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Kubuk BS, Carrasco-Uribarren A, Cabanillas-Barea S, Ceballos-Laita L, Jimenéz-Del-Barrio S, Pérez-Guillén S. The effects of end-range interventions in the management of primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:3206-3220. [PMID: 37559358 DOI: 10.1080/09638288.2023.2243826] [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: 01/26/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To compare the effects of end-range manual therapy versus other conservative intervention on pain intensity, shoulder range of movement (ROM), and physical function in adhesive capsulitis (AC). METHODS Two reviewers conducted a comprehensive search from inception to December 2022. PUBMED, Cochrane Library, CINAHL, EMBASE, and PEDro databases were searched. Clinical trials investigating the effects of end-range mobilisation techniques on pain, ROM, and physical function in patients with AC were included. Methodological quality was evaluated using the PEDro scale, and bias risk was assessed using the Cochrane Collaboration tool. GRADE was used to assess the certainty of the evidence. Data were presented using forest plots, and the random effects models were applied according to the Cochrane handbook. RESULTS Ten randomised controlled trials were reviewed, involving 424 AC patients aged 20-70 years. Methodological quality of studies ranged from high to low. The end-range mobilisation showed improvements in pain intensity, shoulder abduction, internal rotation, and external rotation, and physical function compared to other conservative interventions in the short-and medium-terms. Certainty of the evidence was downgraded to very low. CONCLUSIONS Very low certainty evidence suggests that end-range mobilisation techniques improve pain intensity, shoulder ROM, and physical function in the short-and medium-term in AC.
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Affiliation(s)
- Berktuğ Selçuk Kubuk
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Andoni Carrasco-Uribarren
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Sara Cabanillas-Barea
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Luis Ceballos-Laita
- Surgery Ophthalmology, Otorhinolaryngology and Physiotherapy Department, University of Valladolid, Soria, Spain
| | - Sandra Jimenéz-Del-Barrio
- Surgery Ophthalmology, Otorhinolaryngology and Physiotherapy Department, University of Valladolid, Soria, Spain
| | - Silvia Pérez-Guillén
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
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2
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Cha HJ, Han CH, Jeon JH, Jeong JK, Jung IC, Yang C, Kang BK, Kim MJ, Choi YE, Kim YI. A Pilot Study for Effectiveness and Safety of Adjunctive Pharmacopuncture to Acupuncture Treatment for Rotator Cuff Diseases: A Pragmatic Randomized Controlled Trial. J Pain Res 2024; 17:2203-2221. [PMID: 38947130 PMCID: PMC11213161 DOI: 10.2147/jpr.s457425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 05/12/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Pharmacopuncture therapy has been used in the conservative treatment of rotator cuff disease adjuvant to acupuncture treatment. Despite the increasing utilization of pharmacopuncture therapy, there is still a lack of high-quality research to support its effectiveness. This pilot study aimed to assess the feasibility of pharmacopuncture therapy adjuvant to acupuncture treatment for rotator cuff disease. Patients and Methods This was a parallel-grouped, pragmatic randomized controlled, pilot study. Forty patients were randomly allocated to either the experimental or the control group. All patients received acupuncture treatment for four weeks, and pharmacopuncture was additionally administered to the experimental group. After eight treatments were delivered over four weeks, follow-up assessments were performed. The primary outcome was the mean change in the visual analog scale (VAS) score for shoulder pain from baseline to visit 8. Secondary outcomes included shoulder pain and disability index (SPADI) at visits 4, 8, and 9, shoulder range of motion (ROM) at visits 4, 8, and 9, EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) at visits 8 and 9, patient global impression of change (PGIC) at visits 8 and 9, and mean rescue medication consumption at visits 8 and 9. Results Both groups showed that each treatment effectively improved rotator cuff disease in most assessments. Particularly, the group that received acupuncture plus pharmacopuncture required fewer rescue medications than the group that received acupuncture alone. However, there was little statistically significant difference between the two groups. There were no serious adverse events experienced by patients in this study. Conclusion Although there was little statistical difference between the two groups, the combination of acupuncture and pharmacopuncture for rotator cuff disease was associated with a reduction in the rescue medicine dosage compared with acupuncture alone. Also, it confirmed the safety of pharmacopuncture therapy. This pilot study would help design future research on the effectiveness of pharmacopuncture in rotator cuff disease.
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Affiliation(s)
- Hyun Ji Cha
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Chang-Hyun Han
- Korean Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ju Hyun Jeon
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Jeong Kyo Jeong
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - In Chul Jung
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Changsop Yang
- Korean Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Byoung-Kab Kang
- Korean Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Min Ji Kim
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Young Eun Choi
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Young Il Kim
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
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3
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Alberola-Zorrilla P, Castaño-Ortiz C, Sánchez-Zuriaga D. Where do archers hurt? Epidemiology of injuries during archery practice. Physiother Theory Pract 2024; 40:1343-1350. [PMID: 36326710 DOI: 10.1080/09593985.2022.2136507] [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: 07/07/2022] [Revised: 09/25/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The risk of injury in archery is supposedly low. However, relations between pain, shooting phases and types of bow have not been studied. OBJECTIVE Understanding the biomechanical mechanisms of archery-related injuries. METHODS Online survey for archers from all types of bow. Variables were analyzed using contingency tables and chi-squared tests. RESULTS 396 surveys were completed. 36.9% of the archers had practiced archery for more than 10 years, 23.3% between 5 and 10 years. Olympic recurve bow was the most commonly used (38.2%), followed by traditional (23.3%) and compound (22.0%). 57.3% of the archers suffered some kind of injury during archery practice. Drawing shoulder (28.2%) and neck/back injuries (19.9%) were the most prevalent, preventing 50.3% of those who suffered them from continuing archery practice. There was a moderate association between drawing arm injuries and symptomatology in the drawing phase, especially in the shoulder region (0.55), elbow (0.20), and hand (0.13), and to a lesser extent in the neck/back (0.28). CONCLUSIONS Our results show that injury chronicity is frequent on archery. Correlations between types of bow, phases of the shoot and areas of pain could be a starting point for future studies on the repercussions of different types of injuries in archery practice.
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Affiliation(s)
- Pilar Alberola-Zorrilla
- Department of Anatomy and Human Embryology, Facultat de Medicina i Odontologia, Universitat de València, València, Spain
| | | | - Daniel Sánchez-Zuriaga
- Department of Anatomy and Human Embryology, Facultat de Medicina i Odontologia, Universitat de València, València, Spain
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4
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Picasso R, Pistoia F, Zaottini F, Marcenaro G, Miguel-Pérez M, Tagliafico AS, Martinoli C. Adhesive Capsulitis of the Shoulder: Current Concepts on the Diagnostic Work-Up and Evidence-Based Protocol for Radiological Evaluation. Diagnostics (Basel) 2023; 13:3410. [PMID: 37998547 PMCID: PMC10670865 DOI: 10.3390/diagnostics13223410] [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: 09/29/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Adhesive capsulitis is an idiopathic and disabling disorder characterized by intense shoulder pain and progressive limitation of active and passive glenohumeral joint range of motion. Although adhesive capsulitis has been traditionally considered a diagnosis of exclusion that can be established based on a suggestive medical history and the detection of supporting findings at the physical exam, imaging studies are commonly requested to confirm the diagnostic suspicion and to exclude other causes of shoulder pain. Indeed, clinical findings may be rather unspecific, and may overlap with diseases like calcific tendinitis, rotator cuff pathology, acromioclavicular or glenohumeral arthropathy, autoimmune disorders, and subacromial/subdeltoid bursitis. Magnetic resonance imaging, magnetic resonance arthrography, and high-resolution ultrasound have shown high sensitivity and accuracy in diagnosing adhesive capsulitis through the demonstration of specific pathological findings, including thickening of the joint capsule and of the coracohumeral ligament, fibrosis of the subcoracoid fat triangle, and extravasation of gadolinium outside the joint recesses. This narrative review provides an updated analysis of the current concepts on the role of imaging modalities in patients with adhesive capsulitis, with the final aim of proposing an evidence-based imaging protocol for the radiological evaluation of this condition.
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Affiliation(s)
- Riccardo Picasso
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
| | - Federico Pistoia
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
| | - Federico Zaottini
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
| | - Giovanni Marcenaro
- Department of Health Sciences (DISSAL), Università di Genova, Via Antonio Pastore 1, 16132 Genova, Liguria, Italy;
| | - Maribel Miguel-Pérez
- Unidad de Anatomía y Embriología Humana, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina y Ciencias de la Salud (Campus de Bellvitge), Universitat de Barcelona, 08904 Barcelona, Spain;
| | - Alberto Stefano Tagliafico
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
- Department of Health Sciences (DISSAL), Università di Genova, Via Antonio Pastore 1, 16132 Genova, Liguria, Italy;
| | - Carlo Martinoli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genova, Liguria, Italy; (R.P.); (F.Z.); (A.S.T.); (C.M.)
- Department of Health Sciences (DISSAL), Università di Genova, Via Antonio Pastore 1, 16132 Genova, Liguria, Italy;
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de Sire A, Moggio L, Marotta N, Fortunato F, Spalek R, Inzitari MT, Paolucci T, Ammendolia A. Ultrasound-Guided Injections and Proprioceptive Neuromuscular Facilitation as Shoulder Rehabilitation for Multiple Sclerosis and Neuropathic Pain. Healthcare (Basel) 2022; 10:healthcare10101869. [PMID: 36292316 PMCID: PMC9601756 DOI: 10.3390/healthcare10101869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple sclerosis (MS) represents a major cause of chronic neurological disability in young adults and can result in upper limb sensorimotor impairment with a huge impact on manual dexterity and activities of daily living. Moreover, pain is common in MS and a large proportion of patients suffer from central neuropathic pain. To date, no rehabilitative treatment has been described as useful for these patients. A 46-year-old woman, affected by relapsing-remittent MS, described a one-year history of right shoulder pain (Visual Analogue Scale = 8) that started gradually and without trauma. The patient also presented balance and gait impairments, upper limb strength deficit, and fatigue (Expanded Disability Status Scale = 5.5). A multidisciplinary treatment was proposed, including three intra-articular corticosteroid injections and one month of manual therapy, three sessions/week, based on proprioceptive neuromuscular facilitation for the upper limb. At the end of the rehabilitative treatment, pain relief and an improvement in the range of motion of the affected shoulder, upper limb muscle strength, and hand dexterity were observed. The present paradigmatic case report with literature review demonstrated that a multidisciplinary approach seems to be effective in pain relief in a patient with central neuropathic shoulder pain and relapsing-remitting MS.
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Affiliation(s)
- Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Lucrezia Moggio
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-0961369768
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Renata Spalek
- Rehabilitation Unit, ‘Mons. L. Novarese’ Hospital, 13040 Vercelli, Italy
- Department of Geriatrics, Neurosciences, Orthopedics, Center for Geriatric Medicine (CEMI), Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Maria Teresa Inzitari
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Teresa Paolucci
- Physical Medicine and Rehabilitation, Department of Oral, Medical and Biotechnological Sciences, Physical Medicine and Rehabilitation, University G. D’Annunzio, 66100 Chieti, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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6
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Liu J, Hui SSC, Yang Y, Rong X, Zhang R. Effectiveness of home-based exercise for non-specific shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 2022; 103:2036-2050. [DOI: 10.1016/j.apmr.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
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7
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Ludewig PM, Saini G, Hellem A, Kahnert EK, Rezvanifar SC, Braman JP, Staker JL. Changing our Diagnostic Paradigm Part II: Movement System Diagnostic Classification. Int J Sports Phys Ther 2022; 17:7-17. [PMID: 35024204 PMCID: PMC8720248 DOI: 10.26603/001c.30177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/28/2021] [Indexed: 12/30/2022] Open
Abstract
Diagnostic classification is a foundational underpinning of providing care of the highest quality and value. Diagnosis is pattern recognition that can result in categories of conditions that ideally direct treatment. While pathoanatomic diagnoses are common and traditional in orthopaedic practice, they often are limited with regard to directing best practice physical therapy intervention. Replacement of pathoanatomic labels with non-specific regional pain labels has been proposed, and occurs frequently in clinical practice. For example non-specific low back pain or shoulder pain of unknown origin. These labels avoid some disadvantages of tissue specific pathoanatomic labels, but are not specific enough to direct treatment. A previously introduced movement system diagnostic framework is proposed and updated with application to shoulder conditions. This framework has potential for broad development and application across musculoskeletal physical therapist practice. Movement system diagnostic classification can advance and streamline practice if considered while recognizing the inherent movement variability across individuals.
