at different time points after arthroplasty, understanding how to combine/reconcile provider-assessed and patient-reported outcome measures, and determining the appropriate methods to interpret outcome measure scores. However, further research in these areas is warranted. In addition, the identification of key modifiable factors affecting outcomes and the development of interventions to manage these factors are needed. CONCLUSION There is growing attention paid to delivering interventions for patients at risk or not optimally recovering following hip or knee arthroplasty. To achieve this, it is essential to identify the most appropriate outcome measure tools, factors associated with poorer recovery and management of these factors.
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Affiliation(s)
- Motahareh Karimijashni
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Mehta SP, Karagiannopoulos C, Pepin ME, Ballantyne BT, Michlovitz S, MacDermid JC, Grewal R, Martin RL. Distal Radius Fracture Rehabilitation. J Orthop Sports Phys Ther 2024; 54:CPG1-CPG78. [PMID: 39213418 DOI: 10.2519/jospt.2024.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Distal radius fracture (DRF) is arguably the most common upper extremity fracture resulting from a fall accident. These clinical practice guidelines (CPG) were developed to guide all aspects of the management of DRF by physical therapists and other rehabilitation practitioners, such as certified hand therapists. This CPG employed a systematic review methodology to locate, appraise, and synthesize contemporary evidence while developing practice recommendations for determining the prognosis of outcomes, examination, and interventions while managing individuals with DRF. The quality of the primary studies found in the literature search was appraised using standardized tools. The strength of the available evidence for a particular practice domain (e.g., prognosis or intervention) was graded as strong, moderate, weak, or conflicting, where such gradings guided the level of obligation for each practice recommendation. Lastly, the CPG also provided the gaps in the evidence pool for the rehabilitation of DRF that future research efforts can address. J Orthop Sports Phys Ther 2024;54(9):CPG1-CPG78. doi:10.2519/jospt.2024.0301.
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Brandl A, Wilke J, Horstmann T, Reer R, Egner C, Schmidt T, Schleip R. Quantifying thoracolumbar fascia deformation to discriminate acute low back pain patients and healthy individuals using ultrasound. Sci Rep 2024; 14:20044. [PMID: 39209953 PMCID: PMC11362488 DOI: 10.1038/s41598-024-70982-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
Reduced shear strain and deformability of the thoracolumbar fascia has been linked to low back pain. A number of ultrasound examination methods have been developed for laboratory rather than clinical practice. The aim of this study was to examine the reliability and discriminative validity (patients vs. healthy individuals) of an ultrasound (US) measurement method for the quantification of thoracolumbar fascia deformation (TLFD). A cross-sectional study with US assessment and rater blinding was conducted in a manual therapy clinic and a university laboratory. 16 acute low back pain (aLBP) patients and 15 healthy individuals performed a standardized trunk extension task. US measurements of TLFD were carried out independently by two raters by imaging the TLF in the starting and ending positions of the movement. Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients (ICCs) and minimal detectable changes (MDC) were calculated. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off for TLFD to discriminate the study groups. Kappa statistics were performed to assess rater agreement in discrimination. Intra-rater reliability was excellent (ICC: .92, MDC: 5.54 mm, p < .001) and inter-rater reliability was good (ICC: .78, MDC: 8.70 mm, p < .001). The cut-off for TLFD was 6 mm with a sensitivity of 100% and a specificity of 93.75% and the raters agreed moderately (κ = 0.74, p < .001) when distinguishing patients and controls. The reliability of the US method for assessing TLFD is moderate to excellent, and the ability to discriminate aLBP patients from healthy individuals is moderate. The method could be used to capture an additional parameter in morphological aLBP screenings.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany.
- Conservative and Rehabilitative Orthopedics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
- Vienna School of Osteopathy, Vienna, Austria.
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, Klagenfurt, Austria
| | - Thomas Horstmann
- Conservative and Rehabilitative Orthopedics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rüdiger Reer
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Christoph Egner
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
| | - Tobias Schmidt
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Robert Schleip
- Conservative and Rehabilitative Orthopedics, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
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Çelik D, Van Der Veer P, Tiryaki P. The Clinical Significance of Mulligan's Mobilization with Movement in Shoulder Pathologies: A Systematic Review and Meta-Analysis. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 39189938 DOI: 10.1089/jicm.2024.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Background: Mulligan's mobilization with movement (MWM) is a manual therapy technique designed to address musculoskeletal pain and joint mobility. Despite immediate reported improvements by patients, the clinical significance of MWM compared with other interventions remains uncertain. Objective: To assess the clinical effectiveness of MWM for shoulder pathologies compared with other treatment methods. Methods: The databases PubMed, Web of Science, Cochrane Library, Scopus, and the Physiotherapy Evidence Database (PEDro) were searched up to June 2024. Inclusion criteria were limited to randomized controlled trials published in English and Turkish languages, focusing on the MWM technique for shoulder pathologies. Two independent reviewers evaluated methodological quality based on the PEDro scale. Outcome data were analyzed for pain, function, and range of motion (ROM) using SPSS Statistics 29.0. Results: Twenty-seven studies (1157 participants) were included. MWM demonstrated statistical superiority in function (MD = -11.24, 95% CI: [-18.33, -4.16], p = 001) and shoulder flexion and abduction ROM compared with other mobilization techniques. There was a significant MD in pain intensity, which was -1.55 cm (95% CI: [-2.60, -0.51], p = 0.00), with high heterogeneity (I2 = 93%), favoring MWM in comparison with control group. MWM was significantly better for shoulder abduction ROM in comparison with physical therapy interventions (MD = -14.44, 95% CI: [1.98, 26.90], p = 0.02) with high heterogeneity (I2 = 90%) and control group (SMD = 56.67, 95% CI: [7.71, 111.63], p = 0.02) with high heterogeneity (I2 = 96%). However, clinical significance was not consistently achieved. Conclusions: Although some statistical significance was found when comparing MWM with other her treatment methods, it was observed that most of the statistically significant data did not reach clinical significance. Upon closer examination, outcome measures that showed clinical significance, either the interventions in the comparison group were inadequate, not evidence-based, or the improvements within the group were not logical.
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Affiliation(s)
- Derya Çelik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Pınar Van Der Veer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istinye University, Istanbul, Türkiye
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Pelin Tiryaki
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yalova University, Yalova, Türkiye
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Fleagle TR, Post AA, Dailey DL, Vance CG, Zimmerman MB, Bayman EO, Crofford LJ, Sluka KA, Chimenti RL. Minimal Clinically Important Change of Movement Pain in Musculoskeletal Pain Conditions. THE JOURNAL OF PAIN 2024; 25:104507. [PMID: 38479557 PMCID: PMC11283950 DOI: 10.1016/j.jpain.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
Movement pain, which is distinct from resting pain, is frequently reported by individuals with musculoskeletal pain. There is growing interest in measuring movement pain as a primary outcome in clinical trials, but no minimally clinically important change (MCIC) has been established, limiting interpretations. We analyzed data from 315 participants who participated in previous clinical trials (65 with chronic Achilles tendinopathy; 250 with fibromyalgia) to establish an MCIC for movement pain. A composite movement pain score was defined as the average pain (Numeric Rating Scale: 0-10) during 2 clinically relevant activities. The change in movement pain was calculated as the change in movement pain from pre-intervention to post-intervention. A Global Scale (GS: 1-7) was completed after the intervention on perceived change in health status. Participants were dichotomized into non-responders (GS ≥4) and responders (GS <3). Receiver operating characteristic curves were calculated to determine threshold values and corresponding sensitivity and specificity. We used the Euclidean method to determine the optimal threshold point of the Receiver operating characteristic curve to determine the MCIC. The MCIC for raw change in movement pain was 1.1 (95% confidence interval [CI]: .9-1.6) with a sensitivity of .83 (95% CI: .75-.92) and specificity of .79 (95% CI: .72-.86). For percent change in movement pain the MCIC was 27% (95% CI: 10-44%) with a sensitivity of .79 (95% CI: .70-.88) and a specificity of .82 (95% CI: .72-.90). Establishing an MCIC for movement pain will improve interpretations in clinical practice and research. PERSPECTIVE: A minimal clinically important change (MCIC) of 1.1- points (95% CI: .9-1.6) for movement pain discriminates between responders and non-responders to rehabilitation. This MCIC provides context for interpreting the meaningfulness of improvement in pain specific to movement tasks.
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Affiliation(s)
- Timothy R. Fleagle
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
| | - Andrew A. Post
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
| | - Dana L. Dailey
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
- Department of Physical Therapy, St. Ambrose University, 1320 W. Lombard St. Davenport, IA, USA 52804
| | - Carol G.T. Vance
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
| | - M. Bridget Zimmerman
- Department of Biostatistics, University of Iowa Colleges of Public Health, 145 N. Riverside Drive Iowa City, IA, USA 52242
| | - Emine O Bayman
- Department of Biostatistics, University of Iowa Colleges of Public Health, 145 N. Riverside Drive Iowa City, IA, USA 52242
- Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive 6618 John Colloton Pavillion Iowa City, IA, USA 52242
| | - Leslie J. Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Suite T-3113 Medical Center North 1161 21st Avenue South, Nashville, TN, USA 37232
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
| | - Ruth L. Chimenti
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa Carver College of Medicine, 500 Newton Road, 1-252 Medical Education Building Iowa City, IA, USA 52242
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Tran G, Hensor EMA, Kingsbury SR, O’Connor P, Cowling P, Conaghan PG. The usefulness of ultrasound in predicting outcomes in patients with shoulder pain: a prospective observational study. Rheumatology (Oxford) 2024; 63:2162-2169. [PMID: 37862223 PMCID: PMC11292045 DOI: 10.1093/rheumatology/kead546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVES Shoulder pain is common but current clinical classification has limited utility. We aimed to determine whether groups of ultrasound-based shoulder pathologies exist and to evaluate outcomes according to identified groups and individual pathologies. METHODS This was a prospective study of a community-based cohort with shoulder pain referred for their first ultrasound scan at a single radiology unit, with subsequent routine clinical care. Patient-reported outcomes were collected at baseline, 2 weeks and 6 months; standardized ultrasound reporting was employed. Latent class analysis (LCA) identified ultrasound pathology-based groups. Multiple linear regression analysis explored associations between baseline pathologies, subsequent treatment and Shoulder Pain and Disability Index (SPADI). Short-term response to corticosteroid injections was investigated. RESULTS Of 500 participants (mean age 53.6 years; 52% female), 330 completed follow-up. LCA identified four groups: bursitis with (33%) or without (27%) acromioclavicular joint degeneration, rotator cuff tear (21%) and no bursitis/tear (19%). Total SPADI was higher at baseline for cuff tears (mean 55.1 vs 49.7-51.3; overall P = 0.005), but accounting for this, groups did not differ at 6 months (43.5 vs 38.5-40.5; P = 0.379). Baseline SPADI was the only predictor of 6-month SPADI retained by penalized modelling; neither LCA-derived ultrasound groups nor individual pathologies were selected. Response to baseline injection at week 2 did not differ between groups (mean SPADI 40.1-43.8; P = 0.423). CONCLUSION Ultrasound-based classification (groups or individual pathologies) of shoulder pain did not predict medium-term outcomes using current treatments. The role of routine diagnostic ultrasound for shoulder pain needs consideration; it may be useful to establish evidence-based therapies for specific pathologies.
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Affiliation(s)
- Gui Tran
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
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Kim SW, Lim JY, Kim S, Do JG, Lee JI, Hwang JH. Responsiveness and Minimal Clinically Important Difference of the Canadian Occupational Performance Measure Among Patients With Frozen Shoulder. Am J Occup Ther 2024; 78:7804205060. [PMID: 38917031 DOI: 10.5014/ajot.2024.050573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
IMPORTANCE Patient-reported outcome measures provide insights into intervention effects on patients. The Canadian Occupational Performance Measure (COPM) emphasizes identifying priorities in daily activity engagement and evaluating an individual's perception of changes over time. OBJECTIVE To assess the responsiveness of the COPM and the minimal clinically important difference (MCID) among patients with frozen shoulders. DESIGN Prospective, single-blind, randomized controlled trial. SETTING Two physical medicine and rehabilitation clinics. PARTICIPANTS Ninety-four patients with frozen shoulders enrolled in a previous study. OUTCOMES AND MEASURES Baseline and 3-mo evaluations of the COPM and other measures. Responsiveness was assessed using effect size (ES) and standardized response mean (SRM). The MCID values were determined through a distribution-based approach, which used the 0.5 standard deviation and ES methods, and an anchor-based approach, which used the receiver operating characteristic curve method. RESULTS The ES and SRM results indicated that the COPM had high responsiveness. The distribution-based MCID values for COPM Performance and COPM Satisfaction were 1.17 and 1.44, respectively. The anchor-based MCID values were 2.5 (area under the curve [AUC] = 0.78, 95% confidence interval [CI] [0.64-0.91]) and 2.1 (AUC = 0.76, 95% CI [0.60-0.91]), respectively. CONCLUSIONS AND RELEVANCE The findings suggest that the COPM is a responsive outcome measure for patients with frozen shoulder. The established MCID values for the COPM can be valuable for interpreting changes in patient performance and satisfaction, thus aiding clinical interventions and research planning. Plain-Language Summary: This is the first study to review the effectiveness of the Canadian Occupational Performance Measure (COPM) to determine the success of occupational therapy interventions for people with a frozen shoulder. The findings suggest that the COPM is an effective and valuable tool for clients with a frozen shoulder to understand their experiences and treatment priorities and to detect meaningful changes in their performance and satisfaction after an occupational therapy intervention.
