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He Y, Yuan C, Wang Y, Xu H, Song W, Liu W. Is playing ma-jong, chess and cards associated with a lower incidence of shoulder pain in Chinese elderly adults? The cross-sectional and longitudinal evidence from CHARLS. Exp Gerontol 2024; 194:112518. [PMID: 38986857 DOI: 10.1016/j.exger.2024.112518] [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: 05/21/2024] [Revised: 06/28/2024] [Accepted: 07/07/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The association between playing Ma-jong, chess and cards (PMCC) and shoulder pain among elderly adults in China remains unclear. The present study aimed to examine the association based on a nationally representative large-scale survey. METHODS The study used two waves of data from China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. All subjects met the inclusion criteria were classified based on the results of the CHARLS wave questionnaire. Logistic regression models were conducted to analyze the cross-sectional and longitudinal association between PMCC and shoulder pain. Odds ratios (OR) were reported to indicate the strength of the association. RESULTS In total, 8125 participants aged over 60 years (48.3 % male; mean age 67.9 ± 6.4 years) were enrolled in a cross-sectional association study in 2015, and further 6861 elderly adults were followed up in 2018. The overall prevalence of shoulder pain in the cross-sectional population was 15.6 %. In the non-PMCC and PMCC groups, the incidence of shoulder pain was 16.6 % and 10.7 %, respectively (P < 0.001). In the fully adjusted model, the results showed a significant association between PMCC and shoulder pain (OR: 0.798, 95 % CI: 0.662-0.963, P = 0.018). In the longitudinal analysis from 2015 to 2018, the incidence of new-occurrence shoulder pain in non-PMCC and PMCC groups was 22.1 %, and 18.5 %, respectively (P = 0.004). In the fully adjusted model, compared with the non-PMCC group, the risk of the occurrence of shoulder pain for individuals with PMCC was lower (OR: 0.832, 95 % CI: 0.709-0.975, P = 0.023). CONCLUSIONS PMCC is associated with lower incidence of shoulder pain, which provides evidence for PMCC as a potential protective factor in the occurrence of shoulder pain.
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Affiliation(s)
- Yinong He
- Shanghai Jiao Tong University SJTU-UM Joint Institute, 800 Dongchuan Road, Minhang District, Shanghai 200240, China
| | - Chenrui Yuan
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China
| | - Yifei Wang
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China
| | - Hui Xu
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China
| | - Wei Song
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China.
| | - Wencai Liu
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China.
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Çelik D, Van Der Veer P, Tiryaki P. The Clinical Significance of Mulligan's Mobilization with Movement in Shoulder Pathologies: A Systematic Review and Meta-Analysis. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 39189938 DOI: 10.1089/jicm.2024.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Background: Mulligan's mobilization with movement (MWM) is a manual therapy technique designed to address musculoskeletal pain and joint mobility. Despite immediate reported improvements by patients, the clinical significance of MWM compared with other interventions remains uncertain. Objective: To assess the clinical effectiveness of MWM for shoulder pathologies compared with other treatment methods. Methods: The databases PubMed, Web of Science, Cochrane Library, Scopus, and the Physiotherapy Evidence Database (PEDro) were searched up to June 2024. Inclusion criteria were limited to randomized controlled trials published in English and Turkish languages, focusing on the MWM technique for shoulder pathologies. Two independent reviewers evaluated methodological quality based on the PEDro scale. Outcome data were analyzed for pain, function, and range of motion (ROM) using SPSS Statistics 29.0. Results: Twenty-seven studies (1157 participants) were included. MWM demonstrated statistical superiority in function (MD = -11.24, 95% CI: [-18.33, -4.16], p = 001) and shoulder flexion and abduction ROM compared with other mobilization techniques. There was a significant MD in pain intensity, which was -1.55 cm (95% CI: [-2.60, -0.51], p = 0.00), with high heterogeneity (I2 = 93%), favoring MWM in comparison with control group. MWM was significantly better for shoulder abduction ROM in comparison with physical therapy interventions (MD = -14.44, 95% CI: [1.98, 26.90], p = 0.02) with high heterogeneity (I2 = 90%) and control group (SMD = 56.67, 95% CI: [7.71, 111.63], p = 0.02) with high heterogeneity (I2 = 96%). However, clinical significance was not consistently achieved. Conclusions: Although some statistical significance was found when comparing MWM with other her treatment methods, it was observed that most of the statistically significant data did not reach clinical significance. Upon closer examination, outcome measures that showed clinical significance, either the interventions in the comparison group were inadequate, not evidence-based, or the improvements within the group were not logical.