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Affiliation(s)
- Paula M Ludewig
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | - Gaura Saini
- Department of Rehabilitation Medicine, University of Minnesota Division of Rehabilitation Science
| | - Aaron Hellem
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | - Emily K Kahnert
- Department of Rehabilitation Medicine, University of Minnesota Division of Rehabilitation Science; Orofacial Pain & Dental Sleep Medicine Clinic, University of Minnesota School of Dentistry
| | - S Cyrus Rezvanifar
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | | | - Justin L Staker
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
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Zadro J, Rischin A, Johnston RV, Buchbinder R. Image-guided glucocorticoid injection versus injection without image guidance for shoulder pain. Cochrane Database Syst Rev 2021; 8:CD009147. [PMID: 34435661 PMCID: PMC8407470 DOI: 10.1002/14651858.cd009147.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite widespread use, our 2012 Cochrane review did not confirm that use of imaging to guide glucocorticoid injection for people with shoulder pain improves its efficacy. OBJECTIVES To update our review and assess the benefits and harms of image-guided glucocorticoid injection compared to non-image-guided injection for patients with shoulder pain. SEARCH METHODS We updated the search of the Cochrane Central Register of Controlled Trials (CENTRAL, via Ovid), MEDLINE (Ovid), Embase (Ovid) and clinicaltrials.gov to 15 Feb 2021, and the World Health Organisation International Clinical Trials Registry Platform (http://www.who.int/trialsearch/Default.aspx) to 06 July 2020. We also screened reference lists of retrieved review articles and trials to identify potentially relevant studies. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials that compared image-guided glucocorticoid injection to injection without image guidance (either landmark-guided or intramuscular) injection in patients with shoulder pain (rotator cuff disease, adhesive capsulitis or mixed or undefined shoulder pain). Major outcomes were pain, function, proportion of participants with treatment success, quality of life, adverse events, serious adverse events and withdrawals due to adverse events. Minor outcomes were shoulder range of motion and proportion of participants requiring surgery or additional injections. There were no restrictions on language or date of publication. DATA COLLECTION AND ANALYSIS We used standard methodologic procedures expected by Cochrane. MAIN RESULTS Nineteen trials were included (1035 participants). Fourteen trials included participants with rotator cuff disease, four with adhesive capsulitis, and one with mixed or undefined shoulder pain. Trial size varied from 28 to 256 participants, most participants were female, mean age ranged between 31 and 60 years, and mean symptom duration varied from 2 to 23 months. Two trials were at low risk of bias for all criteria. The most notable sources of bias in the remaining trials included performance bias and detection bias. Moderate-certainty evidence (downgraded for bias) indicates that ultrasound-guided injection probably provides little or no clinically important benefits compared with injection without guidance with respect to pain (15 trials) or function (14 trials) at three to six weeks follow-up. It may not improve quality of life (2 trials, low-certainty evidence, downgraded due to potential for bias and imprecision) and we are uncertain about the effect of ultrasound-guided injection on participant-rated treatment success due to very low-certainty evidence (downgraded for bias, inconsistency and imprecision). Mean pain (scale range 0 to 10, higher scores indicate more pain) was 3.1 points with injection without image guidance and 0.5 points better (0.2 points better to 0.8 points better; 1003 participants, 15 trials) with an ultrasound-guided injection. This represents a slight difference for pain (0.5 to 1.0 points on a 0 to 10 scale). Mean function (scale range 0 to 100, higher scores indicate better function) was 68 points with injection without image guidance and 2.4 points better (0.2 points worse to 5.1 points better; 895 participants, 14 trials) with an ultrasound-guided injection. Mean quality of life (scale range 0 to 100, higher scores indicate better quality of life) was 65 with injection without image guidance and 2.8 points better (0.7 worse to 6.4 better; 220 participants, 2 trials) with an ultrasound-guided injection. In five trials (350 participants), 101/175 (or 606 per 1000) people in the ultrasound-guided group reported treatment success compared with 68/175 (or 389 per 1000) people in the group injected without image guidance (RR 1.56 (95% CI 0.89 to 2.75)), an absolute difference of 22% more reported success (4% fewer to 62% more). Low-certainty evidence (downgraded for bias and imprecision) indicates that ultrasound-guided injections may not reduce the risk of adverse events compared to injections without image guidance. In five trials (402 participants), 38/200 (or 181 per 1000) people in the ultrasound-guided group reported adverse events compared with 51/202 (or 252 per 1000) in the non-image-guided injection group (RR 0.72 (95% CI 0.4 to 1.28)), an absolute difference of 7% fewer adverse events (15% fewer to 7% more). Five trials reported that there were no serious adverse events. The remaining trials did not report serious adverse events. One trial reported that 1/53 (or 19 per 1000) in the injection without image guidance group and 0/53 in the ultrasound-guided group withdrew due to adverse events. Sensitivity analyses indicate that the effects for pain and function may have been influenced by selection bias, and the effects for function may have been influenced by detection bias. The test for subgroup differences indicated there were unlikely to be differences in pain and function across different shoulder conditions. AUTHORS' CONCLUSIONS Our updated review does not support use of image guidance for injections in the shoulder. Moderate-certainty evidence indicates that ultrasound-guided injection in the treatment of shoulder pain probably provides little or no benefit over injection without imaging in terms of pain or function and low-certainty evidence indicates there may be no difference in quality of life. We are uncertain if ultrasound-guided injection improves participant-rated treatment success, due to very low-certainty evidence. Low-certainty evidence also suggests ultrasound-guided injection may not reduce the risk of adverse events compared with non-image-guided injection. No serious adverse events were reported in any trial. The lack of significant benefit of image guidance over injection without image guidance to improve patient-relevant outcomes or reduce harms, suggests that any added cost of image guidance appears unjustified.
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Affiliation(s)
- Joshua Zadro
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adam Rischin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Renea V Johnston
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
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9
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Eliason A, Harringe M, Engström B, Sunding K, Werner S. Bilateral ultrasound findings in patients with unilateral subacromial pain syndrome. Physiother Theory Pract 2021; 38:2568-2579. [PMID: 34402715 DOI: 10.1080/09593985.2021.1962462] [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: 10/20/2022]
Abstract
Background: Subacromial pain syndrome is a common musculoskeletal shoulder problem. The accuracy of clinical tests is low and techniques such as ultrasound and magnetic resonance imaging have been added to set up a diagnosis. Previous researchers have usually only examined the symptomatic shoulder. However, there might be similar findings in the asymptomatic shoulder. Objective:The aim of the present study was to investigate the prevalence of structural abnormalities of both shoulders in patients with clinically diagnosed unilateral subacromial pain syndrome using diagnostic ultrasound. Methods: Bilateral ultrasound examinations were performed in 115 consecutive patients, 54 men and 61 women. The patients were recruited from primary care centers in the area of Stockholm, Sweden. Results: Abnormal ultrasound findings were found in both shoulders and increased with age (p = .0004). Bursitis was the most common ultrasound finding and significantly more prevalent in the symptomatic shoulder compared to the asymptomatic shoulder (90%:74%; p = .0021), though 73% of the bursitis were bilateral. Supraspinatus is the most vulnerable tendon of the rotator cuff in both shoulders. In terms of partial-thickness tears and tendinosis, the tendon was affected more commonly in the symptomatic shoulder compared to the asymptomatic shoulder (30%:14%: 14%; p = .0026) and (24%:10%; p = .0054), respectively, but for calcification no significant difference between the shoulders was found (18%:12%; 0.1988). Conclusion: Ultrasound detected shoulder abnormalities were present in both symptomatic and asymptomatic shoulders. Bursitis and partial-thickness tears were more common in the affected shoulder when compared to the unaffected shoulder. Ultrasound as well as clinical examination findings and patient´s history should be taken into consideration when diagnosing patients with subacromial pain syndrome.
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Affiliation(s)
- Anna Eliason
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Health Care Services Stockholm County (SLSO), Region Stockholm
| | - Marita Harringe
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Aleris Sports Medicine & Ortopedi Sabbatsberg Hospital, Stockholm, Sweden
| | - Björn Engström
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Capio Artro Clinic, Stockholm, Sweden
| | - Kerstin Sunding
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Aleris Sports Medicine & Ortopedi Sabbatsberg Hospital, Stockholm, Sweden
| | - Suzanne Werner
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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10
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Gianola S, Iannicelli V, Fascio E, Andreano A, Li LC, Valsecchi MG, Moja L, Castellini G. Kinesio taping for rotator cuff disease. Cochrane Database Syst Rev 2021; 8:CD012720. [PMID: 34365646 PMCID: PMC8406708 DOI: 10.1002/14651858.cd012720.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Kinesio Taping (KT) is one of the conservative treatments proposed for rotator cuff disease. KT is an elastic, adhesive, latex-free taping made from cotton, without active pharmacological agents. Clinicians have adopted it in the rehabilitation treatment of painful conditions, however, there is no firm evidence on its benefits. OBJECTIVES To determine the benefits and harms of KT in adults with rotator cuff disease. SEARCH METHODS We searched the Cochrane Library, MEDLINE, Embase, PEDro, CINAHL, Clinicaltrials.gov and WHO ICRTP registry to July 27 2020, unrestricted by date and language. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials (RCTs) including adults with rotator cuff disease. Major outcomes were overall pain, function, pain on motion, active range of motion, global assessment of treatment success, quality of life, and adverse events. DATA COLLECTION AND ANALYSIS We used standard methodologic procedures expected by Cochrane. MAIN RESULTS We included 23 trials with 1054 participants. Nine studies (312 participants) assessed the effectiveness of KT versus sham therapy and fourteen studies (742 participants) assessed the effectiveness of KT versus conservative treatment. Most participants were aged between 18 and 50 years. Females comprised 52% of the sample. For the meta-analysis, we considered the last available measurement within 30 days from the end of the intervention. All trials were at risk of performance, selection, reporting, attrition, and other biases. Comparison with sham taping Due to very low-certainty evidence, we are uncertain whether KT improves overall pain, function, pain on motion and active range of motion compared with sham taping. Mean overall pain (0 to 10 scale, 0 no pain) was 2.96 points with sham taping and 3.03 points with KT (3 RCTs,106 participants), with an absolute difference of 0.7% worse, (95% CI 7.7% better to 9% worse) and a relative difference of 2% worse (95% CI 21% better to 24% worse) at four weeks. Mean function (0 to 100 scale, 0 better function) was 47.1 points with sham taping and 39.05 points with KT (6 RCTs, 214 participants), with an absolute improvement of 8% (95% CI 21% better to 5% worse)and a relative improvement of 15% (95% CI 40% better to 9% worse) at four weeks. Mean pain on motion (0 to 10 scale, 0 no pain) was 4.39 points with sham taping and 2.91 points with KT even though not clinically important (4 RCTs, 153 participants), with an absolute improvement of 14.8% (95% CI 22.5% better to 7.1% better) and a relative improvement of 30% (95% CI 45% better to 14% better) at four weeks. Mean active range of motion (shoulder abduction) without pain was 174.2 degrees with sham taping and 184.43 degrees with KT (2 RCTs, 68 participants), with an absolute improvement of 5.7% (95% CI 8.9% worse to 20.3% better) and a relative improvement of 6% (95% CI 10% worse to 22% better) at two weeks. No studies reported global assessment of treatment success. Quality of life was reported by one study but data were disaggregated in subscales. No reliable estimates for adverse events (4 studies; very low-certainty) could be provided due to the heterogeneous description of events in the sample. Comparison with conservative treatments Due to very low-certainty evidence, we are uncertain if KT improves overall pain, function, pain on motion and active range of motion compared with conservative treatments. However, KT may improve quality of life (low certainty of evidence). Mean overall pain (0 to 10 scale, 0 no pain) was 0.9 points with conservative treatment and 0.46 points with KT (5 RCTs, 266 participants), with an absolute improvement of 4.4% (95% CI 13% better to 4.6% worse) and a relative improvement of 15% (95% CI 46% better to 16% worse) at six weeks. Mean function (0 to 100 scale, 0 better function) was 46.6 points with conservative treatment and 33.47 points with KT (14 RCTs, 499 participants), with an absolute improvement of 13% (95% CI 24% better to 2% better) and a relative improvement of 18% (95% CI 32% better to 3% better) at four weeks. Mean pain on motion (0 to 10 scale, 0 no pain) was 4 points with conservative treatment and 3.94 points with KT (6 RCTs, 225 participants), with an absolute improvement of 0.6% (95% CI 7% better to 8% worse) and a relative improvement of 1% (95% CI 12% better to 10% worse) at four weeks. Mean active range of motion (shoulder abduction) without pain was 156.6 degrees with conservative treatment and 159.64 degrees with KT (3 RCTs, 143 participants), with an absolute improvement of 3% (95% CI 11% worse to 17 % better) and a relative improvement of 3% (95% CI 9% worse to 14% better) at six weeks. Mean of quality of life (0 to 100, 100 better quality of life) was 37.94 points with conservative treatment and 56.64 points with KT (1 RCTs, 30 participants), with an absolute improvement of 18.7% (95% CI 14.48% better to 22.92% better) and a relative improvement of 53% (95% CI 41% better to 65% better) at four weeks. No studies were found for global assessment of treatment success. No reliable estimates for adverse events (7 studies, very low certainty of evidence) could be provided due to the heterogeneous description of events in the whole sample. AUTHORS' CONCLUSIONS Kinesio taping for rotator cuff disease has uncertain effects in terms of self-reported pain, function, pain on motion and active range of motion when compared to sham taping or other conservative treatments as the certainty of evidence was very low. Low-certainty evidence shows that kinesio taping may improve quality of life when compared to conservative treatment. We downgraded the evidence for indirectness due to differences among co-interventions, imprecision due to small number of participants across trials as well as selection bias, performance and detection bias. Evidence on adverse events was scarce and uncertain. Based upon the data in this review, the evidence for the efficacy of KT seems to demonstrate little or no benefit.