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Affiliation(s)
- Sun Woo Kim
- Sun Woo Kim, MS, OT, is Researcher, Department of Physical and Rehabilitation Medicine, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ji Young Lim
- Ji Young Lim, PhD, PT, is Research Professor, Department of Physical and Rehabilitation Medicine, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Seonghee Kim
- Seonghee Kim, BS, OT, is Researcher, Department of Physical and Rehabilitation Medicine, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jong Geol Do
- Jong Geol Do, PhD, MD, is Professor, Department of Physical and Rehabilitation Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jong In Lee
- Jong In Lee, PhD, MD, is Professor, Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hye Hwang
- Ji Hye Hwang, PhD, MD, is Professor, Department of Physical and Rehabilitation Medicine, Samsung Medical Center; School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea;
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12
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Hock G, Johnson A, Barber P, Papa C. Current Clinical Concepts: Rehabilitation of Thoracic Outlet Syndrome. J Athl Train 2024; 59:683-695. [PMID: 39048118 PMCID: PMC11277273 DOI: 10.4085/1062-6050-0138.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Thoracic outlet syndrome (TOS) involves inconsistent symptoms, presenting a challenge for medical providers to diagnose and treat. Thoracic outlet syndrome is defined as a compression injury to the brachial plexus, subclavian artery or vein, or axillary artery or vein occurring between the cervical spine and upper extremity. Three common subcategories are now used for clinical diagnosis: neurogenic, arterial, and venous. Postural position and repetitive motions such as throwing, weightlifting, and manual labor can lead to symptoms. Generally, TOS is considered a diagnosis of exclusion for athletes due to the poor accuracy of clinical testing, including sensitivity and specificity. Thus, determining a definitive diagnosis and reporting injury is difficult. Current literature suggests there is not a gold standard diagnostic test. Rehabilitation has been shown to be a vital component in the recovery process for neurogenic TOS and for arterial TOS and venous TOS in postoperative situations.
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Affiliation(s)
- Greg Hock
- Department of Sports Medicine Physical Therapy, Ohio State University Wexner Medical Center, Columbus
| | - Andrew Johnson
- Department of Orthopedics and Sports Medicine, Mayo Clinic, Rochester, MN
| | - Patrick Barber
- Department of Orthopedics and Physical Performance, University of Rochester, NY
| | - Cassidy Papa
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
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Ucero-Lozano R, Pérez-Llanes R, Cuesta-Barriuso R, Donoso-Úbeda E. Changes in Quality of Life, Adherence, and Kinesiophobia in Patients with Hemophilia Treated with Extended Half-Life Treatment: Final Results of the LongHest Project. Pharmaceuticals (Basel) 2024; 17:835. [PMID: 39065686 PMCID: PMC11279452 DOI: 10.3390/ph17070835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/13/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Hemophilia is a bleeding disorder characterized by hemarthrosis. Prophylaxis is the gold standard for bleeding prevention. Extended half-life (EHL) recombinant FVIII replacement products have shown to be associated with low bleeding rates. The aim was to evaluate the efficacy of EHL prophylaxis in improving perceived quality of life, adherence to treatment, and kinesiophobia in patients with hemophilia. (2) Methods: This was a prospective cohort study. Forty-six patients from different regions, who had started EHL FVIII concentrate prophylactic treatment, were evaluated at baseline and at 12-month follow-up. The study variables were as follows: perceived quality of life (36-Item Short Form Health Survey), adherence to treatment (Validated Hemophilia Regimen Treatment Adherence Scale-Prophylaxis), and kinesiophobia (Tampa Scale of Kinesiophobia). (3) Results: There were statistically significant differences in the domains Role-Physical (p < 0.001), Bodily Pain (p < 0.001), Role-Emotional (p < 0.001), Vitality (p = 0.04), and Social Functioning (p = 0.01) and the total scores, Physical Health (p < 0.001) and Mental Health (p < 0.001) on perceived quality of life. There were significant differences in the domains Skipping (p < 0.01), Communicating (p < 0.001), and the total score (p = 0.01) in terms of adherence. There were also significant differences in kinesiophobia (p = 0.02) after the study period. (4) Conclusions: EHL prophylaxis can improve the perceived quality of life of people with hemophilia. This prophylactic regimen, which requires fewer infusions, may improve adherence to treatment in adult patients with hemophilia over a 12-month period. The administration of extended half-life factor VIII concentrates can reduce kinesiophobia in adult patients with hemophilic arthropathy.
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Affiliation(s)
- Roberto Ucero-Lozano
- Department of Physiotherapy, European University of Madrid, 28670 Madrid, Spain;
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), 33011 Oviedo, Spain
| | - Raúl Pérez-Llanes
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), 33011 Oviedo, Spain
- Department of Physiotherapy, University of Murcia, 30100 Murcia, Spain;
| | - Rubén Cuesta-Barriuso
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, 33003 Oviedo, Spain
| | - Elena Donoso-Úbeda
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), 33011 Oviedo, Spain
- Department of Physiotherapy, Catholic University San Antonio-UCAM, 30107 Murcia, Spain;
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Larose G, Roffey DM, Broekhuyse HM, Guy P, O'Brien P, Lefaivre KA. Trajectory of Recovery following ORIF for Distal Radius Fractures. J Wrist Surg 2024; 13:230-235. [PMID: 38808181 PMCID: PMC11129881 DOI: 10.1055/s-0043-1771045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/15/2023] [Indexed: 05/30/2024]
Abstract
Background Distal radius fractures are commonly seen among the elderly, though studies examining their long-term outcomes are limited. Purpose The aim of this study was to describe the 5-year trajectory of recovery of distal radius fractures treated with open reduction and internal fixation (ORIF). Methods Patients with distal radius fractures (AO/OTA 23.A-C) treated by ORIF were prospectively studied. Patient-Rated Wrist Evaluation (PRWE) score was measured at baseline (preinjury recall) and postoperatively at 6 months, 1 year, and 5 years. Clinically relevant change in PRWE score was assessed using the minimal clinically important difference (MCID). Results A total of 390 patients were included, of which 75% completed 5-year follow-up. Mean baseline PRWE score was 1.25 (standard deviation, SD: 2.9). At 6 months, mean PRWE score was at its highest up to 20.2 (SD: 18.4; p < 0.01). A significant improvement in mean PRWE score was observed at 1 year down to 15.2 (SD: 17.6; p < 0.01); 44% of patients were still one MCID outside of their baseline PRWE score at 1 year. Further significant improvement in mean PRWE score occurred at 5 years down to 9.4 (SD: 13.4; p < 0.01); 29% of patients remained one MCID outside of their baseline PRWE score at 5 years. Conclusion Recovery after ORIF for distal radius fractures showed significant worsening after surgery, followed by significant improvements up to 1 year and between years 1 and 5, albeit to a lesser extent. Statistically and clinically relevant wrist pain and disability persisted at 5 years. Future research should examine different treatment modalities and include a nonoperative treatment arm for comparison. Level of Evidence Prognostic level II.
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Affiliation(s)
- Gabriel Larose
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Darren M. Roffey
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Henry M. Broekhuyse
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Pierre Guy
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter O'Brien
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
| | - Kelly A. Lefaivre
- Faculty of Medicine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver, BC, Canada
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Brindisino F, Venturin D, Bartoli M, Caselli S, Pellicciari L, Poser A. Psychometric properties of the Disability of Arm Shoulder and Hand (DASH) in subjects with frozen shoulder: a reliability and validity study. BMC Musculoskelet Disord 2024; 25:260. [PMID: 38566086 PMCID: PMC10986124 DOI: 10.1186/s12891-024-07371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Frozen Shoulder (FS) is a painful condition characterized by severe pain and progressive restriction of shoulder movement, leading to functional impairment and reduced quality of life. While different Patient Reported Outcome Measurements (PROMs) tools exist for assessing shoulder diseases, few specific PROMs are validated for FS patients. PURPOSE This study aims to assess the psychometric properties of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire in FS patients. METHODS One hundred and twenty-four subjects (mean ± SD age = 55.4 ± 7.9 years; 55.6% female) diagnosed with FS were included and completed the DASH questionnaire, the Numerical Pain Rating Scale (NPRS), the Shoulder Pain and Disability Index (SPADI), and the Short-Form Health Survey 36 (SF-36). Floor or ceiling effects were investigated. Structural validity was analysed through a unidimensional Confirmatory Factor Analysis (CFA), internal consistency through Cronbach's alpha, test-retest reliability through the Intraclass Correlation coefficient (ICC), measurement error through the Standard Error of Measurement (SEM), and the Minimum Detectable Change (MDC), and construct validity through the hypothesis testing with the correlation with the other outcome measures used. RESULTS No floor or ceiling effects were observed. CFA confirmed a one-factor structure after addressing local item dependency (Root Mean Square Error of Approximation = 0.055; Standardized Root Mean Square Residual = 0.077; Comparative Fit Index = 0.970; Tucker-Lewis Index = 0.968). Cronbach's alpha was high (= 0.951), and test-retest reliability was excellent (ICC = 0.999; 95% CI: 0.998-1.000). SEM was equal to 0.5 points, and MDC to 1.5 points. Construct validity was considered satisfactory as 80% of the a-priori hypotheses were met. CONCLUSION The DASH questionnaire demonstrated good psychometric properties in FS patients, supporting its use as a valuable tool for assessing the impact of FS in clinical and research settings.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, 86100, Italy
| | - Davide Venturin
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, 86100, Italy
| | - Matteo Bartoli
- Physiotherapy private practice KinesiLab, via Marcantonio Colonna 88, Marino, Italy
| | - Serena Caselli
- Unità Operativa di Medicina Riabilitativa, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Leonardo Pellicciari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna, I-40139, Italy.
| | - Antonio Poser
- Physiotherapy private practice Kinè, Kinè s.r.l, Viale della Quercia 2/B,, Treviso, Italy
- University of Siena, c/o via Banchi di Sotto, 55, Siena, Italy
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Hoexum F, Jongkind V, Coveliers HME, Wisselink W, Yeung KK. Long-Term Outcomes of Nonoperative and Surgical Management of Paget-Schroetter Syndrome. J Endovasc Ther 2024; 31:171-177. [PMID: 36082395 PMCID: PMC10938484 DOI: 10.1177/15266028221120360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE In Paget-Schroetter Syndrome (PSS), subclavian vein thrombosis is caused by external compression of the subclavian vein at the costoclavicular junction. Paget-Schroetter Syndrome can be treated nonoperatively, surgically, or with a combination of treatments. Nonoperative management consists, in most cases, of anticoagulation (AC) or catheter-directed thrombolysis (CDT). With surgical management, decompression of the subclavian vein is performed by resection of the first rib. No prospective randomized trials are available to determine whether nonoperative or surgical management is superior. We report our long-term outcomes of both nonoperative and surgically treated patients. MATERIALS AND METHODS We retrospectively analyzed all patients with PSS who were treated between January 1990 and December 2015. Patients were divided based on primary nonoperative or primary surgical therapy. Long-term outcomes regarding functional outcomes were assessed by questionnaires using the "Disability of the Arm, Shoulder, and Hand" (DASH) questionnaire, a modified Villalta score, and a disease-specific question regarding lifestyle changes. RESULTS In total, 91 patients (95 limbs) were included. Seventy patients (73 limbs) were treated nonoperatively and 21 patients (22 limbs) surgically. Questionnaires were returned by 67 patients (70 limbs). The mean follow-up was 184 months (range, 43-459 months). All functional outcomes were better in the surgical group compared with the nonoperatively treated group (DASH general 3.11 vs 9.86; DASH work 0.35 vs 11.47; DASH sport 5.85 vs 17.98, and modified Villalta score 1.11 vs 3.20 points). Surgically treated patients were more likely to be able to continue their original lifestyle and sports activities (84% vs 40%, p=0.005). Patients with recurrence of thrombosis or the need for surgical intervention after primary nonoperative management reported worse functional outcomes. CONCLUSION Surgical management of PSS with immediate CDT followed by first rib resection leads to excellent functional outcomes with low risk of complications. The results of nonoperative management in our non-matched retrospective comparative series were satisfactory, but resulted in worse functional outcomes and more patients needing to adjust their lifestyle compared with surgically treated patients. CLINICAL IMPACT Patients with Paget-Schroetter Syndrome and their attending physicians are burdened by the lack of evidence concerning the optimal treatment of this entity. Case series comparing the outcomes of non-operative treatment with surgical treatment are scarce and often not focussed on functional outcomes. Data from this series can aid in the shared decision making after diagnosis of Paget-Schroetter Syndrome. Functional outcomes of non-operative management can be satisfying although high demand patient who are not willing to alter their daily activities are probably better off with surgical management.