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Affiliation(s)
- Derya Çelik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Pınar Van Der Veer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istinye University, Istanbul, Türkiye
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Pelin Tiryaki
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yalova University, Yalova, Türkiye
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Nguyen TNA, Nguyen NH, Vu DK, Cu LTN. Short-term effects of Kinesiotaping combined with a rehabilitation program for rotator cuff-related shoulder pain: a randomized, assessor-blinded clinical trial. J Man Manip Ther 2024:1-10. [PMID: 39121188 DOI: 10.1080/10669817.2024.2387913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/30/2024] [Indexed: 08/11/2024] Open
Abstract
OBJECTIVES This study aimed to determine the clinical efficacy of Kinesiotaping (KT) combined with a rehabilitation program to reduce symptoms and functional limitations in patients with Rotator Cuff-Related Shoulder Pain (RCRSP) in Vietnam. METHODS In total, 82 participants who were diagnosed with RCRSP were randomly allocated into two groups. Both groups received a standard rehabilitation program; additionally, the intervention group was treated with KT. Outcomes, assessed at baseline, and 3, 7, and 14 days postintervention, included pain intensity (Visual Analogue Scale, VAS), functional disability (Shoulder Pain and Disability Index, SPADI), and active range of motion (ROM). RESULTS The KT group exhibited significant improvements in all outcome measures. VAS scores decreased by an average of 13.3 points in the KT group at 14 days, which was notably greater than that in the control group (95% CI: -17.77 to -8.82). SPADI scores also improved significantly in the KT group, with reductions of -11.36, -15.27, and -13.3 at days 3, 7, and 14, respectively. Regarding ROM, the KT group showed notable improvements in flexion and external rotation, with flexion ROM differences of 10.78, 10.35, and 11.8 degrees at the respective time points. No significant changes were observed in the abduction or internal rotation ROM. After adjusting for age, baseline scores, and gender, there was a statistically significant interaction between Group and Time on the VAS, SPADI, and ROM abduction. CONCLUSION Incorporating KT into a standard rehabilitation program for RCRSP demonstrated enhanced efficacy in reducing pain and improving shoulder function. The results suggest that KT can be a valuable component of the treatment regimen for RCRSP.
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Affiliation(s)
| | - Nam Hoai Nguyen
- Rehabilitation Department, Hanoi Medical University, Hanoi, Vietnam
| | - Duy Kim Vu
- Center of Training and Research Management, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Lam Tung Ngoc Cu
- National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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Wahlström V, Öhrn M, Harder M, Eskilsson T, Fjellman-Wiklund A, Pettersson-Strömbäck A. Physical work environment in an activity-based flex office: a longitudinal case study. Int Arch Occup Environ Health 2024; 97:661-674. [PMID: 38755483 PMCID: PMC11245412 DOI: 10.1007/s00420-024-02073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/01/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE This study aimed to investigate and explore Occupational Health and Safety (OHS) management, office ergonomics, and musculoskeletal symptoms in a group of office workers relocating from cell offices to activity-based flex offices (AFOs). METHODS The analysis was based on qualitative interview data with 77 employees and longitudinal questionnaire data from 152 employees. RESULTS Results indicate that there was a need to clarify roles and processes related to the management of OHS. Self-rated sit comfort, working posture, and availability of daylight deteriorated and symptoms in neck and shoulders increased after the relocation and seemed to be influenced by many factors, such as difficulties adjusting the workstations, the availability of suitable workplaces, and age, sex, and individual needs. CONCLUSION Research on the long-term effects of physical work environments and management of (OHS) issues after implementing activity-based flex offices is sparse. This study demonstrates the importance of planning and organising OHS issue management when implementing an AFO, and to carefully implement office ergonomics among office workers.
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Affiliation(s)
- Viktoria Wahlström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, 901 87, Sweden.