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Affiliation(s)
- Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Valerio Iannicelli
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | | | - Anita Andreano
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Richmond, Canada
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Lorenzo Moja
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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11
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Brindisino F, Indaco T, Giovannico G, Ristori D, Maistrello L, Turolla A. Shoulder Pain and Disability Index: Italian cross-cultural validation in patients with non-specific shoulder pain. Shoulder Elbow 2021; 13:433-444. [PMID: 34394741 PMCID: PMC8355649 DOI: 10.1177/1758573220913246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/21/2019] [Accepted: 02/10/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health-related patient reported outcome measures are considered essential to determine the impact of disease on the life of individuals. Aim of this study is to culturally adapt the Italian version of the Shoulder Pain and Disability Index (SPADI). The secondary aim is to evaluate psychometric proprieties in patients with non-specific shoulder pain. METHODS The current study is an analysis of a sample of 59 adult patients with non-specific shoulder pain. The SPADI was translated and cross-culturally adapted, and then psychometric properties were tested. Participants completed the Shoulder Pain and Disability Index-Italian (SPADI-I), 36-item short form health survey, the Oxford Shoulder Score, the Disability of Arm, Shoulder, and Hand scale and a pain intensity visual analogue scale. RESULTS SPADI-I included two domains. Internal consistency analysis showed good values for total (α = 0.84) and subscales (α = 0.94 and α = 0.76). For construct validity, there was good correlation between the visual analogue scale, the Oxford Shoulder Score, the DASH and the SPADI-I total score and subscales. Standard error of measurement and minimally detectable change were calculated. CONCLUSIONS The SPADI-I was culturally adapted into Italian. SPADI-I is centred on pain and disability of the shoulder only and can be considered as a useful tool in daily clinical practice for assessing musculoskeletal non-specific shoulder pain because of its good internal consistency and validity. Further studies should focus on other psychometric proprieties such as test re-test reliability, responsiveness and clinical interpretability to improve the available clinimetrics of the tool.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health
Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli
Hospital, Campobasso, Italy
- Physiotherapy and Manual Therapy-FTM-,
Physiotherapy Clinic, Lecce, Italy
| | - Tiziana Indaco
- Physiotherapy Department, Medical Clinic
Aventino, Roma, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health
Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli
Hospital, Campobasso, Italy
- Physiotherapy and Manual Therapy-FTM-,
Physiotherapy Clinic, Lecce, Italy
| | - Diego Ristori
- Department of Neuroscience,
Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of
Genova, Genova, Italy
| | - Lorenza Maistrello
- Laboratory of Neurorehabilitation
Technologies, IRCCS San Camillo Hospital Foundation, Venezia, Italy
| | - Andrea Turolla
- Laboratory of Neurorehabilitation
Technologies, IRCCS San Camillo Hospital Foundation, Venezia, Italy
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12
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Ascani C, Passaretti D, Scacchi M, Bullitta G, De Cupis M, Pasqualetto M, Ascani J. Can adhesive capsulitis of the shoulder be a consequence of COVID-19? Case series of 12 patients. J Shoulder Elbow Surg 2021; 30:e409-e413. [PMID: 33964424 PMCID: PMC8096757 DOI: 10.1016/j.jse.2021.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/17/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Claudio Ascani
- Shoulder and Elbow Unit and Advanced Prosthetic Surgery Unit, C.T.O. Hospital, Rome, Italy
| | - Daniele Passaretti
- Shoulder and Elbow Unit and Advanced Prosthetic Surgery Unit, C.T.O. Hospital, Rome, Italy,Reprint requests: Daniele Passaretti, MD, Shoulder and Elbow Unit and Advanced Prosthetic Surgery Unit, C.T.O. Hospital, Via S. Nemesio 21, 00145, Rome, Italy
| | - Marco Scacchi
- Shoulder and Elbow Unit and Advanced Prosthetic Surgery Unit, C.T.O. Hospital, Rome, Italy
| | - Gianluca Bullitta
- Shoulder and Elbow Unit and Advanced Prosthetic Surgery Unit, C.T.O. Hospital, Rome, Italy
| | - Mauro De Cupis
- Shoulder and Elbow Unit and Advanced Prosthetic Surgery Unit, C.T.O. Hospital, Rome, Italy
| | - Monia Pasqualetto
- Department of Diagnostic Imaging and Interventional Radiology, Polyclinic of Tor Vergata, Tor Vergata University, Rome, Italy
| | - Jacopo Ascani
- Sant’Andrea Hospital, Department of Medicine and Surgery, Sapienza University, Rome, Italy
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13
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Riley SP, Harris J, O'Halloran BJ, Showalter CR, Learman KE. Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1914. [PMID: 34028940 DOI: 10.1002/pri.1914] [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: 11/20/2020] [Revised: 03/20/2021] [Accepted: 05/13/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The objectives of this study were the following: (1) to determine if there was a difference in outcomes between immediate responders to glenohumeral mobilizations at the initial evaluation, 2-week, 4-week, and 6-month follow-up as compared to those that do not respond in participants with subacromial pain syndrome; (2) to see if there were statistically significant differences in outcomes within these groups between these time frames of interest, and (3) to see if symptom response at the initial evaluation was predictive of a favorable recovery. METHODS This was a prospective, single-group observational design. Clinicians pragmatically identified positive responders as improving at least two points on the Numeric Pain Rating Scale and/or a 20° improvement in shoulder active range of motion (AROM) following shoulder mobilization at the initial evaluation. Data were collected for the subjective and objective variables of interest at the initial evaluation, 2-week, 4-week, and 6-month follow-up. RESULTS The prevalence of responders at the initial evaluation was 99 (81.8%). There were no statistically significant between-group differences for the variables of interest except for the Global Rating of Change (GRoC; f = 2.79, p = 0.006). The shoulder abduction AROM between-group difference exceeded the minimal detectable change at 4 weeks. The pair-wise comparison showed statistically significant differences for the outcomes of interest at each time point except for the GRoC between 4 weeks and 6 months. There was a statistically significant correlation between responders at the initial evaluation and shoulder abduction AROM at the 4-week follow-up (rpb (112) = 0.27, p = 0.004). CONCLUSION Individuals with SAPS may benefit from shoulder mobilization independent of their within-session response to shoulder mobilization at the initial evaluation. Future research should seek to differentiate if these improvements are related to the within-session positive treatment response at the initial evaluation in individuals who are randomized to receive shoulder mobilization or not.
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Affiliation(s)
- Sean P Riley
- Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut, USA
| | - Jonathan Harris
- Doctor of Physical Therapy Program, Sacred Heart University, Fairfield, Connecticut, USA
| | | | | | - Kenneth E Learman
- Department of Graduate Studies in Health and Rehabilitation Sciences, Youngstown State University, Youngstown, Ohio, USA
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Kc S, Sharma S, Ginn KA, Reed D. Measurement properties of translated versions of the Shoulder Pain and Disability Index: A systematic review. Clin Rehabil 2020; 35:410-422. [PMID: 33025826 DOI: 10.1177/0269215520963199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To summarise measurement properties of translated versions of the Shoulder Pain and Disability Index (SPADI) and to assess their methodological quality. METHODS Relevant studies testing measurement properties of translated versions of the SPADI in non-specific shoulder pain participants were included from 11 databases (August 2020). Two reviewers independently screened articles and assessed individual measurement property risk of bias using the COSMIN checklist as very good, adequate, doubtful or inadequate. For each measurement property results were pooled and rated sufficient, insufficient, or inconsistent. Synthesised evidence was graded as high, moderate, low or very low (GRADE approach). RESULTS Thirty-four studies (21 languages and 26 different versions) were included from 4402 articles. A total of 141 measurement properties were reported with 60 rated as very good or adequate. These included; internal consistency (19), test-retest reliability (4), construct validity (6), structural validity (10), measurement error (5), responsiveness (9), and cross-cultural validity (2). Comprehensibility was adequate in the Chinese, German, Nepali, Spanish and Urdu versions. Only the Danish, Dutch and Nepali versions confirmed all, or all but one, of their measurement properties with sound methodology. Pooled results of all measurement properties except structural validity were rated as sufficient. Quality of evidence was graded moderate to high with downgrading due to inconsistent results. CONCLUSION Overall evidence suggests the SPADI is valid, reliable and responsive in translated form but less than half the measurement properties tested were of adequate quality. Further testing is required in many languages particularly in; test-retest reliability, measurement error and construct validity.
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Affiliation(s)
- Sudarshan Kc
- Discipline of Anatomy and Histology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.,Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Karen A Ginn
- Discipline of Anatomy and Histology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Darren Reed
- Discipline of Anatomy and Histology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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15
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Engebretsen KB, Brox JI, Juel NG. Patients with shoulder pain referred to specialist care; treatment, predictors of pain and disability, emotional distress, main symptoms and sick-leave: a cohort study with a six-months follow-up. Scand J Pain 2020; 20:775-783. [DOI: 10.1515/sjpain-2020-0044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/10/2020] [Indexed: 12/22/2022]
Abstract
Abstract
Objectives
Recommendations for referral of patients with shoulder pain from primary to specialist care are mainly clinical. Several patients are referred without meeting these criteria for referral, whereas some are referred for a second opinion although surgery is not recommended. The aims of this study were to describe a shoulder pain cohort in specialist healthcare according to demographic data, clinical, and psychological factors; evaluate changes in pain and disability, distress and main symptoms from baseline to six-month follow-up; and to assess predictors of pain and disability, changes in the main symptoms and sick-leave at six-months. Results were compared to previous randomised trials conducted at the same clinic in patients with subacromial shoulder pain.
Methods
This prospective study included 167 patients from an outpatient clinic in specialist healthcare with shoulder pain for more than 6 weeks. Clinical (pain duration, intensity, pain sites), sociodemographic (age, gender, educational level, work status) and psychological variables (emotional distress (HSCL-10), fear of pain, screening of “yellow flags”, health-related quality of life) were collected. Shoulder pain and disability (SPADI-score) were assessed and the patients were asked about their outcome expectation and to predict their status of their shoulder problem the next month. They underwent a clinical interview, a clinical assessment of shoulder function and orthopaedic tests for diagnostic purposes. After six months they received a questionnaire with main variables.
Results
Of the 167 patients (55% women), 50% had symptoms for more than 12 months and 37 (22%) were on sick-leave. Characteristics were in general comparable to patients previously included in clinical trials at the same department. The SPADI-score was 46 (23) points. Mean emotional distress was within the normal range (1.7 (SD 0.6)). More than 80% had received treatment before, mainly physiotherapy in addition to the GPs treatment. One hundred and thirty-seven patients (82%) were re-referred to physiotherapy, 74 (44%) in the outpatient clinic specialist healthcare, and 63 (38%) in primary care. One hundred and eighteen (71%) answered the follow-up questionnaire. Mean change in SPADI-score was 10.5 points (95% CI (6.5–14.5)), and 29% of the patients improved more than the smallest detectable difference (SDD). The percentage sick-listed was 19.5%, and mean change in main symptoms (−9 to +9) was 3.4 (SD 3.9). The subgroup of patients receiving physiotherapy in outpatient specialist care did not show any significant change in the main variables. The prediction models suggested that a lower level of education, more fear of pain and a high baseline SPADI-score, predicted a higher SPADI-score at follow-up. A high baseline HSCL-10 score was the only significant predictor for a high HSCL-10 score. At follow-up, less pain at rest predicted more change in main symptoms and more yellow flags (a higher score on the Örebro screening test) predicted sick-leave.
Conclusions
Within the limitations of a cohort study, patients with persistent shoulder pain referred to an outpatient specialist clinic had similar baseline characteristics but shorter treatment duration, inferior clinical results and predictors somewhat different compared with previous clinical trials conducted at the same clinic. The study raises some questions about the effectiveness of the routines in daily clinical practice, the selection of patients, the treatment duration and content.
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Affiliation(s)
- Kaia B. Engebretsen
- Department of Physical Medicine and Rehabilitation , Oslo University Hospital HF , Oslo , Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation , Oslo University Hospital HF , Oslo , Norway
- Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation , Oslo University Hospital HF , Oslo , Norway
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An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther 2020; 50:131-141. [PMID: 31726927 DOI: 10.2519/jospt.2020.8498] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To update a systematic review published in 2013 that focused on evaluating the effectiveness of interventions within the scope of physical therapy, including exercise, manual therapy, electrotherapy, and combined or multimodal approaches to managing shoulder pain. DESIGN Umbrella review. LITERATURE SEARCH An electronic search of PubMed, Web of Science, and CINAHL was undertaken. Methodological quality was assessed using the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist for systematic reviews. STUDY SELECTION CRITERIA Nonsurgical treatments for subacromial shoulder pain. DATA SYNTHESIS Sixteen systematic reviews were retrieved. Results were summarized qualitatively. RESULTS A strong recommendation can be made for exercise therapy as the first-line treatment to improve pain, mobility, and function in patients with subacromial shoulder pain. Manual therapy may be integrated, with a strong recommendation, as additional therapy. There was moderate evidence of no effect for other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic energy, and ultrasound. CONCLUSION There is a growing body of evidence to support exercise therapy as an intervention for subacromial shoulder pain. Ongoing research is required to provide guidance on exercise type, dose, duration, and expected outcomes. A strong recommendation may be made regarding the inclusion of manual therapy in the initial treatment phase. J Orthop Sports Phys Ther 2020;50(3):131-141. Epub 15 Nov 2019. doi:10.2519/jospt.2020.8498.
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Schwerla F, Hinse T, Klosterkamp M, Schmitt T, Rütz M, Resch KL. Osteopathic treatment of patients with shoulder pain. A pragmatic randomized controlled trial. J Bodyw Mov Ther 2020; 24:21-28. [PMID: 32825990 DOI: 10.1016/j.jbmt.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shoulder complaints are common in the general population. Typically, the diagnosis of a specific pathology is lacking. The objective of this trial was to evaluate the effectiveness of an osteopathic treatment in patients suffering from shoulder pain. METHODS A pragmatic randomized controlled trial was conducted in patients with a history of shoulder pain of 6 weeks to 12 months, and a pain intensity level of at least 40% on the visual analogue scale (VAS). Participants were identified from the general population in Germany and allocated by means of external randomization to an intervention group or a control group. Patients in the intervention group received five osteopathic treatments at intervals of two weeks. Treatment was custom tailored and based on osteopathic principles. Controls received their osteopathic treatment after an 8-week untreated waiting period. Primary outcome parameters were pain intensity and frequency, measured by VAS and Likert Scales. Secondary outcome parameters were shoulder specific pain and disability (Shoulder Pain and Disability Index, SPADI), and quality of life (SF-36). RESULTS A total of 70 patients aged 25-70 years (average age 45.6 ± 13.4 years) were included, 36 in the intervention group and 34 in the control group. The inter-group comparison of changes revealed clinically relevant improvements in favor of the intervention group for the main outcome parameters maximal pain intensity (VAS: between group difference of means 41.5; 95% CI: 34.6 to 48.3; p < 0.005) and average pain intensity (VAS: between group difference of means 40.4; 95% CI: 33.2 to 47.5; p < 0.005). The proportion of participants with a low frequency of pain increased in the osteopathic group only (from 7 to 34 vs. 9 to 6 in the control group, p = 0.006), and the number of patients with a high frequency decreased in the osteopathic group only (from 29 to 2 vs. 25 to 28, p < 0.0005). Shoulder specific pain and disability also improved. The follow-up assessment in the intervention group showed further improvements. CONCLUSIONS Five osteopathic treatments over a period of eight weeks led to statistically significant and clinically relevant positive changes of pain and disability in patients suffering from shoulder pain.