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Affiliation(s)
- Frank Hoexum
- Department of Vascular Surgery, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Vincent Jongkind
- Department of Vascular Surgery, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | - Willem Wisselink
- Department of Vascular Surgery, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Kak Khee Yeung
- Department of Vascular Surgery, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Brandl A, Acikalin E, Bartsch K, Wilke J, Schleip R. Reliability and validity of an app-assisted tissue compliance meter in measuring tissue stiffness on a phantom model. PeerJ 2024; 12:e17122. [PMID: 38464760 PMCID: PMC10924762 DOI: 10.7717/peerj.17122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
Background Most methods for soft tissue stiffness assessment require high financial resources, significant technical effort, or extensive therapist training. The PACT Sense device was developed to be used in a wide range of applications and user groups. However, to date, there are no data on its validity and reliability. The aim of this study was to investigate the validity and reliability of the PACT device. Methods A polyurethane phantom tissue model (PTM) mimicking the mechanical properties of the fascia profunda and the erector spinae muscle was used. Stiffness measurements with PACT were conducted by two independent investigators. For construct validity, correlations were calculated between the known stiffness of the PTM and values obtained with PACT. For concurrent validity, we determined the association between the PACT values and additional measurements with the established MyotonPRO device. To estimate interrater and intrarater (two measurements with an interval of 7 days) reliability, we used the intraclass correlation coefficient (ICC). Results Correlation analysis (PTM/PACT) revealed very high concurrent validity (r = 0.99; p < 0.001), construct validity (PACT/MyotonPRO) was 0.87, p < 0.001. Both, interrater reliability (ICC = 0.85; p = 0.036) and intrarater reliability were good (ICC = 0.89; p < 0.001). Conclusions The PACT provides valid and reliable stiffness measurements in tissue phantoms. Further studies in humans are needed to confirm its physiometric properties under in vivo conditions.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
| | - Eda Acikalin
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Katja Bartsch
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
- Department of Sport Science and Sport, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, Klagenfurt, Austria
| | - Robert Schleip
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
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Podurgiel J, Piscitelli D, Denegar C. Challenges in applying minimal clinically important difference: a critical review. Int J Rehabil Res 2024; 47:10-19. [PMID: 38250825 DOI: 10.1097/mrr.0000000000000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Healthcare clinicians strive to make meaningful changes in patient function and participation. A minimal clinically important difference (MCID) is an estimate of the magnitude of change needed to be meaningful to a patient. Clinicians and investigators may assume that a cited MCID is a valid and generalizable estimate of effect. There are, however, at least two concerns about this assumption. First, multiple methods exist for calculating an MCID that can yield divergent values and raise doubt as to which one to apply. Second, MCID values may be erroneously generalized to patients with dissimilar health conditions. With this in mind, we reviewed the methods used to calculate MCID and citations of reported MCID values for outcome measures commonly used in neurologic, orthopedic, and geriatric populations. Our goal was to assess whether the calculation methods were acknowledged in the cited work and whether the enrolled patients were similar to the sample from which the MCID estimate was derived. We found a concerning variation in the methods employed to estimate MCID. We also found a lack of transparency in identifying calculation methods and applicable health conditions in the cited work. Thus, clinicians and researchers must pay close attention and exercise caution in assuming changes in patient status that exceed a specific MCID reflect meaningful improvements in health status. A common standard for the calculation and reporting of an MCID is needed to address threats to the validity of conclusions drawn from the interpretation of an MCID.
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Affiliation(s)
- Joseph Podurgiel
- Doctor of Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
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Yoo DH, Choi JY, Lee SG, Choi KW, Park HB, Kim H, Cho H, Kim SD, Kim D, Lee YJ, Park KS, Ha IH. Long-Term Follow-Up of Inpatients with Rotator Cuff Tear Who Received Integrative Korean Medicine Treatment: A Retrospective Analysis and Questionnaire Survey. Explore (NY) 2024; 20:212-221. [PMID: 37689574 DOI: 10.1016/j.explore.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 07/24/2023] [Accepted: 08/15/2023] [Indexed: 09/11/2023]
Abstract
CONTEXT Rotator cuff tear is one of the most common causes of shoulder pain and has become a prominent disease most frequently treated by surgery. OBJECTIVES To investigate the long-term therapeutic effect of integrative Korean medicine (KM) as a conservative treatment in treating rotator cuff tears. DESIGN A multicenter observational study. SETTINGS The settings involve four regional network KM hospitals. PATIENTS The study participants are 288 patients aged 19-70 with rotator cuff tear identified by radiologist based on magnetic resonance imaging who received integrative KM treatment for the chief complaint of shoulder pain between 1 January 2015 and 31 March 2020. INTERVENTION None. MAIN OUTCOMES The primary outcome was the pain score in the affected shoulder, measured by the numeric rating scale (NRS). The secondary outcomes were Shoulder Pain and Disability Index (SPADI), 5-Level Quality of life: EuroQol 5-Dimension (EQ-5D-5L), Patient Global Impression of Change (PGIC), and range of motion (ROM) scores. RESULTS Eligible patients for MCID achievement analysis for minimally clinical important change were 167, and 109 completed the follow-up survey. The mean NRS pain score in the affected shoulder was 5.80 ± 1.27 at admission, 3.50 ± 1.32 at discharge, and 3.83 ± 2.04 at follow-up.The mean SPADI score was 51.48 ± 20.18 at admission, 37.76 ± 19.23 at discharge, and 24.26 ± 21.80 at follow-up. The improvement at discharge (P-value < 0.001) and follow-up (P-value < 0.001) compared to those at admission was statistically significant. The results also presented a significant improvement in ROM for all motions at discharge after treatment (P-value < 0.001). The number of patients who achieved minimal clinically important difference in NRS was 116 (69.5%) at discharge and 71 (65.1%) at follow-up, and in SPADI was 82 (50.9%) at discharge and 77 (70.6%) at follow-up. CONCLUSION The results of this study suggested that integrative KM treatment can help improve pain, functional impairment, QoL, and ROM in patients with a rotator cuff tear TRIAL REGISTRATION: NCT04566939.
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Affiliation(s)
- Dong-Hwi Yoo
- Haeundae Jaseng Hospital of Korean Medicine, Busan, 48102, Republic of Korea
| | - Jae-Yong Choi
- Haeundae Jaseng Hospital of Korean Medicine, Busan, 48102, Republic of Korea
| | - Sang-Gun Lee
- Haeundae Jaseng Hospital of Korean Medicine, Busan, 48102, Republic of Korea
| | - Ki-Won Choi
- Haeundae Jaseng Hospital of Korean Medicine, Busan, 48102, Republic of Korea
| | - Han-Bin Park
- Haeundae Jaseng Hospital of Korean Medicine, Busan, 48102, Republic of Korea
| | - Ho Kim
- Haeundae Jaseng Hospital of Korean Medicine, Busan, 48102, Republic of Korea
| | - Hyunwoo Cho
- Haeundae Jaseng Hospital of Korean Medicine, Busan, 48102, Republic of Korea
| | - Sang Don Kim
- Haeundae Jaseng Hospital of Korean Medicine, Busan, 48102, Republic of Korea
| | - Doori Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06110, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06110, Republic of Korea
| | - Kyoung Sun Park
- Jaseng Hospital of Korean Medicine, Seoul, 06110, Republic of Korea.
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06110, Republic of Korea.
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Tang ZY, Ng KS, Koh YLE, Yeung MT. Study protocol for the validation of a new pictorial functional scale in patients with knee osteoarthritis: the functional activity scoring tool (FAST). BMJ Open 2024; 14:e076947. [PMID: 38191249 PMCID: PMC10806685 DOI: 10.1136/bmjopen-2023-076947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/10/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are required for patient-centred care. There are limited PROMs with good psychometric properties, and limitations to any language-based scale are often constrained by the written words or numerals used. Therefore, we developed the Functional Activity Scoring Tool (FAST), a self-reporting pictorial scale. FAST measures the impact of knee osteoarthritis on essential activities of daily living (ADL) and the significant changes in the self-perceived functional status over time. OBJECTIVES This study aims to (1) develop FAST with adaptation from the Wong-Baker FACES pain rating scale, (2) validate FAST against the Patient-Specific Functional Scale (PSFS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) and (3) establish the reliability, validity and responsiveness of FAST in individuals with knee osteoarthritis. METHODS AND ANALYSIS The prospective study protocol investigates the validity, responsiveness and reliability of FAST. The PSFS and KOOS will be gold standard comparisons. Participant recruitment will occur at four public polyclinics that offer physiotherapy outpatient services in Singapore. Onsite physiotherapists familiar with the study eligibilities will refer potential participants to the investigators after the routine physiotherapy assessment. After providing written consent, eligible participants will complete outcome measurements with FAST, the PSFS and KOOS during baseline and follow-up assessments. The Global Rating of Change (GROC) scale will determine how the participant's knee status was changed compared with the beginning of the physiotherapy intervention. ETHICS AND DISSEMINATION SingHealth Centralised Institutional Review Board approved the study (CIRB reference number: 2022/2602). The final results will be published via scientific publication. FAST will benefit the evaluation and management of those who suffer knee osteoarthritis regardless of English proficiency or language barriers. TRIAL REGISTRATION NUMBER NCT05590663.
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Affiliation(s)
- Zhi Yin Tang
- Department of Physiotherapy, SingHealth Polyclinics, Singapore
| | - Khim Siong Ng
- Department of Physiotherapy, SingHealth Polyclinics, Singapore
| | | | - Meredith T Yeung
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
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Beltrán SP, Batista GDA, Dos Passos MHP, da Silva HA, Locks F, Cappato de Araújo R. Effects of a workplace-based exercise program on shoulder pain and function in fruit workers: A randomized controlled trial. Work 2024; 77:1143-1151. [PMID: 38007632 DOI: 10.3233/wor-230085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Shoulder pain affects millions of workers worldwide and is considered one of the leading causes of absenteeism and presenteeism. Therefore, using exercises in the work environment emerges as a strategy to prevent or reduce shoulder pain. OBJECTIVE The objective of this study was to evaluate the effects of a workplace-based exercise program on shoulder pain and function in fruit workers. METHODS This was an 8-week parallel two-arm randomized controlled trial. Forty-four fruit workers who reported chronic shoulder pain were randomized to an Experimental Group (EG) or Control Group (CG). The EG was submitted to a program of resistance and stretching exercises for eight weeks, twice a week. The CG received a booklet with muscle stretching and mobility exercises. The primary outcome was shoulder pain intensity; the secondary outcomes were Shoulder Pain and Disability Index (SPADI) and perceived global effect. RESULTS Both groups showed reductions in pain intensity EG: 4.26 (95% CI 2.78-5.74) and CG: 3.74 (95% CI 1.98-5.50) points. The SPADI results showed an average reduction of 17.76 (CI 95% 3.10-32.43) for the EG and 18.39 (CI 95% 3.66-33.13) for the CG. The mean value of the perceived global effect for the CG was 3.45±2.01, and for the EG, the mean was 4.13±1.24. No differences were observed between groups in any outcome analyzed. CONCLUSION Both groups showed significant changes in the analyzed outcomes. However, the workplace-based exercise program was not superior to the exercise booklet.
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Affiliation(s)
- Sol Patricia Beltrán
- Universidad Santiago de Cali, Cali, Columbia
- Associated Graduate Program in Physical Education UPE/UFPB, University of Pernambuco, Recife, Brazil
| | - Gabriel de Amorim Batista
- Associated Graduate Program in Physical Education UPE/UFPB, University of Pernambuco, Recife, Brazil
| | | | - Hitalo Andrade da Silva
- Associated Graduate Program in Physical Education UPE/UFPB, University of Pernambuco, Recife, Brazil
| | - Francisco Locks
- Department of Physical Therapy, University of Pernambuco, Petrolina, Brazil
- Graduate Program in Rehabilitation and Functional Performance (PPGRDF), University of Pernambuco, Petrolina, Brazil
| | - Rodrigo Cappato de Araújo
- Associated Graduate Program in Physical Education UPE/UFPB, University of Pernambuco, Recife, Brazil
- Department of Physical Therapy, University of Pernambuco, Petrolina, Brazil
- Graduate Program in Rehabilitation and Functional Performance (PPGRDF), University of Pernambuco, Petrolina, Brazil
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22
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Donoso-Úbeda E, Pérez-Llanes R, Meroño-Gallut J, Ucero-Lozano R, Cuesta-Barriuso R. Foam roller-based self-induced myofascial therapy in patients with hemophilic knee arthropathy: a multicenter, single-blind, randomized clinical study. Eur J Phys Rehabil Med 2023; 59:763-771. [PMID: 37869759 PMCID: PMC10795767 DOI: 10.23736/s1973-9087.23.07944-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/05/2023] [Accepted: 10/02/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Hemophilia is a congenital coagulopathy characterized by degenerative joint damage. Self-induced myofascial therapy aims to decrease pain and improve tissue mobility, functionality and proprioception. AIM The aim of this study was to evaluate the safety and efficacy of self-induced myofascial release in patients with hemophilic knee arthropathy. DESIGN This is a randomized clinical study. SETTING This study was carried out in different patient associations. POPULATION Fifty-two patients with hemophilia were included in the study. METHODS Patients were randomized to the experimental group (daily home protocol of foam roller-based self-induced myofascial therapy for 8 weeks) or the control group (no intervention). The variables were the frequency of hemarthrosis (self-reporting), pain intensity (visual analog scale), range of motion (goniometry) and muscle strength (dynamometry). All variables were evaluated at baseline, post-treatment and after a 10-week follow-up. RESULTS The patients included in the experimental group showed significant improvements in terms of a decrease in frequency of hemarthrosis (mean difference [MD]=-0.61; 95% confidence interval [CI]: -0.81; -0.41) and pain intensity (MD=-0.33; 95% CI: -0.48, -0.18), increased range of motion (MD=0.88; 95% CI: 0.39; 1.37), strength in quadriceps (MD=0.88; 95% CI: 0.39; 1.37). (MD=12.39; 95% CI: 3.44; 21.34) and hamstrings (MD=7.85; 95% CI: 0.60; 15.11). There were intergroup differences in the frequency of hemarthrosis (F=14.51; P<0.001), pain intensity (F=9.14; P<0.001) and range of motion (F=13.58; P<0.001). CONCLUSIONS Self-induced myofascial therapy can be an effective complementary technique in the treatment of patients with hemophilic arthropathy. Self-induced myofascial therapy can reduce the frequency of knee hemarthrosis in patients with hemophilia. This technique can improve pain intensity and range of motion in patients with hemophilic knee arthropathy. CLINICAL REHABILITATION IMPACT Hemophilic knee arthropathy is characterized by chronic pain, decreased range of motion, and periarticular muscle atrophy. Foam roller-based self-induced myofascial therapy can reduce the frequency of hemarthrosis and pain intensity and improve range of motion in patients with hemophilic arthropathy. Foam roller-based self-induced myofascial therapy is safe and effective in the treatment of patients with hemophilia. The inclusion of self-induced myofascial therapy exercises in the approach to degenerative joint pathologies may be an effective and safe treatment option.
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Affiliation(s)
- Elena Donoso-Úbeda
- Department of Physiotherapy, UCAM Catholic University of Murcia, Murcia, Spain
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria, Oviedo, Spain
| | - Raúl Pérez-Llanes
- Department of Physiotherapy, UCAM Catholic University of Murcia, Murcia, Spain
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria, Oviedo, Spain
| | - Javier Meroño-Gallut
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria, Oviedo, Spain
- Service of Physiotherapy, Tu Bienestar 360°, San Javier, Spain
| | - Roberto Ucero-Lozano
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria, Oviedo, Spain
- Department of Physiotherapy, European University of Madrid, Madrid, Spain
| | - Rubén Cuesta-Barriuso
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria, Oviedo, Spain -
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain
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23
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Nielsen C, Merrell D, Reichenbach R, Mayolo P, Qubain L, Hustedt JW. An Evaluation of Patient-reported Outcome Measures and Minimal Clinically Important Difference Usage in Hand Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5490. [PMID: 38111720 PMCID: PMC10727676 DOI: 10.1097/gox.0000000000005490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/31/2023] [Indexed: 12/20/2023]
Abstract
Background This study was designed to examine the current use of patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) calculations in the hand surgery literature in an effort to standardize their use for research purposes. Methods A systematic review of the hand surgery literature was conducted. All nonshoulder upper extremity articles utilizing PROMs were compared between different journals, different surgical indications, and differing usage. MCID values were reported, and calculation methods assessed. Results In total, 4677 articles were reviewed, and 410 met the inclusion criteria of containing at least one PROM. Of the 410 articles reporting PROMs, 148 also mentioned an associated MCID. Of the articles that mentioned MCIDs, 14 calculated MCID values based on their specific clinical populations, whereas the remainder referenced prior studies. An estimated 35 different PROMs were reported in the study period; 95 different MCID values were referenced from 65 unique articles. Conclusions There are many different PROMs currently being used in hand surgery clinical reports. The reported MCIDs from their related PROMs are from multiple different sources and calculated by different methods. The lack of standardization in the hand surgery literature makes interpretation of studies utilizing PROMs difficult. There is a need for a standardized method of calculating MCID values and applying these values to established PROMs for nonshoulder upper extremity conditions.
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Affiliation(s)
- Colby Nielsen
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
| | - Dallin Merrell
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
| | - Rachel Reichenbach
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
| | - Patrick Mayolo
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
| | - Leeann Qubain
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
| | - Joshua W Hustedt
- From the Department of Orthopedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Ariz
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24
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Kim DH. Outcome Measurement in Shoulder Diseases: Focus on Shoulder Pain and Disability Index (SPADI). Ann Rehabil Med 2023; 47:315-317. [PMID: 37907222 PMCID: PMC10620495 DOI: 10.5535/arm.23130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
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25
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Mista CA, Intelangelo L, Biurrun Manresa J. Personalized pain management: The relationship between clinical relevance and reliability of measurements. Eur J Pain 2023; 27:1056-1064. [PMID: 36951044 DOI: 10.1002/ejp.2110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 03/24/2023]
Abstract
Reliability is a topic in health science in which a critical appraisal of the magnitudes of the measurements is often left aside to favour a formulaic analysis. Furthermore, the relationship between clinical relevance and reliability of measurements is often overlooked. In this context, the aim of the present article is to provide an overview of the design and analysis of reliability studies, the interpretation of the reliability of measurements and its relationship to clinical significance in the context of pain research and management. The article is divided in two sections: the first section contains a step-by-step guide with simple and straightforward recommendations for the design and analysis of a reliability study, with a relevant example involving a commonly used assessment measure in pain research. The second section provides deeper insight about the interpretation of the results of a reliability study and the association between the reliability of measurements and their experimental and clinical relevance. SIGNIFICANCE: Reliability studies quantify the measurement error in experimental or clinical setups and should be interpreted as a continuous outcome. The assessment of measurement error is useful to design and interpret future experimental studies and clinical interventions. Reliability and clinical relevance are inextricably linked, as measurement error should be considered in the interpretation of minimal detectable change and minimal clinically important differences.
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Affiliation(s)
- Christian Ariel Mista
- Institute for Research and Development in Bioengineering and Bioinformatics (IBB), CONICET-UNER, Oro Verde, Argentina
| | - Leonardo Intelangelo
- University Centre for Assistance, Teaching and Research (CUADI), University of Gran Rosario, Rosario, Argentina
| | - José Biurrun Manresa
- Institute for Research and Development in Bioengineering and Bioinformatics (IBB), CONICET-UNER, Oro Verde, Argentina
- Centre for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark
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26
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Alnahdi AH. Responsiveness and Minimal Important Change of the Arabic Disabilities of the Arm, Shoulder and Hand (DASH) in Patients with Upper Extremity Musculoskeletal Disorders. Healthcare (Basel) 2023; 11:2623. [PMID: 37830660 PMCID: PMC10573051 DOI: 10.3390/healthcare11192623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023] Open
Abstract
The aim of this study was to examine the responsiveness of the Arabic Disabilities of the Arm, Shoulder and Hand (DASH) and to quantify its minimal important change (MIC) for improvement. People with upper extremity musculoskeletal problems who were receiving physical therapy were evaluated at baseline and again during a follow-up appointment, with a median time frame of 7 days between the two testing sessions (range of 6 to 72 days). The participants completed the Arabic DASH, Global Assessment of Function (GAF), Numeric Pain Rating Scale (NPRS) and Global Rating of Change Scale (GRC). The responsiveness of the Arabic DASH was assessed by examining the pre-specified hypotheses. The MIC for improvement was determined using the receiver operating characteristic method (MICROC) and the predictive modeling method (MICpred). As hypothesized, a change in the Arabic DASH demonstrated a significant positive correlation with changes in the GAF (r = 0.69), NPRS (r = 0.68) and GRC (r = 0.73). Consistent with our hypotheses, the DASH change scores could be used to differentiate between participants who improved and those who did not improve (area under the receiver operating characteristic curve = 0.87), and they showed a large magnitude of change (effect size = 1.53, standardized response mean = 1.42) in patients who improved. All the hypotheses specified a priori were supported by the results. The Arabic DASH MICROC and MICpred were estimated to be 14.22 and 14.85. The interaction between the DASH change and baseline score was not a significant predictor of status (improved vs. not improved) (p = 0.75), indicating that the DASH MIC was not baseline-dependent. The Arabic DASH demonstrated sufficient responsiveness, supporting the idea that the Arabic DASH is capable of detecting changes in upper extremity function over time. The value of the Arabic DASH MIC was similar when estimated using the predictive modeling and ROC methods, and the MIC was not dependent on baseline status.
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Affiliation(s)
- Ali H Alnahdi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
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27
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Longo UG, Di Naro C, Campisi S, Casciaro C, Bandini B, Pareek A, Bruschetta R, Pioggia G, Cerasa A, Tartarisco G. Application of Machine Learning Algorithms for Prognostic Assessment in Rotator Cuff Pathologies: A Clinical Data-Based Approach. Diagnostics (Basel) 2023; 13:2915. [PMID: 37761282 PMCID: PMC10530213 DOI: 10.3390/diagnostics13182915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
AIM The overall aim of this proposal is to ameliorate the care of rotator cuff (RC) tear patients by applying an innovative machine learning approach for outcome prediction after arthroscopic repair. MATERIALS AND METHODS We applied state-of-the-art machine learning algorithms to evaluate the best predictors of the outcome, and 100 RC patients were evaluated at baseline (T0), after 1 month (T1), 3 months (T2), 6 months (T3), and 1 year (T4) from surgical intervention. The outcome measure was the Costant-Murley Shoulder Score, whereas age, sex, BMI, the 36-Item Short-Form Survey, the Simple Shoulder Test, the Hospital Anxiety and Depression Scale, the American Shoulder and Elbow Surgeons Score, the Oxford Shoulder Score, and the Shoulder Pain and Disability Index were considered as predictive factors. Support vector machine (SVM), k-nearest neighbors (k-NN), naïve Bayes (NB), and random forest (RF) algorithms were employed. RESULTS Across all sessions, the classifiers demonstrated suboptimal performance when using both the complete and shrunken sets of features. Specifically, the logistic regression (LR) classifier achieved a mean accuracy of 46.5% ± 6%, while the random forest (RF) classifier achieved 51.25% ± 4%. For the shrunken set of features, LR obtained a mean accuracy of 48.5% ± 6%, and RF achieved 45.5% ± 4.5%. No statistical differences were found when comparing the performance metrics of ML algorithms. CONCLUSIONS This study underlines the importance of extending the application of AI methods to new predictors, such as neuroimaging and kinematic data, in order to better record significant shifts in RC patients' prognosis. LIMITATIONS The data quality within the cohort could represent a limitation, since certain variables, such as smoking, diabetes, and work injury, are known to have an impact on the outcome.
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Affiliation(s)
- Umile Giuseppe Longo
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.D.N.); (C.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Calogero Di Naro
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.D.N.); (C.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Simona Campisi
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (S.C.); (R.B.); (G.P.); (A.C.)
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Carlo Casciaro
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.D.N.); (C.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Benedetta Bandini
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (C.D.N.); (C.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Ayoosh Pareek
- Hospital for Special Surgery, New York, NY 10021, USA;
| | - Roberta Bruschetta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (S.C.); (R.B.); (G.P.); (A.C.)