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Affiliation(s)
- Florian Schwerla
- German Academy of Osteopathy, Research Commission, Gauting, Germany.
| | | | | | | | - Michaela Rütz
- German Academy of Osteopathy, Research Commission, Gauting, Germany.
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Franco ESB, Puga MEDS, Imoto AM, de Almeida J, da Mata V, Peccin S. What do Cochrane Systematic Reviews say about conservative and surgical therapeutic interventions for treating rotator cuff disease? Synthesis of evidence. SAO PAULO MED J 2019; 137:543-549. [PMID: 32159641 PMCID: PMC9754280 DOI: 10.1590/1516-3180.2019.0275160919] [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: 07/17/2019] [Accepted: 09/16/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Shoulder pain is considered to be the third largest cause of musculoskeletal functional alterations in individuals presenting pain during movement. OBJECTIVE The purpose of this synthesis of evidence was to identify the clinical effectiveness of conservative and surgical treatments reported in Cochrane systematic reviews among individuals diagnosed with rotator cuff disease. DESIGNAND SETTING Review of systematic reviews, conducted in the Federal University of São Paulo (Universidade Federal de São Paulo, UNIFESP). METHODS This synthesis of evidence included systematic reviews that had been published in the Cochrane database. The inclusion criteria were that these systematic reviews should involve individuals aged ≥ 16 years with rotator cuff disease, comparing surgical procedures with or without associated nonsurgical procedures versus placebo, no treatment or other nonsurgical interventions. RESULTS Thirty-one systematic reviews were included, involving comparisons between surgical procedures and conservative treatment; procedures either combined or not combined with drugs, versus other procedures; and procedures involving exercises, manual therapy and electrothermal or phototherapeutic resources. CONCLUSIONS The findings suggest that strengthening exercises, with or without associated manual therapy techniques and other resources, were the interventions with greatest power of treatment over the medium and long terms, for individuals with shoulder pain. These had greater therapeutic power than surgical procedures, electrotherapy or photobiomodulation.Protocol registration number in the PROSPERO database: ID - CRD42018096578.
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Affiliation(s)
| | | | - Aline Mizusaki Imoto
- PhD. Physiotherapist and Professor, College of Health Sciences, Brasília (DF), Brazil.
| | - Jhony de Almeida
- PT. Master’s Student and Physiotherapist, Universidade Federal de São Paulo (UNIFESP), Santos (SP), Brazil.
| | - Vitor da Mata
- Physiotherapy Student, Universidade Federal de São Paulo (UNIFESP), Santos (SP), Brazil.
| | - Stella Peccin
- PhD. Physiotherapist and Professor, Universidade Federal de São Paulo (UNIFESP), Santos (SP), Brazil.
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Rosedale R, Rastogi R, Kidd J, Lynch G, Supp G, Robbins SM. A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS). J Man Manip Ther 2019; 28:222-230. [DOI: 10.1080/10669817.2019.1661706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
| | - Ravi Rastogi
- Physiotherapist, London Health Sciences Centre, London, Canada
| | - Josh Kidd
- Physiotherapist, Advance Sports and Spine Physical Therapy, Portland, OR, USA
| | - Greg Lynch
- Physiotherapist, Inform Physiotherapy Limited, Silverstream, New Zealand
| | - Georg Supp
- Physiotherapist, Pulz Physiotherapy, Freiburg, Germany
| | - Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Does the outcome of diagnostic ultrasound influence the treatment modalities and recovery in patients with shoulder pain in physiotherapy practice? Results from a prospective cohort study. Musculoskelet Sci Pract 2019; 41:28-35. [PMID: 30903910 DOI: 10.1016/j.msksp.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 01/29/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
STUDY DESIGN Prospective cohort study including patients with shoulder pain in primary care physiotherapy. BACKGROUND There is an increased tendency to use diagnostic ultrasound to aid the diagnostic strategy and target treatment. It is a relatively cheap and accessible imaging technique but the implications for practice and patients are unknown. OBJECTIVES To study the influence of diagnostic ultrasound (DUS) on diagnostic work-up, treatment modalities and recovery. METHODS Participants (n = 389) with a new episode of shoulder pain were assessed at baseline and followed for 6, 12 and 26 weeks. Diagnostic work-up, including the use of DUS, and treatment strategies were reported by the therapists at 3, 6 and 12 weeks. RESULTS Most patients (41%) were diagnosed with subacromial impingement/pain syndrome after physical examination or DUS. DUS was used in 31% of the participants. Tendinopathy was the most found abnormality in this sub-population. Patients who underwent DUS were more frequently treated using exercise therapy. Patients that not had DUS were more likely to receive massage therapy, trigger point therapy or mobilisation techniques. Logistic regression analyses did not show a significant association between DUS and recovery after 26 weeks (0.88, 95%CI:0.50-1.57). Correcting for the therapist as a confounder using a multilevel binary logistic regression did not show a significant cluster effect. CONCLUSION Diagnostic US as a work-up component does not seem to influence diagnosis or recovery but does influence the choice of treatment modality. Conclusions are limited to observational data. High quality randomized trials should study the effect of DUS on recovery.
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Thoomes-de Graaf M, Ottenheijm RPG, Verhagen AP, Duijn E, Karel YHJM, van den Borne MPJ, Beumer A, van Broekhoven J, Dinant GJ, Tetteroo E, Lucas C, Koes BW, Scholten-Peeters GGM. Agreement between physical therapists and radiologists of stratifying patients with shoulder pain into new treatment related categories using ultrasound; an exploratory study. Musculoskelet Sci Pract 2019; 40:1-9. [PMID: 30660988 DOI: 10.1016/j.msksp.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/23/2018] [Accepted: 01/10/2019] [Indexed: 01/08/2023]
Abstract
STUDY DESIGN A systematic overview of the literature and an agreement study. OBJECTIVES The aim of this study is to explore the inter-professional agreement of diagnostic musculoskeletal ultrasound (DMUS) between physical therapists (PT) and radiologists, using a new classification strategy based upon the therapeutic consequences in patients with shoulder pain. BACKGROUND DMUS is frequently used by PTs, although the agreement regarding traditional diagnostic labels between PTs and radiologists is only fair. Nevertheless, DMUS could be useful when used as a stratifying-tool. METHODS First, a systematic overview of current evidence was performed to assess which traditional diagnostic labels could be recoded into new treatment related categories (referral to secondary care, corticosteroid injections, physical therapy, watchful waiting). Next, kappa values were calculated for these categories between PTs and radiologists. RESULTS Only three categories were extracted, as none of the traditional diagnostic labels were classified into the 'corticosteroid injection' category. Overall, we found moderate agreement to stratify patients into treatment related categories and substantial agreement for the category 'referral to secondary care'. Both categories 'watchful waiting' and 'indication for physical therapy' showed moderate agreement between the two professions. CONCLUSION Our results indicate that the agreement between radiologists and PTs is moderate to substantial when labelling is based on treatment consequences. DMUS might be able to help the PT to guide treatment, especially for the category 'referral to secondary care' as this showed the highest agreement. However, as this is just an explorative study, more research is needed, to validate and assess the consequences of this stratification classification for clinical care.
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Affiliation(s)
- M Thoomes-de Graaf
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Research Group Diagnostics, Avans University of Applied Science, Breda, the Netherlands.
| | - R P G Ottenheijm
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - A P Verhagen
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - E Duijn
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Research Group Diagnostics, Avans University of Applied Science, Breda, the Netherlands
| | - Y H J M Karel
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Research Group Diagnostics, Avans University of Applied Science, Breda, the Netherlands
| | | | - A Beumer
- Department of Orthopaedic Surgery, AMPHIA Hospital, Breda, the Netherlands
| | | | - G J Dinant
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - E Tetteroo
- Department of Radiology, AMPHIA Hospital, Breda, the Netherlands
| | - C Lucas
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - B W Koes
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - G G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
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Sirén M, Viikari-Juntura E, Arokoski J, Solovieva S. Work participation and working life expectancy after a disabling shoulder lesion. Occup Environ Med 2019; 76:363-369. [PMID: 30928906 PMCID: PMC6585271 DOI: 10.1136/oemed-2018-105647] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/11/2019] [Accepted: 02/25/2019] [Indexed: 11/26/2022]
Abstract
Objective To examine the impact of a disabling non-traumatic shoulder lesion on work participation and working life expectancy. Methods From a 70% random sample of the Finnish population, we selected 30–59-year-old wage earners with prolonged sickness absence due to a shoulder lesion (n=7644). We followed the persons from 2006 to 2014 and calculated the proportion of time a person spent in different work participation statuses. The associations of potential determinants with a preterm exit from paid employment were tested using Cox regression. Years expected to be spent in different work participation statuses were estimated applying the Sullivan method for healthy life expectancy. Results During 9 years of follow-up time spent at work was reduced from 77.7% to 46.7%, and 15.8% of the persons were granted disability retirement, mostly due to shoulder and other musculoskeletal diseases. Compared with the general population persons with a disabling shoulder disease are expected to lose from 1.8 to 8.1 years of working life, depending on their age. Age, gender, education, duration of initial sickness absence due to the shoulder lesion, not being able to return to work sustainably and participation in vocational rehabilitation predicted preterm exit from work. Heavy lifting increased the risk of preterm exit marginally. Conclusions Working life expectancy is markedly reduced in persons with a disabling shoulder lesion, mainly because of disability retirement due to musculoskeletal problems. Clinicians should consider interventions targeted at improving musculoskeletal functioning and necessary work modifications before shoulder problems become chronic or the persons develop disabling comorbid musculoskeletal conditions.
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Affiliation(s)
- Maria Sirén
- Finnish Institute of Occupational Health, Helsinki, Finland.,Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland
| | | | - Jari Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
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Abstract
BACKGROUND Decreased scapulothoracic upward rotation has been theorized to increase an individual's risk for rotator cuff compression by reducing the clearance for the tendons in the subacromial space (ie, subacromial proximities). However, the impact of decreased scapulothoracic upward rotation on subacromial proximities has not been tested during dynamic in vivo shoulder motion. OBJECTIVE To determine the impact of decreased scapulothoracic upward rotation on subacromial proximities. METHODS Shoulder kinematics were quantified in 40 participants, classified as having high or low scapulothoracic upward rotation, during scapular plane abduction using single-plane fluoroscopy and 2-D/3-D shape-matching. Subacromial proximities were calculated as (1) the normalized minimum distance between the coracoacromial arch and humeral rotator cuff insertion, and (2) the surface area of the humeral rotator cuff insertion in immediate proximity to the coracoacromial arch. The effect of decreased scapulothoracic upward rotation on subacromial proximities was assessed using 2-factor mixed-model analyses of variance. The prevalence of contact between the coracoacromial arch and rotator cuff was also quantified. RESULTS Subacromial distances were generally smallest below 70° of humerothoracic elevation. With the arm at the side, the normalized minimum distance for participants in the low scapulothoracic upward rotation group was 34.8% smaller compared to those in the high upward rotation group (P = .049). Contact between the coracoacromial arch and rotator cuff tendon occurred in 45% of participants. CONCLUSION Decreased scapulothoracic upward rotation shifts the range of risk for subacromial rotator cuff compression to lower angles. However, the low prevalence of contact suggests that subacromial rotator cuff compression may be less common than traditionally presumed. J Orthop Sports Phys Ther 2019;49(3):180-191. Epub 18 Jan 2019. doi:10.2519/jospt.2019.8590.
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Edwards A, Chepeha J, Jones A, Sheps DM, Beaupré L. Can clinical assessment differentiate partial thickness rotator cuff tears from full thickness rotator cuff tears? A secondary analysis. Disabil Rehabil 2019; 42:2351-2358. [PMID: 30735064 DOI: 10.1080/09638288.2018.1563637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: Shoulder pain causes significant disability, with rotator cuff disease as a common diagnosis. Differentially diagnosing partial tears of the rotator cuff tendons is difficult despite use of imaging and clinical examination. Our objective was to determine if a clinical assessment framework could discriminate between patients with partial and full thickness tears.Materials and Methods: Pre-operative baseline data from two randomized controlled trials of 452 adult patients awaiting rotator cuff repair were analyzed in this secondary analysis. Nineteen items from a pre-defined clinical assessment framework were investigated for association with the outcome of surgically confirmed partial or full thickness tear. Logistic regression tested independent associations and multivariable models were developed to create the most parsimonious model.Results: Thirty-two participants (7%) had partial thickness tears. Constant Power Score was the sole item associated with partial thickness tears (OR 1.07, 95% CI 1.02-1.12). Traumatic mechanism of injury trended toward significance (OR 2.17, 95% CI 1.06-4.48).Conclusions: Greater abduction strength (i.e., Constant Power Score) was associated with partial thickness tears. Other clinical assessment items did not differentiate between partial and full tears. Our results add to the growing body of research showing most clinical findings are not associated with a diagnosis in rotator cuff disease.Implications for RehabilitationGreater shoulder abduction strength (as measured with the Constant Power Score) was associated with partial thickness rotator cuff tears.Most findings within our clinical assessment framework did not distinguish between partial thickness and full thickness rotator cuff tears and thus, did not contribute to a differential pathoanatomical diagnosis.Since structural integrity of the rotator cuff and patient presentation show poor association, and rehabilitation intervention is often impairment-based, pathoanatomical diagnosis may not adequately direct non-surgical treatment. Including movement-based diagnoses or treatment classification systems in evaluation of rotator cuff disease may improve selection of appropriate conservative treatment.