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (S.C.); (R.B.); (G.P.); (A.C.)
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (S.C.); (R.B.); (G.P.); (A.C.)
- S’Anna Institute, 88900 Crotone, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Arcavacata di Rende, Italy
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy; (S.C.); (R.B.); (G.P.); (A.C.)
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Brush PL, Santana A, Nanavati R, Toci GR, Issa TZ, Fletcher DJ, Hornstein J. Arthroscopic Treatment of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes to Isolated Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2023; 5:100751. [PMID: 37577173 PMCID: PMC10413075 DOI: 10.1016/j.asmr.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/25/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR). Methods Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator cuff tear (RCT) size, surgical outcomes, further surgical intervention, rotator cuff retear rate, postoperative range of motion (ROM), and SF-12 results at 1 year after surgery. Delta values were calculated for component scores of the SF-12 and ROM values by subtracting the preoperative result from the postoperative result. Results A total of 89 patients with SSS were compared to 156 patients in the control group at final analysis. The patients in the SSS group experienced a significant improvement in the delta mental health component score (MCS-12) of the SF-12 survey that was not seen in the control group (P = .005 to P = .539). Both groups experienced significant improvement by the delta physical health component score (PCS-12) of the SF-12 survey (SSS: 7.68; P < .001; control: 6.95; P < .001). The SSS group also experienced greater improvement of their forward flexion (25.8° vs 12.9°; P = .005) and external rotation (7.13° vs 1.65°; P = .031) ROM than the control group. Conclusions Operative intervention of SSS at the time of RCR has equivalent postoperative SF-12 survey outcome scores when compared to patients undergoing RCR without preoperative stiffness despite those patients having lower preoperative scores. Level of Evidence Level III retrospective comparative study.
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Affiliation(s)
- Parker L. Brush
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Adrian Santana
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Ruchir Nanavati
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Gregory R. Toci
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Tariq Z. Issa
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Daniel J. Fletcher
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Joshua Hornstein
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
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29
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Dao M, Mosby H, Westphalen E, Post AA, Wilken JM, de Cesar Netto C, Hall MM, Danielson J, Sluka KA, Chimenti RL. Reliability and validity of two-dimensional motion capture to assess ankle dorsiflexion motion and heel raise work. Phys Ther Sport 2023; 62:10-16. [PMID: 37300968 PMCID: PMC10526702 DOI: 10.1016/j.ptsp.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To determine the inter-rater reliability and criterion validity of two-dimensional (2D) measures of ankle function in the sagittal plane for participants with Achilles tendinopathy (AT). DESIGN Cohort study. SETTING University Laboratory, Participants, Adults with AT (N = 18, Women: 72.2%, Age = 43.4 ± 15.8 years, BMI = 28.7 ± 8.9 kg/m2) MAIN OUTCOME MEASURES: Reliability and validity were determined with intra-class correlation coefficients (ICC), standard error of the measurement (SEM), minimal detectable change (MDC), and Bland-Altman plots for ankle dorsiflexion and positive work during heel raises. RESULTS Inter-rater reliability between three raters for all 2D motion analysis tasks was good to excellent (ICC = 0.88 to 0.99). Criterion validity between 2D and 3D motion analyses for all tasks was good to excellent (ICC = 0.76 to 0.98). 2D motion analysis overestimated ankle dorsiflexion motion by 1.0-1.7° (3% of mean sample value) and positive ankle joint work by 76.8 J (9% of mean) compared to 3D motion analysis. CONCLUSION Although 2D and 3D measures are not interchangeable, the good to excellent reliability and validity of 2D measures in the sagittal plane support the use of video analysis to quantify ankle function for individuals with foot and ankle pain.
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Affiliation(s)
- Megan Dao
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Hadley Mosby
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Emma Westphalen
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Andrew A Post
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedics & Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Mederic M Hall
- Department of Orthopaedics & Rehabilitation, University of Iowa, Iowa City, IA, USA; University of Iowa Sports Medicine, University of Iowa, Iowa City, IA, USA
| | - Jessica Danielson
- Institute for Clinical and Translational Science, University of Iowa Hospital and Clinics, IA, USA
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
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Kao SC, Pai HC. Minimal Clinically Important Differences and Changes in Stroke Disease-Specific Quality of Life in Stroke Survivors: A Prospective Cohort Study. Clin Nurs Res 2023; 32:510-517. [PMID: 35923119 DOI: 10.1177/10547738221113904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The aims of the present study were to investigate changes in QOL in post-stroke patients during the first 3 months of rehabilitation treatment. We estimate minimal detectable changes (MDCs) and minimal clinically important differences (MCIDs) of the eight dimensions of QOL and assess the proportion of patients' change scores that exceed MDCs and MCIDs in stroke survivors who receive rehabilitation in a hospital ward. This prospective cohort study enrolled 40 stroke survivors (57.5% male; Mage = 58.3 years) who received in-hospital rehabilitation for a total of 3 months. The Stroke Impact Scale 3.0, which has eight subscales-strength, activities of daily living (ADLs)/instrumental ADLs (IADLs), mobility, hand function, communication, memory and thinking, emotion, and social participation-was used for assessment on the third day of rehabilitation (Time 1), 1 month later (Time 2), and 3 months later (Time 3). Our findings indicated that the MDC95 and MCID proportions varied from 7.5% to 30% and 7.5% to 65%, respectively, of individuals who exhibited change based on individual change scores. The findings show compliance with MDC and MCID values in physical function, with the lowest proportion in hand function.
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Affiliation(s)
- Shu-Chuan Kao
- Chung-Shan Medical University Hospital, Taichung City
| | - Hsiang-Chu Pai
- Chung-Shan Medical University Hospital, Taichung City.,Chung-Shan Medical University, Taichung City
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Birinci T, Van Der Veer P, Mutlu C, Mutlu EK. The Reliability and Validity of the Turkish Version of Smartphone Impact Scale. Eval Health Prof 2023; 46:84-91. [PMID: 35575445 DOI: 10.1177/01632787221097703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Smartphone Impact Scale (SIS) was originally developed in English to determine the cognitive, affective, social, and behavioral impacts of smartphones. This study aimed to translate and cross-culturally adapt the SIS instrument into Turkish and investigate its psychometric properties. Two hundred and sixty-four young and middle-aged adults (186 females) with a mean age of 36.24 years (SD = 14.93; range, 18-65 years) were included. For cross-cultural adaptation, two bi-lingual translators used the back-translation procedure. Within a 5-to-7-day period after the first assessment, the participants completed the Turkish version of SIS (SIS-T) to evaluate test-retest reliability. Cronbach's alpha (α) was used to assess internal consistency. The correlation between the Turkish version of the Smartphone Addiction Scale (SAS-T) and the Nottingham Health Profile was determined to check the validity. The SIS-T had a high-level internal consistency (α = 0.86) and test-retest reliability (ICC2,1 = 0.56 to 0.89 for subscales). The SIS-T subscales were correlated with the SAS-T (r = 0.31 to 0.66, p < 0.01), indicating a good concurrent validity. The results show that the SIS-T is semantically and linguistically adequate to determine smartphones' cognitive, affective, social, and behavioral impacts on young and middle-aged adults. Good internal validity and test-retest reliability of the SIS-T were defined to evaluate the impacts of smartphones among Turkish-speaking young and middle-aged adults.
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Affiliation(s)
- Tansu Birinci
- 226842Istanbul Medeniyet University, Faculty of Health Sciences, Department Physiotherapy and Rehabilitation
| | - Pınar Van Der Veer
- 469683Istinye University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Turkey
| | - Caner Mutlu
- 37523Bursa Uludağ University, Faculty of Medicine, Department of Child and Adolescent Mental Health and Diseases, Turkey
| | - Ebru Kaya Mutlu
- 450200Bandırma Onyedi Eylul University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Turkey
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Assessing reliability and validity of different stiffness measurement tools on a multi-layered phantom tissue model. Sci Rep 2023; 13:815. [PMID: 36646734 PMCID: PMC9842673 DOI: 10.1038/s41598-023-27742-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
Changes in the mechanical properties (i.e., stiffness) of soft tissues have been linked to musculoskeletal disorders, pain conditions, and cancer biology, leading to a rising demand for diagnostic methods. Despite the general availability of different stiffness measurement tools, it is unclear as to which are best suited for different tissue types and the related measurement depths. The study aimed to compare different stiffness measurement tools' (SMT) reliability on a multi-layered phantom tissue model (MPTM). A polyurethane MPTM simulated the four layers of the thoracolumbar region: cutis (CUT), subcutaneous connective tissue (SCT), fascia profunda (FPR), and erector spinae (ERS), with varying stiffness parameters. Evaluated stiffness measurement tools included Shore Durometer, Semi-Electronic Tissue Compliance Meter (STCM), IndentoPRO, MyotonPRO, and ultrasound imaging. Measurements were made by two independent, blinded examiners. Shore Durometer, STCM, IndentoPRO, and MyotonPRO reliably detected stiffness changes in three of the four MPTM layers, but not in the thin (1 mm thick) layer simulating FPR. With ultrasound imaging, only stiffness changes in layers thicker than 3 mm could be measured reliably. Significant correlations ranging from 0.70 to 0.98 (all p < 0.01) were found. The interrater reliability ranged from good to excellent (ICC(2,2) = 0.75-0.98). The results are encouraging for researchers and clinical practitioners as the investigated stiffness measurement tools are easy-to-use and comparatively affordable.
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Tudini F, Levine D, Healy M, Jordon M, Chui K. Evaluating the effects of two different kinesiology taping techniques on shoulder pain and function in patients with hypermobile Ehlers-Danlos syndrome. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 4:1089748. [PMID: 36726531 PMCID: PMC9885497 DOI: 10.3389/fpain.2023.1089748] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
Background Ehlers-Danlos Syndrome (EDS) is a group of inherited connective tissue disorders which predominantly affects women and has a prevalence as high as 1 in 5,000 individuals. Hypermobile EDS (hEDS) is the most common subtype of EDS and is characterized by multi-joint pain, particularly in large joints such as the shoulder. Physical therapy is often utilized to address the pain, physical impairments, and functional loss in patients with EDS. Kinesiology Tape (KT) is an intervention commonly used by physical therapists for treating shoulder pain and dysfunction. Studies related to the effectiveness of KT in patients with shoulder pain is equivocal and there are a lack of studies specifically studying the effects of KT in an EDS population. Purpose The purpose of this study was to assess the efficacy and short-term effects of two different KT techniques on shoulder pain and function in individuals with hEDS and shoulder pain. Methods Participants were recruited from EDS support groups in the New England area of the United States; were diagnosed with hEDS by their physician; and had shoulder pain. Baseline demographic information was obtained for each participant followed by completion of 4 patient reported outcome (PRO) measures: the Upper Extremity Functional Index, QuickDASH (Disabilities of the Arm, Shoulder, & Hand), Shoulder Pain and Disability Index, and the Western Ontario Shoulder Instability Index. Current pain level, average pain over the past 24 h, and worst pain over the past 24 h were recorded using the numeric pain rating scale (NPRS). Subjects were randomly assigned to receive either an experimental shoulder KT procedure or a control shoulder taping. Immediately after taping, the NPRS was reassessed. Subjects then returned 48 h later to repeat the NPRS and PRO measures. Results There was no significant difference between the experimental and control tape groups for any outcome measure. There was a significant improvement from pre-taping to 48-hours post taping for each of the 4 PRO measures with large effect sizes (p < 0.001; ƞ p 2 = .517-.719). Likewise, average, and worst pain over the last 24 h significantly improved with large effect sizes over the same period (p = 0.005; ƞ p 2 = .225 and p < 0.001; ƞ p 2 = .382, respectively). Current NPRS levels significantly improved from pre-tape to immediately post-tape (p = .023, ƞ p 2 = .131) and was maintained through the 48-hour follow up, although no further improvement was seen. Conclusion KT is an inexpensive and relatively safe intervention that is easy to apply and can offer temporary improvements in pain and function for patients with EDS and shoulder pain.