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Affiliation(s)
- Anne Edwards
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Judy Chepeha
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - David M Sheps
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Lauren Beaupré
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
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Somerville K, Walston Z, Marr T, Yake D. Treatment of shoulder pathologies based on irritability: a case series. Physiother Theory Pract 2019; 36:1266-1274. [DOI: 10.1080/09593985.2019.1571136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Tye Marr
- PT Solutions Physical Therapy, Atlanta, GA, USA
| | - Dale Yake
- PT Solutions Physical Therapy, Atlanta, GA, USA
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Weisman A, Masharawi Y. Does Altering Sitting Posture Have a Direct Effect on Clinical Shoulder Tests in Individuals With Shoulder Pain and Rotator Cuff Degenerative Tears? Phys Ther 2019; 99:194-202. [PMID: 30351428 DOI: 10.1093/ptj/pzy111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 08/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Posture variations have been repeatedly linked to shoulder kinematics, strength, range of motion, and rotator cuff diseases. However, to our knowledge, no study has yet examined their possible link with shoulder pain provocation and pain levels during clinical shoulder tests. OBJECTIVE The objective was to examine whether changing posture while sitting modifies pain provocation and pain level during performance of 3 clinical shoulder tests in participants with shoulder pain and rotator cuff degenerative tears (RCDTs). METHODS Seventy individuals were allocated into 2 groups by an experienced physical therapist: 35 participants with symptomatic shoulders and RCDT diagnosed by ultrasound (tear size = 1.0 +/- 0.5 cm) and 35 control participants with no symptoms in the upper limb. All participants were tested by a second physical therapist for pain provocation (yes/no) and pain level (visual analog scale) using 3 common clinical shoulder tests: the Neer, the Hawkins-Kennedy, and the empty can while sitting in a neutral, slouched, and upright posture. Shoulder muscle forces were examined by a hand-held dynamometer for possible correlations only in the neutral posture. All participants were asked to fill out the quick DASH (disabilities of the arm shoulder and hand) questionnaire. RESULTS In the symptomatic group, all 3 clinical tests demonstrated similar pain provocation (100% repeatability) and pain level in all 3 sitting postures (visual analog scale scores 3.7-4.4). Muscle force mean ranges of the study groups were 4.4 to 7 kg and, in the control group, 6 to 10.5 kg. No correlations were found between age, body mass index, shoulder pain, hand dominance, onset of symptoms, severity, and tear size with any of the dependent variables. CONCLUSIONS Changing posture while sitting did not directly affect pain provocation and pain levels during performance of 3 clinical shoulder tests in participants with shoulder pain and RCDTs.
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Affiliation(s)
- Asaf Weisman
- Clalit Health Services, Holon, Israel; and Spinal Research Laboratory, Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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The management of shoulder impingement and related disorders: A systematic review on diagnostic accuracy of physical tests and manual therapy efficacy. J Bodyw Mov Ther 2018; 23:604-618. [PMID: 31563378 DOI: 10.1016/j.jbmt.2018.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 06/25/2018] [Accepted: 08/25/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Diagnostic accuracy of physical tests and effectiveness of musculoskeletal rehabilitation of shoulder disorders are still debated. OBJECTIVES To investigate diagnostic accuracy of physical tests, efficacy of physiotherapy and coherence between target of assessment and intervention for shoulder impingement and related disorders like bursitis, rotator cuff and long head biceps tendinopathy and labral lesions. METHODS A systematic search of four databases was conducted, including RCTs and cross-sectional studies. Cochrane Risk of Bias and QUADAS-2 were adopted for critical appraisal and a narrative synthesis was undertaken. RESULTS 6 RCTs and 2 cross-sectional studies were appraised. Studies presented low to moderate risk of bias. There is a lack of evidence to support the mechanical construct guiding the choice of physical tests for diagnosis of impingement. Manual techniques appear to yield better results than placebo and ultrasounds, but not better than exercise therapy alone. Discrepancy between the goal of assessment strategies and the relative proposed treatments were present together with high heterogeneity in terms of selection of patients, type of endpoints and follow-ups. CONCLUSIONS Musculoskeletal physiotherapy seems to be an effective treatment for patients with shoulder pain although it is still based on weak diagnostic clinical instruments. The adoption of more functional and prognostic assessment strategies is advisable to improve coherence between evaluation and treatment.
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Ristori D, Miele S, Rossettini G, Monaldi E, Arceri D, Testa M. Towards an integrated clinical framework for patient with shoulder pain. Arch Physiother 2018; 8:7. [PMID: 29862049 PMCID: PMC5975572 DOI: 10.1186/s40945-018-0050-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/23/2018] [Indexed: 01/03/2023] Open
Abstract
Background Shoulder pain (SP) represents a common musculoskeletal condition that requires physical therapy care. Along the years, the usual evaluation strategies based on clinical tests and diagnostic imaging has been challenged. Clinical tests appear unable to clearly identify the structures that generated pain and interpretation of diagnostic imaging is still controversial. The current patho-anatomical diagnostic categories have demonstrated poor reliability and seem inadequate for the SP treatment. Objectives The present paper aims to (1) describe the different proposals of clinical approach to SP currently available in the literature; to (2) integrate these proposals in a single framework in order to help the management of SP. Conclusion The proposed clinical framework, based on a bio-psychosocial vision of health, integrates symptoms characteristics, pain mechanisms and expectations, preferences and psychosocial factors of patients that may guide physiotherapist to make a diagnostic triage and to choose the right treatment for the individual patient.
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Affiliation(s)
- Diego Ristori
- Via Veneto, 6, Subbiano, Arezzo Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Simone Miele
- Via Paolo VI, Cologne, Brescia Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Giacomo Rossettini
- Via de Gaspari, 9, Montecchio Maggiore, Vicenza Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Erica Monaldi
- Via Italo Svevo, 2 Codogno, Lodi, Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Diego Arceri
- Via Eugenio Scalfaro, 17, Catanzaro, Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Marco Testa
- Via Magliotto, 2 17100, Savona, Italy.,7Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
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Thoracic manual therapy is not more effective than placebo thoracic manual therapy in patients with shoulder dysfunctions: A systematic review with meta-analysis. Musculoskelet Sci Pract 2018; 33:1-10. [PMID: 29055216 DOI: 10.1016/j.msksp.2017.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Manual treatments targeting different regions (shoulder, cervical spine, thoracic spine, ribs) have been studied to deal with patients complaining of shoulder pain. Thoracic manual treatments seem able to produce beneficial effects on this group of patients. However, it is not clear whether the patient improvement is a consequence of thoracic manual therapy or a placebo effect. OBJECTIVES To compare the efficacy of thoracic manual therapy and placebo thoracic manual treatment for patients with shoulder dysfunction. METHODS Electronic databases (MEDLINE, CENTRAL, PEDro, CINAHL, WoS, EMBASE, ERIC) were searched through November 2016. Randomized Controlled Trials assessing pain, mobility and function were selected. The Cochrane bias estimation tool was applied. Outcome results were either extracted or computed from raw data. Meta-analysis was performed for outcomes with low heterogeneity. RESULTS Four studies were included in the review. The methodology of the included studies was generally good except for one study that was rated as high risk of bias. Meta-analysis showed no significant effect for "pain at present" (SMD -0.02; 95% CI: -0.35, 0.32) and "pain during movement" (SMD -0.12; 95% CI: -0.45, 0.21). CONCLUSION There is very low to low quality of evidence that a single session of thoracic manual therapy is not more effective than a single session of placebo thoracic manual therapy in patients with shoulder dysfunction at immediate post-treatment.
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Consistency of commonly used orthopedic special tests of the shoulder when used with the McKenzie system of mechanical diagnosis and therapy. Musculoskelet Sci Pract 2018; 33:11-17. [PMID: 29059632 DOI: 10.1016/j.msksp.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/25/2017] [Accepted: 10/04/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Shoulder Orthopedic Special Tests (OSTs) are used to assist with diagnosis in shoulder disorders. Issues with reliability and validity exist, making their interpretation challenging. Exploring OST results on repeated testing within Mechanical Diagnosis and Therapy (MDT) shoulder classifications may offer insight into the poor performance of these tests. OBJECTIVES To investigate in patients with shoulder complaints, whether MDT classifications affect the agreement of OST results over the course of treatment. METHODS An international group of MDT clinicians recruited 105 patients with shoulder problems. Three commonly used OSTs (Empty Can, Hawkins-Kennedy, and Speed's tests) were utilized. Results of the OSTs were collected at sessions 1, 3, 5 and 8, or at discharge from an MDT classification-based treatment. The Kappa statistic was utilized to determine the agreement of the OST results over time for each of the MDT classifications. RESULTS The overall Kappa values for Empty Can, Hawkins-Kennedy and Speed's tests were 0.28 (SE = 0.07), 0.28 (SE = 0.07) and 0.29 (SE = 0.07), respectively. The highest level of agreement was for Articular Dysfunction for the Empty Can test (0.84, SE = 0.19). For shoulder Derangements, there was no agreement for any of the OSTs (P values > 0.05). CONCLUSION The lack of agreement when the OSTs were consecutively tested in the presence of the MDT Derangement classification contrasted with the other MDT classifications. The presence of Derangement was responsible for reducing the overall agreement of commonly used OSTs and may explain the poor consistency for OSTs.
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Page MJ, Huang H, Verhagen AP, Gagnier JJ, Buchbinder R. Outcome Reporting in Randomized Trials for Shoulder Disorders: Literature Review to Inform the Development of a Core Outcome Set. Arthritis Care Res (Hoboken) 2018; 70:252-259. [PMID: 28388821 DOI: 10.1002/acr.23254] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/04/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To explore the outcome domains and measurement instruments reported across randomized trials of any interventions for various shoulder disorders. METHODS We searched for shoulder trials included in Cochrane reviews published up to Issue 10, 2015, or indexed in PubMed between 2006 and 2015. Trials were eligible for inclusion if they focused on any intervention for rotator cuff disease, adhesive capsulitis, shoulder instability, glenohumeral or acromioclavicular osteoarthritis, shoulder dislocation, proximal humeral or humeral head fractures, or unspecified shoulder pain. Two authors independently selected trials for inclusion and extracted information on the domains and measurement instruments reported, with consensus discussion among all authors where required. RESULTS We included 409 trials, published between 1954 and 2015. Across the trials, we identified 319 different instruments that were classified into 32 domains. Most trials reported a measure of pain (90%), range of motion (78%), and physical function (71%). The recording of adverse events was reported in only 31% of the trials. Muscle strength was reported in 44% of the trials and imaging outcomes in 21%. Other patient-reported outcome measures, such as global assessment of treatment success, health-related quality of life, work ability, and psychological functioning, were each reported in ≤15% of the trials. Most of the domains were reported at similar frequencies across different shoulder disorders. CONCLUSION The domains and measurement instruments reported were widely diverse. Our results provide a foundation for the development of a core outcome set for use in future trials across all shoulder disorders.
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Juul-Kristensen B, Schmedling K, Rombaut L, Lund H, Engelbert RHH. Measurement properties of clinical assessment methods for classifying generalized joint hypermobility-A systematic review. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:116-147. [PMID: 28306223 DOI: 10.1002/ajmg.c.31540] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose was to perform a systematic review of clinical assessment methods for classifying Generalized Joint Hypermobility (GJH), evaluate their clinimetric properties, and perform the best evidence synthesis of these methods. Four test assessment methods (Beighton Score [BS], Carter and Wilkinson, Hospital del Mar, Rotes-Querol) and two questionnaire assessment methods (Five-part questionnaire [5PQ], Beighton Score-self reported [BS-self]) were identified on children or adults. Using the Consensus-based Standards for selection of health Measurement Instrument (COSMIN) checklist for evaluating the methodological quality of the identified studies, all included studies were rated "fair" or "poor." Most studies were using BS, and for BS the reliability most of the studies showed limited positive to conflicting evidence, with some shortcomings on studies for the validity. The three other test assessment methods lack satisfactory information on both reliability and validity. For the questionnaire assessment methods, 5PQ was the most frequently used, and reliability showed conflicting evidence, while the validity had limited positive to conflicting evidence compared with test assessment methods. For BS-self, the validity showed unknown evidence compared with test assessment methods. In conclusion, following recommended uniformity of testing procedures, the recommendation for clinical use in adults is BS with cut-point of 5 of 9 including historical information, while in children it is BS with cut-point of at least 6 of 9. However, more studies are needed to conclude on the validity properties of these assessment methods, and before evidence-based recommendations can be made for clinical use on the "best" assessment method for classifying GJH. © 2017 Wiley Periodicals, Inc.
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Lawrence RL, Schlangen DM, Schneider KA, Schoenecker J, Senger AL, Starr WC, Staker JL, Ellermann JM, Braman JP, Ludewig PM. Effect of glenohumeral elevation on subacromial supraspinatus compression risk during simulated reaching. J Orthop Res 2017; 35:2329-2337. [PMID: 28071815 PMCID: PMC5503805 DOI: 10.1002/jor.23515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/28/2016] [Indexed: 02/04/2023]
Abstract
Mechanical subacromial rotator cuff compression is one theoretical mechanism in the pathogenesis of rotator cuff disease. However, the relationship between shoulder kinematics and mechanical subacromial rotator cuff compression across the range of humeral elevation motion is not well understood. The purpose of this study was to investigate the effect of humeral elevation on subacromial compression risk of the supraspinatus during a simulated functional reaching task. Three-dimensional anatomical models were reconstructed from shoulder magnetic resonance images acquired from 20 subjects (10 asymptomatic, 10 symptomatic). Standardized glenohumeral kinematics from a simulated reaching task were imposed on the anatomic models and analyzed at 0, 30, 60, and 90° humerothoracic elevation. Five magnitudes of humeral retroversion were also imposed on the models at each angle of humerothoracic elevation to investigate the impact of retroversion on subacromial proximities. The minimum distance between the coracoacromial arch and supraspinatus tendon and footprint were quantified. When contact occurred, the magnitude of the intersecting volume between the supraspinatus tendon and coracoacromial arch was also quantified. The smallest minimum distance from the coracoacromial arch to the supraspinatus footprint occurred between 30 and 90°, while the smallest minimum distance to the supraspinatus tendon occurred between 0 and 60°. The magnitude of humeral retroversion did not significantly affect minimum distance to the supraspinatus tendon except at 60 or 90° humerothoracic elevation. The results of this study provide support for mechanical rotator cuff compression as a potential mechanism for the development of rotator cuff disease. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2329-2337, 2017.
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Candela V, Giannicola G, Passaretti D, Venditto T, Gumina S. Adhesive capsulitis of the shoulder: pain intensity and distribution. Musculoskelet Surg 2017; 101:153-158. [PMID: 28756507 DOI: 10.1007/s12306-017-0488-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/19/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Papers regarding adhesive capsulitis (AC) of the shoulder focused on etiology, epidemiology, diagnosis, and treatment; until now, information on shoulder pain characteristics is still scarce. Our aim was to analyze pain intensity and distribution in patients with AC. METHODS The study group was composed of 278 (133M-145F) consecutive patients with AC. After diagnosis, shoulder pain distribution was assessed through an upper limb pain map and pain intensity through a visual analog scale. Patients were distinguished on the basis of gender, age, time elapsed from onset of symptoms, and severity of functional limitation. Data were submitted to statistical analysis. RESULTS Intensity of shoulder pain caused by AC was higher in females (p < 0.05); it did not vary with the side and between patient younger and older than 55 years. Patients whose pain arose from more than 3 months suffered a lower intensity of shoulder pain. Furthermore, pain intensity was higher in the most severe form of AC (active forward flexion < 60°) (p < 0.05). Pain was localized predominantly on the anterior aspect of the shoulder (dermatomes C5-C6) and rarely extended beyond the distal third of the arm. No differences were found in pain distribution between male and female, between patients with pain from less or more than 3 months and between different levels of AC severity (p > 0.05). CONCLUSION Shoulder pain due to AC may be influenced by gender and severity of functional limitation. AC pain distribution principally involves anterior aspect of the shoulder with downward extension of the arm until its distal third. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- V Candela
- Department of Orthopaedics and Traumatology, Shoulder and Elbow Unit, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - G Giannicola
- Department of Orthopaedics and Traumatology, Shoulder and Elbow Unit, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - D Passaretti
- Department of Orthopaedics and Traumatology, Shoulder and Elbow Unit, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - T Venditto
- Physical Medicine and Rehabilitation Unit, Sapienza University of Rome, Rome, Italy
| | - S Gumina
- Department of Orthopaedics and Traumatology, Shoulder and Elbow Unit, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
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Gianola S, Andreano A, Castellini G, Li LC, Moja L, Valsecchi MG. Kinesiotaping for rotator cuff disease. Hippokratia 2017. [DOI: 10.1002/14651858.cd012720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Silvia Gianola
- IRCCS Galeazzi Orthopaedic Institute; Unit of Clinical Epidemiology; Milan Italy
- University of Milano-Bicocca; Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery; Monza Italy
| | - Anita Andreano
- University of Milano-Bicocca; Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery; Monza Italy
| | - Greta Castellini
- IRCCS Galeazzi Orthopaedic Institute; Unit of Clinical Epidemiology; Milan Italy
- University of Milan; Department of Biomedical Sciences for Health; Milan Italy
| | - Linda C Li
- University of British Columbia; Department of Physical Therapy; 5591 No. 3 Rd Richmond BC Canada V6X 2C7
| | - Lorenzo Moja
- IRCCS Galeazzi Orthopaedic Institute; Unit of Clinical Epidemiology; Milan Italy
- University of Milan; Department of Biomedical Sciences for Health; Milan Italy
| | - Maria Grazia Valsecchi
- University of Milano-Bicocca; Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery; Monza Italy
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Navarro-Ledesma S, Struyf F, Labajos-Manzanares MT, Fernandez-Sanchez M, Morales-Asencio JM, Luque-Suarez A. Does the acromiohumeral distance matter in chronic rotator cuff related shoulder pain? Musculoskelet Sci Pract 2017; 29:38-42. [PMID: 28315580 DOI: 10.1016/j.msksp.2017.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND/HYPOTHESIS The relation between acromiohumeral distance (AHD) and severity of pain, disability and range of movement (ROM) in patients with chronic rotator cuff related shoulder pain (RCRSP) has not been reported. OBJECTIVES The aim of this study was to investigate the level of association between AHD measured by ultrasonography and pain-disability and shoulder range of movement (ROM), in patients suffering from chronic RCRSP. As a secondary objective, the determination of the intrarater reliability of AHD at both 0 and 60 degrees of shoulder elevation was carried out. DESIGN This was a cross-sectional study. METHOD A sample comprised of 97 patients with chronic RCSRP symptoms was recruited from three different primary care centres. Acromio-humeral distance (AHD) measured by ultrasonography at 0 and 60 degrees of shoulder elevation, shoulder pain-function (SPADI) and range of movement (ROM) were taken. RESULTS There was no correlation between AHD at 0° (-0,215), and at 60° (-0,148), with SPADI. No correlations were found with AHD and shoulder ROM at both 0 and 60°. Intrarater reliability was excellent for AHD at 0 and 60°. CONCLUSIONS There was a small association between AHD and shoulder pain and function, as well as with shoulder ROM, in patients with chronic RCRSP. Hence, clinicians should consider other possibilities rather than focusing their therapies only in increasing AHD when patients with chronic RCRSP are treated.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physiotherapy, University of Malaga, Spain; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium.
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium.
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Kothari SY, Srikumar V, Singh N. Comparative Efficacy of Platelet Rich Plasma Injection, Corticosteroid Injection and Ultrasonic Therapy in the Treatment of Periarthritis Shoulder. J Clin Diagn Res 2017; 11:RC15-RC18. [PMID: 28658861 DOI: 10.7860/jcdr/2017/17060.9895] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/07/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Periarthritis (PA) shoulder characterised by pain and restricted range of motion has a plethora of treatment options with inconclusive evidence. Platelet Rich Plasma (PRP) is an emerging treatment option and its efficacy needs to be examined and compared with other routine interventions. AIM To assess the efficacy of PRP injection and compare it with corticosteroid injection and ultrasonic therapy in the treatment of PA shoulder. MATERIALS AND METHODS Patients with PA shoulder (n=195) were randomised to receive single injection of PRP (2 ml) or corticosteroid (80 mg of methylprednisolone) or ultrasonic therapy (seven sittings in two weeks; 1.5 W/cm2, 1 MHz, continuous mode). All participants were also advised to perform a home based 10 minute exercise therapy. The primary outcome measure was active range of motion of the shoulder. Secondary outcome measures used were Visual Analogue Scale (VAS) for pain and a shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) for function. Participants were evaluated at 0, 3, 6 and 12 weeks. Chi-square test, one way and repeated measures of ANOVA tests were used to determine significant differences. RESULTS PRP treatment resulted in statistically significant improvements over corticosteroid and ultrasonic therapy in active as well as passive range of motion of shoulder, VAS and QuickDASH at 12 weeks. At six weeks, PRP treatment resulted in statistically significant improvements over ultrasonic therapy in VAS and QuickDASH. No major adverse effects were observed. CONCLUSION This study demonstrates that single injection of PRP is effective and better than corticosteroid injection or ultrasonic therapy in treatment of PA shoulder.
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Affiliation(s)
- Shashank Yeshwant Kothari
- Ex-Professor, Department of Physical Medicine and Rehabilitation, VMMC and Safdarjang Hospital, New Delhi, India
| | - Venkataraman Srikumar
- Assistant Professor, Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Singh
- Senior Resident, Department of Physical Medicine and Rehabilitation, PGIMER and Dr. R.M.L. Hospital, New Delhi, India
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Heidar Abady A, Rosedale R, Chesworth BM, Rotondi MA, Overend TJ. Application of the McKenzie system of Mechanical Diagnosis and Therapy (MDT) in patients with shoulder pain; a prospective longitudinal study. J Man Manip Ther 2017; 25:235-243. [PMID: 29449765 DOI: 10.1080/10669817.2017.1313929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Objectives The primary objective was to determine if the pain and function response to the McKenzie system of Mechanical Diagnosis and Therapy (MDT) differs by MDT classification category at two and four weeks following the start of MDT treatment for shoulder complaints. The secondary objective was to describe the frequency of discharge over time by MDT classification. Methods International, MDT-trained study collaborators recruited 93 patients attending physiotherapy for rehabilitation of a shoulder problem. The Numeric Pain Rating Scale (NPRS) and the Upper Extremity Functional Index (UEFI) were collected at the initial assessment and two and four weeks after treatment commenced. A two-way mixed model analysis of variance with planned pairwise comparisons was performed to identify where the differences between MDT classification groups actually existed. Results The Derangement and Spinal classifications had significantly lower NPRS scores than the Dysfunction group at week 2 and week 4 (p < 0.05). The Derangement and Spinal classifications had significantly higher UEFI scores than the Dysfunction group at week 2 and week 4 (p < 0.05). The frequency of discharge at week 2 was 37% for both Derangement and Spinal classifications, with no discharges for the Dysfunction classification at this time point. The frequency of discharge at week 4 was 83, 82 and 15% for the Derangement, Spinal and Dysfunction classifications, respectively. Discussion Classifying patients with shoulder pain using the MDT system can impact treatment outcomes and the frequency of discharge. When MDT-trained clinicians are allowed to match the intervention to a specific MDT classification, the outcome is aligned with the response expectation of the classification.Level of Evidence: 2b.
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Affiliation(s)
| | | | - Bert M Chesworth
- School of Physical Therapy, Western University, London, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Michael A Rotondi
- School of Kinesiology and Health Sciences, York University, Toronto, Canada
| | - Tom J Overend
- School of Physical Therapy, Western University, London, Canada
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Navarro-Ledesma S, Struyf F, Labajos-Manzanares MT, Fernandez-Sanchez M, Luque-Suarez A. Is coracohumeral distance associated with pain-function, and shoulder range of movement, in chronic anterior shoulder pain? BMC Musculoskelet Disord 2017; 18:136. [PMID: 28376749 PMCID: PMC5379620 DOI: 10.1186/s12891-017-1498-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was twofold: (i) to assess the intrarater reliability of coracohumeral distance; (ii) to investigate the level of association between coracohumeral distance measured by ultrasonography, and pain-disability and shoulder range of movement, in patients suffering from chronic anterior shoulder pain. METHODS An observational, cross sectional study was carried out. A convenience sample comprised of 87 patients with chronic anterior shoulder pain was assessed from 3 primary care centres. Main outcomes as pain and function were measured through the shoulder pain and disability index. Furthermore, shoulder range of movement-free of pain in shoulder elevation, as well as coracohumeral distance at both 0 and 60 degrees, were collected. RESULTS Absence of any correlation was found between coracohumeral distance and shoulder pain and disability index at both 0 and 60 degrees of shoulder elevation. Furthermore, absence of any correlation was found between coracohumeral distance measurements and active shoulder range of movement -free of pain. CONCLUSIONS There was poor association between coracohumeral distance and shoulder pain and function, as well as with shoulder range of movement, in patients with chronic anterior shoulder pain. Hence, clinicians should consider, not only increasing this space, but also other possibilities in their therapies, when patients with anterior shoulder pain are treated. TRIAL REGISTRATION ACTRN12614000144617 . Registered: 1st March 2014.
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Affiliation(s)
- S Navarro-Ledesma
- Department of Physiotherapy, University of Malaga, Malaga, Spain.,Departament of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
| | - F Struyf
- Departament of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
| | | | - M Fernandez-Sanchez
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
| | - A Luque-Suarez
- Department of Physiotherapy, University of Malaga, Malaga, Spain.
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Abstract
Background An understanding of the epidemiology of a problem is central to facilitating clinical understanding, resource allocation and future research priorities. Objectives To systematically review and report incidence, prevalence, risk and prognostic factors for rotator cuff tendinopathy. Methods An electronic search of MEDLINE, CiNAHL, PsychINFO to December 2012 was complemented by hand and citation-searching. Studies were selected in relation to pre-defined criteria. A narrative synthesis was undertaken. Results The incidence of rotator cuff tendinopathy ranges from 0.3% to 5.5% and annual prevalence from 0.5% to 7.4%. There is limited evidence suggesting that increasing age and other personal, work-related and psychosocial factors are associated with onset. There is strong evidence suggesting that high baseline pain and disability and previous episodes of shoulder pain are associated with an unfavourable outcome and strong evidence suggesting that biomedical diagnosis is not associated with outcome. Other factors were identified but were only supported by moderate or limited evidence. Conclusions Rotator cuff tendinopathy is a common problem but uncertainty remains regarding the true extent and risk factors associated with onset. High baseline pain and disability and previous episodes are associated with an unfavourable outcome but biomedical diagnosis is not associated with outcome.
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Affiliation(s)
- Chris Littlewood
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen May
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Stephen Walters
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Gismervik SØ, Drogset JO, Granviken F, Rø M, Leivseth G. Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance. BMC Musculoskelet Disord 2017; 18:41. [PMID: 28122541 PMCID: PMC5267375 DOI: 10.1186/s12891-017-1400-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Physical examination tests of the shoulder (PETS) are clinical examination maneuvers designed to aid the assessment of shoulder complaints. Despite more than 180 PETS described in the literature, evidence of their validity and usefulness in diagnosing the shoulder is questioned. METHODS This meta-analysis aims to use diagnostic odds ratio (DOR) to evaluate how much PETS shift overall probability and to rank the test performance of single PETS in order to aid the clinician's choice of which tests to use. This study adheres to the principles outlined in the Cochrane guidelines and the PRISMA statement. A fixed effect model was used to assess the overall diagnostic validity of PETS by pooling DOR for different PETS with similar biomechanical rationale when possible. Single PETS were assessed and ranked by DOR. Clinical performance was assessed by sensitivity, specificity, accuracy and likelihood ratio. RESULTS Six thousand nine-hundred abstracts and 202 full-text articles were assessed for eligibility; 20 articles were eligible and data from 11 articles could be included in the meta-analysis. All PETS for SLAP (superior labral anterior posterior) lesions pooled gave a DOR of 1.38 [1.13, 1.69]. The Supraspinatus test for any full thickness rotator cuff tear obtained the highest DOR of 9.24 (sensitivity was 0.74, specificity 0.77). Compression-Rotation test obtained the highest DOR (6.36) among single PETS for SLAP lesions (sensitivity 0.43, specificity 0.89) and Hawkins test obtained the highest DOR (2.86) for impingement syndrome (sensitivity 0.58, specificity 0.67). No single PETS showed superior clinical test performance. CONCLUSIONS The clinical performance of single PETS is limited. However, when the different PETS for SLAP lesions were pooled, we found a statistical significant change in post-test probability indicating an overall statistical validity. We suggest that clinicians choose their PETS among those with the highest pooled DOR and to assess validity to their own specific clinical settings, review the inclusion criteria of the included primary studies. We further propose that future studies on the validity of PETS use randomized research designs rather than the accuracy design relying less on well-established gold standard reference tests and efficient treatment options.