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Affiliation(s)
- Frank Tudini
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States,Correspondence: Frank Tudini
| | - David Levine
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Michael Healy
- Healy Physical Therapy and Sports Medicine, East Providence, RI, United States
| | - Max Jordon
- Department of Physical Therapy, The University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Kevin Chui
- Department of Physical Therapy, Radford University, Roanoke, VA, United States
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Ucero-Lozano R, Pérez-Llanes R, López-Pina JA, Cuesta-Barriuso R. 180-degree immersive VR motion visualization in the treatment of haemophilic ankle arthropathy. Haemophilia 2023; 29:282-289. [PMID: 36261396 PMCID: PMC10092164 DOI: 10.1111/hae.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with haemophilic arthropathy suffer chronic pain that affects and restricts their quality of life. Visualization of movement through immersive virtual reality is used for pain management. AIM To evaluate the efficacy of 180-degree immersive VR motion visualization therapy in patients with haemophilic ankle arthropathy. METHODS Prospective, multicentre pilot study. Fifteen adult patients with bilateral haemophilic ankle arthropathy were recruited (mean age: 42.73 ± 12.36 years). The intervention lasted 4 weeks, with daily home sessions of 180-degree immersive motion visualization. The patients were given virtual reality glasses to use with their smartphones. From the YouTube mobile app® they accessed the recorded video with access from the He-Mirror App®. The study variables were joint state (Haemophilia Joint Health Score), pressure pain threshold (pressure algometer), muscle strength (dynamometry) and range of motion (goniometry). Three evaluations were performed: at baseline (T0), after the intervention (T1) and at the end of a 16-week follow-up period (T2). RESULTS No patient developed ankle hemarthrosis during the experimental phase. In the repeated measures analysis we found statistically significant differences in joint state (F = 51.38; η2 p = .63), pressure pain threshold of the lateral malleolus (F = 12.34; η2 p = .29) and range of motion (F = 11.7; η2 p = .28). CONCLUSIONS Therapy using immersive motion visualization does not cause hemarthrosis. This intervention can improve joint condition, pressure pain threshold and range of motion in patients with ankle arthropathy. Changes greater than the MDC were reported in more than 40% of patients for the variables pressure pain threshold, anterior tibialis strength and range of motion, which were considered clinically relevant.
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Affiliation(s)
| | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | - Rubén Cuesta-Barriuso
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain.,Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine, University of Oviedo, Oviedo, Spain
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Jain A, Nagar M, Jain S, Barasker SK. Suprascapular nerve block is faster and as effective as hydrodistension in relieving frozen shoulder-associated pain and disability: A prospective, single-blind observational study with a follow-up of 24 weeks. J Anaesthesiol Clin Pharmacol 2023; 39:45-50. [PMID: 37250252 PMCID: PMC10220177 DOI: 10.4103/joacp.joacp_114_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/09/2021] [Accepted: 07/20/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Hydrodistension (HD) and suprascapular nerve block (SSNB) have been shown to reduce pain and improve shoulder function in frozen shoulder (FS). The aim of this study was to compare the efficacy of HD and SSNB in the treatment of idiopathic FS. Material and Methods This was a prospective observational study. A total of 65 patients with FS were treated with SSNB or HD. The functional outcome was evaluated by Shoulder Pain and Disability Index (SPADI) score and active shoulder range of motion (ROM) measured at 2 weeks, 6 weeks, 12 weeks, and 24 weeks. Parametric data were analyzed using an independent sample T-test. Nonparametric data were analyzed using the Mann-Whitney test and Wilcoxon test. A P value less than 0.05 was considered significant. Result At the end of 24 weeks, the two-group improved significantly from the baseline and the improvement was comparable between the two groups. ROM also improved significantly in both groups. At 2nd week, SPADI score was significantly less in SSNB group (P < 0.05). About 43% of patients considered HD extremely painful. Conclusion Both HD and SSNB are almost equally effective in reducing pain and improving shoulder function. However, SSNB leads to a faster improvement.
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Affiliation(s)
- Anuj Jain
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Manoj Nagar
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Suruchi Jain
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Swapnil Kumar Barasker
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, Martin RL. Lateral Elbow Pain and Muscle Function Impairments. J Orthop Sports Phys Ther 2022; 52:CPG1-CPG111. [PMID: 36453071 DOI: 10.2519/jospt.2022.0302] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Although often described as a self-limiting condition and likely to resolve on its own, high recurrence rates and extended sick leave frame a need for effective non-surgical treatment for people with lateral elbow tendinopathy. The interrelationship of histological and structural changes to the tendon, the associated impairments in motor control, and potential changes in pain processing may all drive symptoms. This clinical practice guideline covers the epidemiology, functional anatomy and pathophysiology, risk factors, clinical course, prognosis, differential diagnosis, tests and measures, and interventions for managing lateral elbow tendinopathy in the physical therapy clinic. J Orthop Sports Phys Ther 2022;52(12):CPG1-CPG111. doi:10.2519/jospt.2022.0302.
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van Gorp B, Krastman P, Kraan G, Mathijssen NM, Bierma-Zeinstra SM, Runhaar J. Psychometric qualities of the patient rated Wrist/Hand evaluation (PRWHE) in dutch primary care patients with wrist complaints. BMC PRIMARY CARE 2022; 23:274. [PMID: 36333651 PMCID: PMC9635128 DOI: 10.1186/s12875-022-01885-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Background Knowledge on the course, disability and functionality of wrist complaints is still compendious in primary care guidelines, despite the high prevalence in primary care. Valid questionnaires can facilitate the monitoring of patients in primary care and research initiatives. In this study, we aimed to study the psychometric qualities of the Dutch version of the Patient Rated Wrist/Hand Evaluation (PRWHE-DLV) among adults with (sub)acute wrist complaints in primary care. Methods An observational cohort of 35 adults with (sub)acute wrist complaints in Dutch primary care was established. The content validity of the PRWHE-DLV was validated by assessing the floor and ceiling effects at baseline (T0). Reproducibility was assessed by the test-retest reliability between T0 and T1 (2–5 days after T0), using the Intra-class Correlation Coefficient. The construct validity was assessed based on the correlation between the PRWHE-DLV and the Quick-DASH, Physical Component Score (SF-12), VAS-function, Physical Functioning (SF-12), VAS-pain and Bodily Pain (SF-12) at T0. Responsiveness was defined as the ability of the PRWHE-DLV to measure change 3 weeks after T0 (internal) and the relation of these changes to clinically important outcomes (external). Results Psychometric qualities of the PRWHE-DLV demonstrated high content validity with no floor or ceiling effects, excellent reliability (Intra-class correlation coefficient = 0.90; 95% CI 0.80–0.95), high construct validity with the validated Quick-DASH and VAS score (r = 0.85 with Quick-DASH, r = 0.75 with VAS-function and r = 0.78 with VAS-pain) and high responsiveness. Conclusion The PRWHE-DLV provided reliable and adequate information for primary care clinical practice.
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Snyder Valier AR, Huxel Bliven KC, Lam KC, Valovich McLeod TC. Patient-reported outcome measures as an outcome variable in sports medicine research. Front Sports Act Living 2022; 4:1006905. [PMID: 36406772 PMCID: PMC9666499 DOI: 10.3389/fspor.2022.1006905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Injury prevention and rehabilitation research often address variables that would be considered clinician-oriented outcomes, such as strength, range of motion, laxity, and return-to-sport. While clinician-oriented variables are helpful in describing the physiological recovery from injury, they neglect the patient perspective and aspects of patient-centered care. Variables that capture patient perspective are essential when considering the impact of injury and recovery on the lives of patients. The inclusion of patient-reported outcome measures (PROMs) as dependent variables in sports medicine research, including injury prevention and rehabilitation research, provides a unique perspective regarding the patient's perception of their health status, the effectiveness of treatments, and other information that the patient deems important to their care. Over the last 20 years, there has been a significant increase in the use of PROMs in sports medicine research. The growing body of work gives opportunity to reflect on what has been done and to provide some ideas of how to strengthen the evidence moving forward. This mini-review will discuss ideas for the inclusion of PROMs in sports medicine research, with a focus on critical factors, gaps, and future directions in this area of research. Important elements of research with PROMs, including instrument selection, administration, and interpretation, will be discussed and areas for improvement, consideration, and standardization will be provided.
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Affiliation(s)
- Alison R. Snyder Valier
- Department of Athletic Training, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ, United States
| | - Kellie C. Huxel Bliven
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States
| | - Kenneth C. Lam
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States
| | - Tamara C. Valovich McLeod
- Department of Athletic Training, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ, United States,*Correspondence: Tamara C. Valovich McLeod
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Haldane C, Frost G, Ogalo E, Bristol S, Doherty C, Berger M. A systematic review and meta-analysis of patient-reported outcomes following nerve transfer surgery for brachial plexus injury. PM R 2022; 14:1368-1381. [PMID: 35100499 DOI: 10.1002/pmrj.12778] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to determine the effect of nerve transfer surgery for brachial plexus injury (BPI) on patient-reported outcomes. LITERATURE SURVEY MEDLINE, EMBASE, and CINAHL were searched and screened in duplicate for relevant studies on September 25, 2019 and repeated June 24, 2020. METHODOLOGY The patient population included male and female patients who received nerve transfer surgery for BPI. Further inclusion criteria were: (1) all levels of evidence; (2) published in English; (3) conducted in humans; and (4) report of patient-reported outcome. Two reviewers independently abstracted data regarding injury type, surgical technique, surgical timing, follow-up duration, strength, and patient-reported outcome measures. Quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies criteria. SYNTHESIS Twenty-one studies involving 464 participants were included in analyses. The mean age ± SD was 32.4 ± 1.8 (range: 5-77) and 89.2% of included participants were male. The mean time to surgery was 5.6 ± 0.6 months and the mean follow-up time was 48.1 ± 8.4 months. The most used patient-reported outcome was the Disabilities of Arm, Shoulder and Hand (DASH), where scores variably improved postoperatively, although the degree of disability remained high. Return to work was reported in five studies, with 66.0% of participants returning to work. Patient satisfaction was assessed in four studies with an overall satisfaction proportion of 64.0%. Pain was assessed in 12 studies using various measures. In studies reporting pain intensity postoperatively, 29.3% of patients were "pain-free" or had "no pain." CONCLUSIONS Patient-reported outcomes following nerve transfer for BPI are infrequently reported in the literature. Although patient-reported outcomes demonstrate variable postoperative improvement, there is evidence of ongoing limitations and postoperative DASH scores report a high degree of ongoing disability. Future studies with greater reporting as well as validation of patient-reported outcomes within BPI are warranted.
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Affiliation(s)
- Chloe Haldane
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey Frost
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emmanuel Ogalo
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Bristol
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Doherty
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Berger
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
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Hong M, Topete M, Yang M, Bailey JF. Effects of a Digital Musculoskeletal Acute Care Program on Chronic Pain Prevention: An Observational Study with Nonparticipant Comparison Group. J Pain Res 2022; 15:3605-3613. [DOI: 10.2147/jpr.s385134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
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Shafiee E, MacDermid J, Farzad M, Karbalaei M. A systematic review and meta-analysis of Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE) measurement properties, translation, and/ or cross-cultural adaptation. Disabil Rehabil 2022; 44:6551-6565. [PMID: 34505793 DOI: 10.1080/09638288.2021.1970250] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To critically appraise, summarize, and synthesize the evidence on the psychometric, translation and/or cross-cultural adaptation properties of the Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE). MATERIALS AND METHODS Four electronic databases were searched from 1998 to February 2021. Studies addressing psychometric, translation and/or cross-cultural adaptation properties were included. Two independent reviewers extracted data and assessed methodological quality of the studies using the COSMIN checklist. Where possible, meta-analysis was conducted to pool the estimates of each measurement property. Otherwise, qualitative synthesis was conducted. The overall quality of evidence on each measurement property was provided using GRADE principles. RESULTS Forty-four studies were eligible for data extraction. The PRWE/PRWHE has been translated into 21 languages. The best factor structure was a one-dimensional construct with three unidimensional subscales. High-quality evidence supports very good structural and cross-cultural validity, internal consistency, test-retest reliability, measurement error, and hypothesis testing for construct validity against DASH in wrist and hand injuries. However, low-quality evidence supports acceptable responsiveness property. The minimal clinically important difference for the PRWE/PRWHE was 24 points for patient-level comparisons and 17 for groups. CONCLUSION High-quality evidence supports the use of PRWE/PRWHE as a reliable, valid, and structurally sound questionnaire to assess pain and disability in patients with various wrist and hand injuries. Registration code: CRD42020180250IMPLICATION FOR REHABILITATIONSThe PRWE/PRWHE is a reliable and valid anatomical region-specific measure to assess pain and disability in patients with wrist and hand injuries.Each individual subscale of the PRWE/PRHWE (pain, specific activities, and usual activities) can be used separately as a measure of pain and disability.Change scores less than 9/100 in the total score, should be considered as measurement error, not real change. Changes in the total score between 17 and 24/100 could be assumed as the minimal clinically important change in the condition of patients over time. The PRWE/PRWHE is available in 21 different languages and has been successfully adapted into highly diverse cultures. This point could be considered as one of the merits of using PRWE/PRWHE in clinical settings in multi-lingual and multi-cultural countries, when clinicians need a psychometrically sound patient reported wrist/hand measure..