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Affiliation(s)
- Sigmund Ø Gismervik
- Department Physical Medicine and Rehabilitation, St.Olavs University Hospital, P.B. 3250 Sluppen, NO-7006, Trondheim, Norway. .,Department of Public Health and General Practice, Norwegian University of Science and Technology, P.B. 8905 MTFS, 7491, Trondheim, Norway.
| | - Jon O Drogset
- Institute of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, P.B 8905 MTFS, 7491, Trondheim, Norway.,Department of Orthopedic Surgery, Trondheim University Hospital, P.B. 3250 Sluppen, NO-7006, Trondheim, Norway
| | - Fredrik Granviken
- Department Physical Medicine and Rehabilitation, St.Olavs University Hospital, P.B. 3250 Sluppen, NO-7006, Trondheim, Norway
| | - Magne Rø
- Department Physical Medicine and Rehabilitation, St.Olavs University Hospital, P.B. 3250 Sluppen, NO-7006, Trondheim, Norway
| | - Gunnar Leivseth
- Department of Clinical Medicine, Neuromuscular Diseases Research Group, UiT The Arctic University of Norway, N-9037, Tromsø, Norway.,Unicare Medical Rehabilitation Centre, Hokksund, Norway
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Watts AR, Williams B, Kim SW, Bramwell DC, Krishnan J. Shoulder impingement syndrome: a systematic review of clinical trial participant selection criteria. Shoulder Elbow 2017; 9:31-41. [PMID: 28572848 PMCID: PMC5441616 DOI: 10.1177/1758573216663201] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/04/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Shoulder impingement syndrome (SIS) is a common diagnosis for patients with pain and dysfunction of the shoulder. Variations in the signs and symptoms might lead to uncertainty regarding the definition of SIS. The aim of this review is to explore the participant selection criteria used in the literature when investigating SIS and to assess differences in criteria among treating professions. METHODS This is a PRISMA systematic review of publications from 2009 to 2014 from MEDLINE, PubMed, The Cochrane Library, Embase, Scopus and CINAHL. RESULTS Ninety-seven articles met inclusion criteria for this review. Twenty-five different surgical and nonsurgical treatments were investigated. Impingement-specific index tests were used in all studies. Exclusion index tests were used in 62% of studies. Twenty index tests were identified. Radiological investigations were reported in 53% of all studies, of which a further 53% reported using two or more radiological investigations. CONCLUSIONS This systematic review has illustrated that studies investigating SIS test for various signs and symptoms, which is in keeping with describing the condition as a 'syndrome'. However, there are inconsistencies in participant selection criteria between health disciplines, highlighting a need for harmonization of the selection criteria in the form of an international editorial consensus.
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Affiliation(s)
- Amy R. Watts
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
| | - Ben Williams
- Department of Orthopaedics, Flinders Medical Centre, Adelaide, Australia
| | - Susan W. Kim
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Donald C. Bramwell
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
| | - Jeganath Krishnan
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
- Department of Orthopaedics, Flinders Medical Centre, Adelaide, Australia
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Karel YHJM, Scholten-Peeters GGM, Thoomes-de Graaf M, Duijn E, van Broekhoven JB, Koes BW, Verhagen AP. Physiotherapy for patients with shoulder pain in primary care: a descriptive study of diagnostic- and therapeutic management. Physiotherapy 2016; 103:369-378. [PMID: 28801032 DOI: 10.1016/j.physio.2016.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Shoulder pain is one of the three main musculoskeletal complaints and more than 50% of the patients have symptoms longer than 6 months. Until now, limited data exist about the content of physiotherapy for patients with shoulder pain in primary care. OBJECTIVE Describe current physiotherapeutic diagnostic- and therapeutic management, including the use of diagnostic ultrasound, in patients with shoulder pain in primary care. DESIGN AND SETTING A prospective cohort study in primary care physiotherapy with a 12 week follow-up. METHODS Descriptive data from physiotherapists was collected, such as: the diagnostic hypotheses after patient history and physical examination, the use of specific tests and diagnostic ultrasound, the interventions used and possible changes in treatment plan. RESULTS Subacromial impingement syndrome was the most common hypothesis after patient history (48%) as well as physical examination (39%). Diagnostic ultrasound was used in 31% and of these patients the clinical diagnosis changed in 29%. Various interventions were used in all clinical diagnoses. After 12 weeks 41% of patients still received physiotherapy treatment. CONCLUSIONS Patients with shoulder pain in physiotherapy practice frequently show signs of subacromial impingement syndrome. The interventions used by the physiotherapists were generally in line with the guideline for subacromial impingement syndrome however a small proportion of physiotherapists used massage and tape/bracing techniques. A large proportion of patients were still receiving treatment after 12 weeks when no improvement was observed. If treatment for patients with subacromial impingement shows no benefit patients should be referred back to the general practitioner or orthopedic surgeon. Conclusions from this study might be slightly biased because of the selection of physiotherapists.
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Affiliation(s)
- Y H J M Karel
- Research Group Diagnostics, Avans University of Applied Sciences, Breda, The Netherlands; Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - G G M Scholten-Peeters
- Research Group Diagnostics, Avans University of Applied Sciences, Breda, The Netherlands; Faculty of Behavioural and Movement Sciences, MOVE Research Institute Amsterdam, VU University of Amsterdam, Amsterdam, The Netherlands
| | - M Thoomes-de Graaf
- Research Group Diagnostics, Avans University of Applied Sciences, Breda, The Netherlands; Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E Duijn
- Department of Human Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - B W Koes
- Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A P Verhagen
- Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Ottenheijm RPG, Cals JWL, Winkens B, Weijers RE, de Bie RA, Dinant GJ. Ultrasound imaging to tailor the treatment of acute shoulder pain: a randomised controlled trial in general practice. BMJ Open 2016; 6:e011048. [PMID: 27872111 PMCID: PMC5128954 DOI: 10.1136/bmjopen-2016-011048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 07/18/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine the clinical effectiveness of ultrasound tailored treatment in patients with acute subacromial disorders. DESIGN Pragmatic randomised controlled trial. SETTING Dutch general practice. PARTICIPANTS Patients aged 18-65 years with acute (duration <3 months) unilateral shoulder pain and no previous treatment, in whom the general practitioner suspected a subacromial disorder was enrolled. INTERVENTIONS All patients underwent ultrasound imaging of the affected shoulder. Patients who were still symptomatic after a qualification period of 2 weeks with standard treatment were randomised to treatment tailored to ultrasound diagnosis (disclosure of the ultrasound diagnosis) or usual care (non-disclosure of the ultrasound diagnosis). PRIMARY OUTCOME MEASURE Patient-perceived recovery using the Global Perceived Effect questionnaire at 1 year. RESULTS 129 patients were included. 18 patients recovered during the 2-week qualification period, resulting in 111 randomised patients; 56 were allocated to ultrasound tailored treatment and 55 to usual care. After 1 year, no statistically significant differences in recovery were found between the ultrasound tailored treatment group (72.5% (37/51)) and the usual care group (60% (30/50), OR 2.24 (95% CI 0.72 to 6.89; p=0.16)). Also, healthcare use was similar. CONCLUSIONS This study has shown no clinically significant difference in the primary outcome measure between the ultrasound tailored treatment and usual care groups. Furthermore, there was no overall difference in healthcare resources used between groups. Although no formal cost data are included, one can only assume that the ultrasound examinations are additional costs for the intervention group, which cannot be justified in routine practice based on this trial. Based on this study, no change in current pragmatic guidelines to incorporate early ultrasound imaging can be recommended. TRIAL REGISTRATION NUMBER NTR2403; Results.
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Affiliation(s)
- Ramon P G Ottenheijm
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - René E Weijers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Geert-Jan Dinant
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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45
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Gordon CM, Andrasik F, Schleip R, Birbaumer N, Rea M. Myofascial triggerpoint release (MTR) for treating chronic shoulder pain: A novel approach. J Bodyw Mov Ther 2016; 20:614-22. [PMID: 27634087 DOI: 10.1016/j.jbmt.2016.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/14/2015] [Accepted: 01/24/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study comprehensively evaluated a myofascial triggerpoint release (MTR) technique for shoulder pain. METHODS Twenty-three (from an initial sample of 25) patients experiencing shoulder pain received MTR, in four 10-min sessions over a period of 2 weeks, applied exclusively on the more painful shoulder, with assessments being recorded both before and after treatment (and for pain at 1 and 13 months). Measures of stiffness and elasticity were collected to monitor the process of therapy, while subjective measures of pain and objective measures of pressure pain thresholds tracked primary outcomes. Secondary outcomes focused on suffering, stress, and quality of life. RESULTS A statistically significant decrease in stiffness and increase in elasticity was observed post intervention for the treated side only, while pressure pain thresholds improved on the untreated side as well. Reports of pain significantly decreased after treatment, with gains being maintained at 1 and 13 months following treatment. Levels of suffering, stress, and quality of life revealed statistically significant improvement as well. CONCLUSIONS MTR resulted in clinically significant improvements in the primary measures of pain, objective mechanical tissue properties, and secondary measures in patients with chronic shoulder pain.
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Affiliation(s)
- Christopher-Marc Gordon
- Center für Integrative Therapie, Ahorn Str 31, 70597 Stuttgart, Germany; Fascia Research Group, Division of Neurophysiology, University of Ulm, Albert-Einstein-Allee 11, Ulm, Germany.
| | - Frank Andrasik
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Robert Schleip
- Fascia Research Group, Division of Neurophysiology, University of Ulm, Albert-Einstein-Allee 11, Ulm, Germany
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany; Ospedale San Camillo, Istituto di Ricovero e Cura a Carattere Scientifico, Venezia-Lido, Italy
| | - Massimiliano Rea
- Department of General Psychiatry, University of Tübingen, Tübingen, Germany
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Page MJ, Green S, Mrocki MA, Surace SJ, Deitch J, McBain B, Lyttle N, Buchbinder R. Electrotherapy modalities for rotator cuff disease. Cochrane Database Syst Rev 2016; 2016:CD012225. [PMID: 27283591 PMCID: PMC8570637 DOI: 10.1002/14651858.cd012225] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Management of rotator cuff disease may include use of electrotherapy modalities (also known as electrophysical agents), which aim to reduce pain and improve function via an increase in energy (electrical, sound, light, or thermal) into the body. Examples include therapeutic ultrasound, low-level laser therapy (LLLT), transcutaneous electrical nerve stimulation (TENS), and pulsed electromagnetic field therapy (PEMF). These modalities are usually delivered as components of a physical therapy intervention. This review is one of a series of reviews that form an update of the Cochrane review, 'Physiotherapy interventions for shoulder pain'. OBJECTIVES To synthesise available evidence regarding the benefits and harms of electrotherapy modalities for the treatment of people with rotator cuff disease. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (January 1966 to March 2015), Ovid EMBASE (January 1980 to March 2015), CINAHL Plus (EBSCOhost, January 1937 to March 2015), ClinicalTrials.gov and the WHO ICTRP clinical trials registries up to March 2015, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials, to identify potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-randomised trials, including adults with rotator cuff disease (e.g. subacromial impingement syndrome, rotator cuff tendinitis, calcific tendinitis), and comparing any electrotherapy modality with placebo, no intervention, a different electrotherapy modality or any other intervention (e.g. glucocorticoid injection). Trials investigating whether electrotherapy modalities were more effective than placebo or no treatment, or were an effective addition to another physical therapy intervention (e.g. manual therapy or exercise) were the main comparisons of interest. Main outcomes of interest were overall pain, function, pain on motion, patient-reported global assessment of treatment success, quality of life and the number of participants experiencing adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment and assessed the quality of the body of evidence for the main outcomes using the GRADE approach. MAIN RESULTS We included 47 trials (2388 participants). Most trials (n = 43) included participants with rotator cuff disease without calcification (four trials included people with calcific tendinitis). Sixteen (34%) trials investigated the effect of an electrotherapy modality delivered in isolation. Only 23% were rated at low risk of allocation bias, and 49% were rated at low risk of both performance and detection bias (for self-reported outcomes). The trials were heterogeneous in terms of population, intervention and comparator, so none of the data could be combined in a meta-analysis.In one trial (61 participants; low quality evidence), pulsed therapeutic ultrasound (three to five times a week for six weeks) was compared with placebo (inactive ultrasound therapy) for calcific tendinitis. At six weeks, the mean reduction in overall pain with placebo was -6.3 points on a 52-point scale, and -14.9 points with ultrasound (MD -8.60 points, 95% CI -13.48 to -3.72 points; absolute risk difference 17%, 7% to 26% more). Mean improvement in function with placebo was 3.7 points on a 100-point scale, and 17.8 points with ultrasound (mean difference (MD) 14.10 points, 95% confidence interval (CI) 5.39 to 22.81 points; absolute risk difference 14%, 5% to 23% more). Ninety-one per cent (29/32) of participants reported treatment success with ultrasound compared with 52% (15/29) of participants receiving placebo (risk ratio (RR) 1.75, 95% CI 1.21 to 2.53; absolute risk difference 39%, 18% to 60% more). Mean improvement in quality of life with placebo was 0.40 points on a 10-point scale, and 2.60 points with ultrasound (MD 2.20 points, 95% CI 0.91 points to 3.49 points; absolute risk difference 22%, 9% to 35% more). Between-group differences were not important at nine months. No participant reported adverse events.Therapeutic ultrasound produced no clinically important additional benefits when combined with other physical therapy interventions (eight clinically heterogeneous trials, low quality evidence). We are uncertain whether there are differences in patient-important outcomes between ultrasound and other active interventions (manual therapy, acupuncture, glucocorticoid injection, glucocorticoid injection plus oral tolmetin sodium, or exercise) because the quality of evidence is very low. Two placebo-controlled trials reported results favouring LLLT up to three weeks (low quality evidence), however combining LLLT with other physical therapy interventions produced few additional benefits (10 clinically heterogeneous trials, low quality evidence). We are uncertain whether transcutaneous electrical nerve stimulation (TENS) is more or less effective than glucocorticoid injection with respect to pain, function, global treatment success and active range of motion because of the very low quality evidence from a single trial. In other single, small trials, no clinically important benefits of pulsed electromagnetic field therapy (PEMF), microcurrent electrical stimulation (MENS), acetic acid iontophoresis and microwave diathermy were observed (low or very low quality evidence).No adverse events of therapeutic ultrasound, LLLT, TENS or microwave diathermy were reported by any participants. Adverse events were not measured in any trials investigating the effects of PEMF, MENS or acetic acid iontophoresis. AUTHORS' CONCLUSIONS Based on low quality evidence, therapeutic ultrasound may have short-term benefits over placebo in people with calcific tendinitis, and LLLT may have short-term benefits over placebo in people with rotator cuff disease. Further high quality placebo-controlled trials are needed to confirm these results. In contrast, based on low quality evidence, PEMF may not provide clinically relevant benefits over placebo, and therapeutic ultrasound, LLLT and PEMF may not provide additional benefits when combined with other physical therapy interventions. We are uncertain whether TENS is superior to placebo, and whether any electrotherapy modality provides benefits over other active interventions (e.g. glucocorticoid injection) because of the very low quality of the evidence. Practitioners should communicate the uncertainty of these effects and consider other approaches or combinations of treatment. Further trials of electrotherapy modalities for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.
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Affiliation(s)
- Matthew J Page
- Monash UniversitySchool of Public Health & Preventive MedicineLevel 1, 549 St Kilda RoadMelbourneVictoriaAustralia3004
| | - Sally Green
- School of Public Health & Preventive Medicine, Monash UniversityAustralasian Cochrane CentreLevel 1, 549 St Kilda RoadMelbourneVictoriaAustralia3004
| | - Marshall A Mrocki
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | | | | | - Brodwen McBain
- Melbourne Hand RehabSuite 3, 20 Commercial RoadMelbourneVictoriaAustralia3000
| | - Nicolette Lyttle
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalSuite 41, Cabrini Medical Centre183 Wattletree RoadMalvernVictoriaAustralia3144
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Page MJ, Green S, McBain B, Surace SJ, Deitch J, Lyttle N, Mrocki MA, Buchbinder R. Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev 2016; 2016:CD012224. [PMID: 27283590 PMCID: PMC8570640 DOI: 10.1002/14651858.cd012224] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Management of rotator cuff disease often includes manual therapy and exercise, usually delivered together as components of a physical therapy intervention. This review is one of a series of reviews that form an update of the Cochrane review, 'Physiotherapy interventions for shoulder pain'. OBJECTIVES To synthesise available evidence regarding the benefits and harms of manual therapy and exercise, alone or in combination, for the treatment of people with rotator cuff disease. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE (January 1966 to March 2015), Ovid EMBASE (January 1980 to March 2015), CINAHL Plus (EBSCO, January 1937 to March 2015), ClinicalTrials.gov and the WHO ICTRP clinical trials registries up to March 2015, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials, to identify potentially relevant trials. SELECTION CRITERIA We included randomised and quasi-randomised trials, including adults with rotator cuff disease, and comparing any manual therapy or exercise intervention with placebo, no intervention, a different type of manual therapy or exercise or any other intervention (e.g. glucocorticoid injection). Interventions included mobilisation, manipulation and supervised or home exercises. Trials investigating the primary or add-on effect of manual therapy and exercise were the main comparisons of interest. Main outcomes of interest were overall pain, function, pain on motion, patient-reported global assessment of treatment success, quality of life and the number of participants experiencing adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment and assessed the quality of the body of evidence for the main outcomes using the GRADE approach. MAIN RESULTS We included 60 trials (3620 participants), although only 10 addressed the main comparisons of interest. Overall risk of bias was low in three, unclear in 14 and high in 43 trials. We were unable to perform any meta-analyses because of clinical heterogeneity or incomplete outcome reporting. One trial compared manual therapy and exercise with placebo (inactive ultrasound therapy) in 120 participants with chronic rotator cuff disease (high quality evidence). At 22 weeks, the mean change in overall pain with placebo was 17.3 points on a 100-point scale, and 24.8 points with manual therapy and exercise (adjusted mean difference (MD) 6.8 points, 95% confidence interval (CI) -0.70 to 14.30 points; absolute risk difference 7%, 1% fewer to 14% more). Mean change in function with placebo was 15.6 points on a 100-point scale, and 22.4 points with manual therapy and exercise (adjusted MD 7.1 points, 95% CI 0.30 to 13.90 points; absolute risk difference 7%, 1% to 14% more). Fifty-seven per cent (31/54) of participants reported treatment success with manual therapy and exercise compared with 41% (24/58) of participants receiving placebo (risk ratio (RR) 1.39, 95% CI 0.94 to 2.03; absolute risk difference 16% (2% fewer to 34% more). Thirty-one per cent (17/55) of participants reported adverse events with manual therapy and exercise compared with 8% (5/61) of participants receiving placebo (RR 3.77, 95% CI 1.49 to 9.54; absolute risk difference 23% (9% to 37% more). However adverse events were mild (short-term pain following treatment).Five trials (low quality evidence) found no important differences between manual therapy and exercise compared with glucocorticoid injection with respect to overall pain, function, active shoulder abduction and quality of life from four weeks up to 12 months. However, global treatment success was more common up to 11 weeks in people receiving glucocorticoid injection (low quality evidence). One trial (low quality evidence) showed no important differences between manual therapy and exercise and arthroscopic subacromial decompression with respect to overall pain, function, active range of motion and strength at six and 12 months, or global treatment success at four to eight years. One trial (low quality evidence) found that manual therapy and exercise may not be as effective as acupuncture plus dietary counselling and Phlogenzym supplement with respect to overall pain, function, active shoulder abduction and quality life at 12 weeks. We are uncertain whether manual therapy and exercise improves function more than oral non-steroidal anti-inflammatory drugs (NSAID), or whether combining manual therapy and exercise with glucocorticoid injection provides additional benefit in function over glucocorticoid injection alone, because of the very low quality evidence in these two trials.Fifty-two trials investigated effects of manual therapy alone or exercise alone, and the evidence was mostly very low quality. There was little or no difference in patient-important outcomes between manual therapy alone and placebo, no treatment, therapeutic ultrasound and kinesiotaping, although manual therapy alone was less effective than glucocorticoid injection. Exercise alone led to less improvement in overall pain, but not function, when compared with surgical repair for rotator cuff tear. There was little or no difference in patient-important outcomes between exercise alone and placebo, radial extracorporeal shockwave treatment, glucocorticoid injection, arthroscopic subacromial decompression and functional brace. Further, manual therapy or exercise provided few or no additional benefits when combined with other physical therapy interventions, and one type of manual therapy or exercise was rarely more effective than another. AUTHORS' CONCLUSIONS Despite identifying 60 eligible trials, only one trial compared a combination of manual therapy and exercise reflective of common current practice to placebo. We judged it to be of high quality and found no clinically important differences between groups in any outcome. Effects of manual therapy and exercise may be similar to those of glucocorticoid injection and arthroscopic subacromial decompression, but this is based on low quality evidence. Adverse events associated with manual therapy and exercise are relatively more frequent than placebo but mild in nature. Novel combinations of manual therapy and exercise should be compared with a realistic placebo in future trials. Further trials of manual therapy alone or exercise alone for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.
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Affiliation(s)
- Matthew J Page
- Monash UniversitySchool of Public Health & Preventive MedicineLevel 1, 549 St Kilda RoadMelbourneVictoriaAustralia3004
| | - Sally Green
- School of Public Health & Preventive Medicine, Monash UniversityAustralasian Cochrane CentreLevel 1, 549 St Kilda RoadMelbourneVictoriaAustralia3004
| | - Brodwen McBain
- Melbourne Hand RehabSuite 3, 20 Commercial RoadMelbourneVictoriaAustralia3000
| | | | | | - Nicolette Lyttle
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalMalvernAustralia3144
| | - Marshall A Mrocki
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalMalvernAustralia3144
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash UniversityMonash Department of Clinical Epidemiology, Cabrini HospitalMalvernAustralia3144
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Evaluation of measurement properties of self-administered PROMs aimed at patients with non-specific shoulder pain and "activity limitations": a systematic review. Qual Life Res 2016; 25:2141-60. [PMID: 27039305 PMCID: PMC4980404 DOI: 10.1007/s11136-016-1277-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To critically appraise and compare the measurement properties of self-administered patient-reported outcome measures (PROMs) focussing on the shoulder, assessing "activity limitations." STUDY DESIGN Systematic review. The study population had to consist of patients with shoulder pain. We excluded postoperative patients or patients with generic diseases. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using the COSMIN checklist. RESULTS Out of a total of 3427 unique hits, 31 articles, evaluating 7 different questionnaires, were included. The SPADI is the most frequently evaluated PROM and its measurement properties seem adequate apart from a lack of information regarding its measurement error and content validity. CONCLUSION For English, Norwegian and Turkish users, we recommend to use the SPADI. Dutch users could use either the SDQ or the SST. In German, we recommend the DASH. In Tamil, Slovene, Spanish and the Danish languages, the evaluated PROMs were not yet of acceptable validity. None of these PROMs showed strong positive evidence for all measurement properties. We propose to develop a new shoulder PROM focused on activity limitations, taking new knowledge and techniques into account.
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Subacromial shoulder disorders among baggage handlers: an observational cohort study. Int Arch Occup Environ Health 2016; 89:867-76. [PMID: 26994603 DOI: 10.1007/s00420-016-1127-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the influence of cumulative employment as baggage handler on the risk of incident subacromial shoulder disorders. Baggage handling is characterized by repetitive work primarily consisting of heavy lifting in awkward positions and time pressure. METHODS This cohort study is based on the Copenhagen Airport Cohort consisting of unskilled men with employment at Copenhagen Airport and unskilled men with employment in other firms in the Greater Copenhagen area during the period 1990-2012. Only men were included. We followed the cohort in the National Patient Register and Civil Registration System. The primary exposure was cumulative years of employment as a baggage handler, and the primary outcome was diagnoses and surgical treatment of subacromial shoulder disorders. RESULTS The cohort contained 3396 baggage handlers and 63,909 workers in the reference group. Baggage handlers with longer cumulative years of employment had higher incidence compared to baggage handlers with shorter employment; for example, baggage handlers with 10-19 years of employment had incidence rate ratio of 2.07 (95 % confidence interval, 1.27-3.38) compared to baggage handlers with less than 3 years of employment. Spline regression showed an increase in incidence within the first few years after employment whereupon the increased risk remained constant for longer employment. Baggage handlers had increased incidence in younger ages than the reference population. CONCLUSIONS In this large cohort study, we found increased incidence of subacromial shoulder disorders for workers with longer cumulative years of employment. These results support that long-term lifting in awkward positions and time pressure influences the risk of subacromial shoulder disorders.
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Luque-Suarez A, Rondon-Ramos A, Fernandez-Sanchez M, Roach KE, Morales-Asencio JM. Spanish version of SPADI (shoulder pain and disability index) in musculoskeletal shoulder pain: a new 10-items version after confirmatory factor analysis. Health Qual Life Outcomes 2016; 14:32. [PMID: 26927584 PMCID: PMC4772691 DOI: 10.1186/s12955-016-0436-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/23/2016] [Indexed: 01/09/2023] Open
Abstract
Background The Shoulder Pain and Disability Index (SPADI) is a tool designed to evaluate the impact of shoulder pathology. The aim of this study was to cross culturally adapt a Spanish version of the SPADI for Spanish population with a musculoskeletal shoulder pain, and to determine the psychometric properties of this instrument using confirmatory factor analysis (CFA). Methods Cross-cultural adaptation was performed according to the international guidelines. To assess factor structure, a confirmatory factor analysis was done. Internal consistency was measured using Cronbach’s alpha. Item-total and inter-item correlations were assessed. Pearson and Spearman correlations were calculated to assess the convergent validity between SPADI and quick-DASH. Results A new Spanish version of SPADI was achieved. The original SPADI factor structure was tested by CFA, obtaining a poor fit: relative chi-square (χ2/df) 3.16, CFI 0.89, NFI 0.92, and RMSEA 0.10 (90 % CI 0.08 to 0.12). An additional model was tested, after deleting items which have had a poor adjustment in the model (1, 11, and 12), obtaining the best fit: relative chi-square (χ2/df) of 1.94, CFI 0.98, NFI 0.95, GFI 0,95, and RMSEA 0.06 (90 % CI 0.04 to 0.09). The analysis confirmed the bidimensional structure (pain and disability subscales). A correlation Spearman’s Rho coefficient of 0.752 (p < 0.0001) and a Cronbach’s alpha of 0.90 were obtained. Conclusions This study validated a new 10-items version of SPADI for Spanish population with musculoskeletal shoulder pain providing a patient reported outcome measure that could be used in both clinical practice and research.
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Affiliation(s)
| | - Antonio Rondon-Ramos
- Las Lagunas Primary Health Care Center, Costa del Sol Sanitary District, Fuengirola-Mijas, Spain.
| | | | - Kathryn E Roach
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, USA.
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