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Affiliation(s)
- Erfan Shafiee
- School of physical therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
| | - Joy MacDermid
- School of physical therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
| | - Maryam Farzad
- School of physical therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada.,Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahdieh Karbalaei
- Department of Occupational Therapy, Tehran University of Medical Sciences, Tehran, Iran
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Ucero-Lozano R, Pérez-Llanes R, López-Pina JA, Cuesta-Barriuso R. Approach to Knee Arthropathy through 180-Degree Immersive VR Movement Visualization in Adult Patients with Severe Hemophilia: A Pilot Study. J Clin Med 2022; 11:jcm11206216. [PMID: 36294536 PMCID: PMC9605271 DOI: 10.3390/jcm11206216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
(1) Background: Hemarthrosis is a typical clinical manifestation in patients with hemophilia. Its recurrence causes hemophilic arthropathy, characterized by chronic joint pain. Watching movement recorded from a first-person perspective and immersively can be effective in the management of chronic pain. The objective of this study was to evaluate the effectiveness of an immersive virtual reality intervention in improving the pain intensity, joint condition, muscle strength and range of motion in patients with hemophilic knee arthropathy. (2) Methods: Thirteen patients with hemophilic knee arthropathy were recruited. The patients wore virtual reality glasses and watched a flexion-extension movement of the knee on an immersive 180° video, recorded from a first-person perspective over a 28-day period. The primary variable was the pain intensity (visual analog scale). The secondary variables were the joint status (Hemophilia Joint Health Score), quadriceps and hamstring strength (dynamometry), and range of motion (goniometry). (3) Results: After the intervention period, statistically significant differences were observed in the intensity of the joint pain (Standard error [SE] = 19.31; 95% interval confidence [95%CI] = -1.05; -0.26), joint condition (SE = 18.68; 95%CI = -1.16; -0.52) and quadriceps strength (SE = 35.00; 95%CI = 2.53; 17.47). We found that 38.46% and 23.07% of the patients exhibited an improvement in their quadriceps muscle strength and joint condition above the minimum detectable change for both variables (8.21% and 1.79%, respectively). (4) Conclusions: One hundred and eighty degree immersive VR motion visualization can improve the intensity of joint pain in patients with hemophilic knee arthropathy. An intervention using immersive virtual reality can be an effective complementary approach to improve the joint condition and quadriceps strength in these patients.
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Affiliation(s)
| | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, 30107 Murcia, Spain
| | | | - Rubén Cuesta-Barriuso
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, 33006 Oviedo, Spain
- Correspondence: ; Tel.: +34-985103386
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Birinci T, Kaya Mutlu E, Altun S. The efficacy of graded motor imagery in post-traumatic stiffness of elbow: a randomized controlled trial. J Shoulder Elbow Surg 2022; 31:2147-2156. [PMID: 35803550 DOI: 10.1016/j.jse.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/14/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Physiotherapy improves the movement range after the onset of post-traumatic elbow stiffness and reduces the pain, which is a factor limiting elbow range of motion. However, no results have been reported for motor-cognitive intervention programs in post-traumatic elbow stiffness management. The objective was to investigate the efficacy of graded motor imagery (GMI) in post-traumatic elbow stiffness. METHODS Fifty patients with post-traumatic elbow stiffness (18 female; mean age, 41.9 ± 10.9 years) were divided into 2 groups. The GMI group (n = 25) received a program consisting of left-right discrimination, motor imagery, and mirror therapy (twice a week for 6 weeks); the structured exercise (SE) group (n = 25) received a program consisting of range-of-motion, stretching, and strengthening exercises (twice a week for 6 weeks). Both groups received a 6-week home exercise program. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The secondary outcomes were the active range of motion (AROM), visual analog scale (VAS), Tampa Scale for Kinesiophobia (TSK), muscle strength of elbow flexors and extensors, grip strength, left-right discrimination, and Global Rating of Change. Patients were assessed at baseline, at the end of treatment (12 sessions), and a 6-week follow-up. RESULTS The results indicated that both GMI and SE interventions significantly improved outcomes (P < .05). After a 6-week intervention, the DASH score was significantly improved with a medium effect size in the GMI group compared with the SE group, and improvement continued at the 6-week follow-up (F1,45 = 3.10, P = .01). The results with a medium to large effect size were also significant for elbow flexion AROM (P = .02), elbow extension AROM (P = .03), VAS-activity (P = .001), TSK (P = .01), and muscle strength of elbow flexors and elbow extensors (P = .03) in favor of the GMI group. CONCLUSION The GMI is an effective motor-cognitive intervention program that might be applied to the rehabilitation of post-traumatic elbow stiffness to improve function, elbow AROM, pain, fear of movement-related pain, and muscle strength.
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Affiliation(s)
- Tansu Birinci
- Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey; Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Ebru Kaya Mutlu
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bandırma Onyedi Eylul University, Balıkesir, Turkey
| | - Süleyman Altun
- Department of Orthopedics and Traumatology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: A Clinical Practice Guideline. J Orthop Sports Phys Ther 2022; 52:647-664. [PMID: 35881707 DOI: 10.2519/jospt.2022.11306] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To develop a clinical practice guideline covering the assessment, management, and return to work of adults with rotator cuff disorders. DESIGN: Clinical practice guideline. METHODS: Using systematic reviews, appraisal of the literature, and an iterative approach to obtain consensus from key stakeholders, clinical recommendations and algorithms were developed in the context of the health care system and work environment of the province of Quebec (Canada). RESULTS: Recommendations (n = 73) and clinical decision algorithms (n = 3) were developed to match the objectives. The initial assessment should include the patient's history, a subjective assessment, and a physical examination. Diagnostic imaging is only necessary in select circumstances. Acetaminophen, nonsteroidal anti-inflammatory drugs, and injection therapies may be useful to reduce pain in the short term. Clinicians should prescribe an active and task-oriented rehabilitation program (exercises and education) to reduce pain and disability in adults with rotator cuff disorders. Subacromial decompression is not recommended to treat rotator cuff tendinopathy. Surgery is appropriate for selected patients with a full-thickness rotator cuff tear. A return-to-work plan should be developed early, in collaboration with the worker and other stakeholders, and must combine multiple strategies to promote return to work. CONCLUSION: This clinical practice guideline was developed to assist the multidisciplinary team of clinicians who provide health care for adults with a rotator cuff disorder. The CPG guides clinical decisionmaking for diagnosis and treatment, and planning for successful return to work. J Orthop Sports Phys Ther 2022;52(10):647-664. Epub: 27 July 2022. doi:10.2519/jospt.2022.11306.
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Kim HJ, Choi W, Jung J, Park S, Joo Y, Lee S, Lee S. Efficacy of radial extracorporeal shockwave therapy in rehabilitation following arthroscopic rotator cuff repair: A STROBE compliant study. Medicine (Baltimore) 2022; 101:e30053. [PMID: 36107497 PMCID: PMC9439771 DOI: 10.1097/md.0000000000030053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Rotator cuff tear is a common cause of shoulder pain and disability. Arthroscopic rotator cuff repair (ARCR) is performed to treat a torn tendon. Postoperative joint immobilization is essential, but it is a problem that needs to be addressed in the rehabilitation process. This study aimed to evaluate the effects of radial extracorporeal shock wave therapy (rESWT) in patients who underwent ARCR and required active movement after the immobilization period. This study was an open-label, prospective, single-arm trial of 30 inpatients aged >18 years who underwent ARCR. A total of 6 rESWT sessions, along with the conventional rehabilitation program for ARCR patients, were provided at the hospital's sports rehabilitation center for 2 weeks. The application sites of rESWT are periscapular muscles (supraspinatus, infraspinatus, teres minor, and rhomboid). Evaluations were conducted 3 time points-baseline, immediately after the first session of rESWT, and after 2 weeks of intervention. The outcome measures were the numeric pain rating scale for pain, and shoulder flexion, scaption flexion, abduction, horizontal adduction, external rotation, and internal rotation for shoulder range of motion. For shoulder function, disabilities of the arm, shoulder and hand, shoulder pain and disability index, and simple shoulder test were used, and muscle strength was expressed by grip strength. supraspinatus and infraspinatus evaluated thickness, tone, and stiffness. The muscle strength (95% CI, -3.554 to -0.073) and supraspinatus tone (P = .017) showed significant changes immediately after the first session of rESWT. Further, there was significant improvement in ROM (P < .01); shoulder function (P < .01); and muscle strength (95% CI, -3.561 to -0.625), supraspinatus stiffness (95% CI, -67.455 to -26.345), and infraspinatus stiffness (P = .045) after 2 weeks of intervention. However, muscle thickness and tone were significantly improved only in supraspinatus (P = .044, P = .040). Rehabilitation with radial extracorporeal shock wave therapy additionally applied to the periscapular muscles in patients who started active movement in rehabilitation after arthroscopic rotator cuff repair is effective for shoulder function and muscle properties (muscle strength, thickness, tone, and stiffness). However, a randomized controlled trial is needed to further assess the effects of radial extracorporeal shock wave therapy alone.
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Affiliation(s)
- Hyun-Joong Kim
- Sports Rehabilitation Center, The Better Hospital, Gwangju, Republic of Korea
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Wonjae Choi
- Department of Physical Therapy, Joongbu University, Chungcheongnam-do, Republic of Korea
| | - JiHye Jung
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
- Institute of SMART Rehabilitation Sahmyook University, Seoul, Republic of Korea
| | - SunGeon Park
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - YoungLan Joo
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Sangbong Lee
- Department of Physical Therapy, Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Republic of Korea
- *Correspondence: Seungwon Lee, Department of Physical Therapy, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 01795, Republic of Korea (e-mail: )
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Habechian FAP, Flores Quezada ME, Cools AM, Kjaer BH, Cuevas Cid RI, Zanca GG. Shoulder-specific rehabilitation combined with aerobic exercises versus solely shoulder-specific rehabilitation in patients with type 2 diabetes mellitus: study protocol for a randomized controlled superiority trial. Trials 2022; 23:678. [PMID: 35978380 PMCID: PMC9387007 DOI: 10.1186/s13063-022-06647-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Musculoskeletal disorders are very common in patients with diabetes mellitus (DM). The upper limb is one of the regions that is most frequently affected generally presenting limited joint mobility, pain, and a decreased muscle strength. Most clinical trials with a focus on shoulder musculoskeletal rehabilitation are carried out in patients who do not present DM. Thus, the purpose of the present study is to compare the effects of two distinct treatment protocols (conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises versus solely conventional shoulder musculoskeletal rehabilitation) on shoulder pain, function, strength, kinematics, and supraspinatus tendon thickness in patients with type 2 DM after 12 weeks of intervention and a subsequent follow-up at week 20. Methods A randomized controlled superiority trial will be conducted. Participants with a clinical diagnosis of type 2 DM of both sexes, age between 40 and 70 years, presenting shoulder pain will be randomly assigned to one of the following groups: (1) conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises; (2) solely conventional shoulder musculoskeletal rehabilitation. All individuals will be evaluated before starting the treatment protocol (baseline) and at the end of treatment (post 12 weeks) and as a follow-up at 20 weeks. The shoulder function assessed by the SPADI (Shoulder Pain and Disability Index) questionnaire will be considered as primary outcome; the secondary outcome will be shoulder pain, measured with NPRS scales. Other outcomes will include range of motion, measured using a digital inclinometer; isometric shoulder muscle strength, measured using a manual muscle dynamometer; shoulder kinematics, measured using three-dimensional inertial units measurement; supraspinatus tendon thickness, measured using an ultrasound; AGE accumulation, using a skin autofluorescence measurement; and HbA1c (hemoglobin a1c), fasting glucose and lipid profile measured by a simple blood test. Discussion DM is a highly prevalent disease and a public health problem worldwide, and the upper extremity musculoskeletal disorders in DM are barely recognized and largely underestimated. In this way, it would be interesting to analyze if the combination of aerobic exercises with conventional musculoskeletal rehabilitation protocols could generate better results in the functionality, pain, mobility and an improvement in the biochemical aspects related to the hyperglycemia of these patients compared to solely the conventional musculoskeletal rehabilitation. Trial registration ClinicalTrials.gov NCT04817514. Registered on March 26, 2021.
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Affiliation(s)
- Fernanda A P Habechian
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Casa Central: Avda. San Miguel, 3605, Talca, Chile.
| | - Mauricio E Flores Quezada
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Casa Central: Avda. San Miguel, 3605, Talca, Chile
| | - Ann M Cools
- Faculty Medicine and Health Sciences, Department of Rehabilitation Science and Physiotherapy, Ghent University, Campus Heymans (UZ Ghent), Building B3 - Second floor, De Pintelaan 185, 9000, Ghent, Belgium
| | - Birgitte Hougs Kjaer
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospitals, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
| | - Rodrigo I Cuevas Cid
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Casa Central: Avda. San Miguel, 3605, Talca, Chile
| | - Gisele G Zanca
- Postgraduate Program in Aging Sciences and Postgraduate Program in Physical Education, São Judas Tadeu University, Rua Taquari, 546. Mooca, São Paulo, 03166-000, Brazil
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Wang G, Yang M, Hong M, Krauss J, Bailey JF. Clinical Outcomes After a Digital Musculoskeletal Program for Acute and Subacute Pain: Observational, Longitudinal Study With Comparison Group. JMIR Rehabil Assist Technol 2022; 9:e38214. [PMID: 35759317 PMCID: PMC9274396 DOI: 10.2196/38214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
Background Telerehabilitation for musculoskeletal (MSK) conditions may produce similar or better outcomes than usual care, but most telerehabilitation studies address only chronic or postsurgical pain. Objective We aimed to examine pain and function at 3, 6, and 12 weeks for individuals with acute and subacute MSK pain who took part in a digital MSK program versus a nonparticipant comparison group. Methods We conducted an observational, longitudinal study with a nonparticipant comparison group. The intervention group had video visits with physical therapists who recommended exercise therapies and educational articles delivered via an app. Nonparticipants were those who were registered but unable to participate because their benefit coverage had not yet begun. We collected pain and function outcomes through surveys delivered at 3-, 6-, and 12-week follow-ups. We conducted descriptive analyses, unadjusted regression, and mixed effects regression adjusting for baseline characteristics, time as fixed effects, and a time*group interaction term. Results The analysis included data from 675 nonparticipants and 262 intervention group participants. Compared to baseline, the intervention group showed significantly more pain improvement at 3, 6, and 12 weeks versus nonparticipants after adjusting for baseline factors. Specifically, the intervention group’s pain scores decreased by 55.8% at 3 weeks versus baseline, 69.1% at 6 weeks, and 73% at 12 weeks. The intervention group’s adjusted pain scores decreased from 43.7 (95% CI 41.1-46.2) at baseline to 19.3 (95% CI 16.8-21.8) at 3 weeks to 13.5 (95% CI 10.8-16.2) at 6 weeks to 11.8 (95% CI 9-14.6) at 12 weeks. In contrast, nonparticipants’ pain scores decreased by 30.8% at 3 weeks versus baseline, 45.8% at 6 weeks, and 46.7% at 12 weeks. Nonparticipants’ adjusted pain scores decreased from 43.8 (95% CI 42-45.5) at baseline to 30.3 (95% CI 27.1-33.5) at 3 weeks to 23.7 (95% CI 20-27.5) at 6 weeks to 23.3 (95% CI 19.6-27) at 12 weeks. After adjustments, the percentage of participants reporting that pain was better or much better at follow-up was significantly higher by 40.6% at 3 weeks, 31.4% at 6 weeks, and 31.2% at 12 weeks for intervention group participants versus nonparticipants. After adjustments, the percentage of participants with meaningful functional improvement at follow-up was significantly higher by 15.2% at 3 weeks and 24.6% at 12 weeks for intervention group participants versus nonparticipants. Conclusions A digital MSK program may help to improve pain and function in the short term among those with acute and subacute MSK pain.
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Affiliation(s)
- Grace Wang
- Hinge Health, Inc, San Francisco, CA, United States
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
| | - Mindy Hong
- Hinge Health, Inc, San Francisco, CA, United States
| | | | - Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, United States
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Heil J, Büsch D. Dynamic postural control and physical stress: an approach to determining injury risk in real sporting conditions. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2022. [DOI: 10.1007/s12662-022-00833-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractDynamic postural control is one of the essential factors in situations where non-contact injuries mainly occur, i.e., landing, cutting, or stopping. Therefore, testing of dynamic postural control should be implemented in injury risk assessment. Moreover, non-contact injuries mainly occur under loaded conditions when the athlete is physically stressed. Therefore, risk factors and mechanisms of these injuries should also be regarded under loading conditions and not only when the athlete is recovered. Current studies examining the influence of physical load on risk factors, such as dynamic postural control, often use cycling protocols to stress the participants. Nevertheless, most types of sports require running as a central element and the induced internal load after cycling might not be the same after running. Therefore, the current study aimed to examine the influence of a running and a cycling protocol on dynamic postural control and to determine the potential injury risk under representative conditions. In total, 128 sport students (64 males and 64 females, age: 23.64 ± 2.44, height: 176.54 ± 8.96 cm, weight: 68.85 ± 10.98 kg) participated in the study. They were tested with the Y Balance Test before and after one loading protocol. A total of 64 participants completed a protocol on a cycle ergometer and the other 64 on a treadmill. A mixed ANOVA showed significant interactions of time and load type. Dynamic postural control was reduced immediately after cycling but did not change after running. These findings indicate a load type dependence of dynamic postural control that must be considered while assessing an athlete’s potential injury risk and they support the need for more representative designs.
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Handoll HH, Elliott J, Thillemann TM, Aluko P, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 2022; 6:CD000434. [PMID: 35727196 PMCID: PMC9211385 DOI: 10.1002/14651858.cd000434.pub5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Fractures of the proximal humerus, often termed shoulder fractures, are common injuries, especially in older people. The management of these fractures varies widely, including in the use of surgery. This is an update of a Cochrane Review first published in 2001 and last updated in 2015. OBJECTIVES To assess the effects (benefits and harms) of treatment and rehabilitation interventions for proximal humeral fractures in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trial registries, and bibliographies of trial reports and systematic reviews to September 2020. We updated this search in November 2021, but have not yet incorporated these results. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials that compared non-pharmacological interventions for treating acute proximal humeral fractures in adults. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected studies, assessed risk of bias and extracted data. We pooled data where appropriate and used GRADE for assessing the certainty of evidence for each outcome. We prepared a brief economic commentary for one comparison. MAIN RESULTS We included 47 trials (3179 participants, mostly women and mainly aged 60 years or over) that tested one of 26 comparisons. Six comparisons were tested by 2 to 10 trials, the others by small single-centre trials only. Twelve studies evaluated non-surgical treatments, 10 compared surgical with non-surgical treatments, 23 compared two methods of surgery, and two tested timing of mobilisation after surgery. Most trials were at high risk of bias, due mainly to lack of blinding. We summarise the findings for four key comparisons below. Early (usually one week post injury) versus delayed (after three or more weeks) mobilisation for non-surgically-treated fractures Five trials (350 participants) made this comparison; however, the available data are very limited. Due to very low-certainty evidence from single trials, we are uncertain of the findings of better shoulder function at one year in the early mobilisation group, or the findings of little or no between-group difference in function at 3 or 24 months. Likewise, there is very low-certainty evidence of no important between-group difference in quality of life at one year. There was one reported death and five serious shoulder complications (1.9% of 259 participants), spread between the two groups, that would have required substantive treatment. Surgical versus non-surgical treatment Ten trials (717 participants) evaluated surgical intervention for displaced fractures (66% were three- or four-part fractures). There is high-certainty evidence of no clinically important difference between surgical and non-surgical treatment in patient-reported shoulder function at one year (standardised mean difference (SMD) 0.10, 95% confidence interval (CI) -0.07 to 0.27; 7 studies, 552 participants) and two years (SMD 0.06, 95% CI -0.13 to 0.25; 5 studies, 423 participants). There is moderate-certainty evidence of no clinically important between-group difference in patient-reported shoulder function at six months (SMD 0.17, 95% CI -0.04 to 0.38; 3 studies, 347 participants). There is high-certainty evidence of no clinically important between-group difference in quality of life at one year (EQ-5D (0: dead to 1: best quality): mean difference (MD) 0.01, 95% CI -0.02 to 0.04; 6 studies, 502 participants). There is low-certainty evidence of little between-group difference in mortality: one of the 31 deaths was explicitly linked with surgery (risk ratio (RR) 1.35, 95% CI 0.70 to 2.62; 8 studies, 646 participants). There is low-certainty evidence of a higher risk of additional surgery in the surgery group (RR 2.06, 95% CI 1.21 to 3.51; 9 studies, 667 participants). Based on an illustrative risk of 35 subsequent operations per 1000 non-surgically-treated patients, this indicates an extra 38 subsequent operations per 1000 surgically-treated patients (95% CI 8 to 94 more). Although there was low-certainty evidence of a higher overall risk of adverse events after surgery, the 95% CI also includes a slightly increased risk of adverse events after non-surgical treatment (RR 1.46, 95% CI 0.92 to 2.31; 3 studies, 391 participants). Open reduction and internal fixation with a locking plate versus a locking intramedullary nail Four trials (270 participants) evaluated surgical intervention for displaced fractures (63% were two-part fractures). There is low-certainty evidence of no clinically important between-group difference in shoulder function at one year (SMD 0.15, 95% CI -0.12 to 0.41; 4 studies, 227 participants), six months (Disability of the Arm, Shoulder, and Hand questionnaire (0 to 100: worst disability): MD -0.39, 95% CI -4.14 to 3.36; 3 studies, 174 participants), or two years (American Shoulder and Elbow Surgeons score (ASES) (0 to 100: best outcome): MD 3.06, 95% CI -0.05 to 6.17; 2 studies, 101 participants). There is very low-certainty evidence of no between-group difference in quality of life (1 study), and of little difference in adverse events (4 studies, 250 participants) and additional surgery (3 studies, 193 participants). Reverse total shoulder arthroplasty (RTSA) versus hemiarthroplasty There is very low-certainty evidence from two trials (161 participants with either three- or four-part fractures) of no or minimal between-group differences in self-reported shoulder function at one year (1 study) or at two to three years' follow-up (2 studies); or in quality of life at one year or at two or more years' follow-up (1 study). Function at six months was not reported. Of 10 deaths reported by one trial (99 participants), one appeared to be surgery-related. There is very low-certainty evidence of a lower risk of complications after RTSA (2 studies). Ten people (6.2% of 161 participants) had a reoperation; all eight cases in the hemiarthroplasty group received a RTSA (very low-certainty evidence). AUTHORS' CONCLUSIONS There is high- or moderate-certainty evidence that, compared with non-surgical treatment, surgery does not result in a better outcome at one and two years after injury for people with displaced proximal humeral fractures. It may increase the need for subsequent surgery. The evidence is absent or insufficient for people aged under 60 years, high-energy trauma, two-part tuberosity fractures or less common fractures, such as fracture dislocations and articular surface fractures. There is insufficient evidence from randomised trials to inform the choices between different non-surgical, surgical or rehabilitation interventions for these fractures.
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Affiliation(s)
- Helen Hg Handoll
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
- Department of Orthopaedics and Trauma, The University of Edinburgh, Edinburgh, UK
| | - Joanne Elliott
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Theis M Thillemann
- Department of Orthopaedics, Shoulder and Elbow Unit, Aarhus University Hospital, Aarhus N, Denmark
| | - Patricia Aluko
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Stig Brorson
- Centre for Evidence-Based Orthopaedics, Zealand University Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Kim H, Lee S. The Efficacy of Pain Neuroscience Education on Active Rehabilitation Following Arthroscopic Rotator Cuff Repair: A CONSORT-Compliant Prospective Randomized Single-Blind Controlled Trial. Brain Sci 2022; 12:764. [PMID: 35741649 PMCID: PMC9221079 DOI: 10.3390/brainsci12060764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
Pain neuroscience education (PNE), a modern educational therapy, has been reported to be effective in pain control by reducing fear of movement. This study investigated the effects of additional PNE on a physical therapy rehabilitation protocol (PTRP) following arthroscopic rotator cuff repair (ARCR). In this single-blind, randomized controlled trial, 34 patients who had undergone ARCR were randomly allocated (1:1) into two groups: PNE (PTRP plus PNE) and PTRP. PTRP was performed five times a week, for four weeks, 115 min per session (physical agents, manual therapy, and exercises), and PNE was performed twice at the beginning (face-to-face PNE) and end (non-face-to-face) of the PTRP. The outcome measures were measured four times for pain intensity, pain cognition, and shoulder function; two times for a range of motion; and once for satisfaction. No significant difference in pain intensity was observed between the groups. However, in pain cognition, the Tampa Scale for Kinesiophobia avoidance showed a significant interaction between time and group, and PNE showed a higher effect size than PTRP in the post-test and follow-up in several variables. In conclusion, the significant improvement in avoidance in postoperative rehabilitation suggests that there is a partially positive benefit in terms of pain, range of motion, and shoulder function in ARCR patients.
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Affiliation(s)
- Hyunjoong Kim
- Department of Physical Therapy, Graduate School of Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul 01795, Korea;
| | - Seungwon Lee
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul 01795, Korea
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