| | - Maria Öhrn
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mette Harder
- Umeå School of Architecture, Umeå University, Umeå, Sweden
| | - Therese Eskilsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Hernandez-Sanchez S, Roses-Conde J, Martinez-Llorens N, Ruiz D, Espejo-Antúnez L, Tomás-Rodríguez I, Toledo-Marhuenda JV, Albornoz-Cabello M. EFisioTrack System for Monitoring Therapeutic Exercises in Patients with Shoulder Orthopedic Injuries in a Hospital Setting: A Pilot Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:4898. [PMID: 39123945 PMCID: PMC11314742 DOI: 10.3390/s24154898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/20/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
To assess the effects of the eFisioTrack monitoring system on clinical variables in patients with prescribed physiotherapy for shoulder injuries, twenty-four adult patients with shoulder orthopaedic injuries who underwent physical therapy treatment in a hospital setting participated in the study (twelve in the experimental group and twelve as controls). Clinical outcome measures were shoulder function and pain (Constant-Murley Score and Disabilities of the Arm, Shoulder, and Hand or DASH score). Each variable was measured by a blinded physiotherapist at baseline and at one month follow-up. Patients performed the prescribed exercises either supervised by the physiotherapist (control group) or in a separate room without therapist supervision (experimental group). There were no statistically significant differences between groups before treatment or at follow-up for any outcomes (p ≥ 0.05). There was a statistically significant decrease (p ≤ 0.05) of at least 10 points in both groups for the DASH score at follow-up. Differences in the total score and subjective components of the Constant-Murley were also evidenced within groups. The use of the eFisioTrack system showed similar results in clinical measures compared to those performed under the direct supervision of the physiotherapist. This approach might be suitable for providing an effective shoulder exercise program at home.
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Affiliation(s)
- Sergio Hernandez-Sanchez
- Translational Research Center in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Ctra. Alicante-Valencia Km. 8, 7-N 332, 03550 Alicante, Spain; (S.H.-S.); (I.T.-R.)
| | - Jorge Roses-Conde
- Rehabilitation Service, General University Hospital of Elche, Carrer Almazara, 11, 03203 Alicante, Spain; (J.R.-C.); (N.M.-L.)
| | - Neus Martinez-Llorens
- Rehabilitation Service, General University Hospital of Elche, Carrer Almazara, 11, 03203 Alicante, Spain; (J.R.-C.); (N.M.-L.)
| | - Daniel Ruiz
- Department of Computer Technology, University of Alicante, Carrer de Sant Vincent S/N, 03690 Alicante, Spain;
| | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, University of Extremadura, 06071 Badajoz, Spain;
| | - Isabel Tomás-Rodríguez
- Translational Research Center in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Ctra. Alicante-Valencia Km. 8, 7-N 332, 03550 Alicante, Spain; (S.H.-S.); (I.T.-R.)
| | - Jose-Vicente Toledo-Marhuenda
- Translational Research Center in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Ctra. Alicante-Valencia Km. 8, 7-N 332, 03550 Alicante, Spain; (S.H.-S.); (I.T.-R.)
| | - Manuel Albornoz-Cabello
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, San Fernando, 4, 41009 Sevilla, Spain;
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Tozzo MC, Reis FJJ, Alaiti RK, Hotta GH, Oliveira ASD. Association between perception of harm and valence of shoulder movement images with disability levels related to chronic shoulder pain. Pain 2024:00006396-990000000-00661. [PMID: 39037869 DOI: 10.1097/j.pain.0000000000003337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/09/2024] [Indexed: 07/24/2024]
Abstract
ABSTRACT Recent studies highlight an interplay between pain perception and emotional responses. This necessitates a thorough investigation into how beliefs and motivational influences respond to visual stimuli of movements. Such an analysis is crucial for understanding the extent to which these factors contribute to disability levels associated with shoulder pain. We aimed to investigate the relationship between the perception of harm and the valence in images depicting shoulder movements and determine how these perceptions are linked to disability levels associated with shoulder pain. This cross-sectional study recruited 42 individuals with chronic shoulder pain. Participants were presented with 58 shoulder movements images. Each participant evaluated these images for emotional valence and arousal using the self-assessment manikin. For every image, they provided their level of avoidance, fear, and perception of harm in a numerical scale. We measured disability levels and pain catastrophizing using the Shoulder Pain and Disability Index and the Pain Catastrophizing Scale. A direct acyclic graph was used. Multiple linear regression analysis was conducted with shoulder disability as the dependent variable and perception of harm and valence as independent variables, adjusted for the confounders catastrophizing and arousal. This analysis resulted in a significant model (F4,37 = 11.44; adjusted R2 = 0.547; P < 0.01). The perception of harm to shoulder movement (β = 0.11; P < 0.001; 95% confidence interval = 5.6-11.8) was significantly associated with the level of shoulder disability, whereas valence did not show a significant association (β = 0.26; P = 0.15; 95% confidence interval = 1.7-10.8). The perception of harm associated with shoulder movements images during daily activities was associated with disability. Individuals who believe that shoulder movements are harmful have greater disability.
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Affiliation(s)
- Marcela Camargo Tozzo
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Felipe J J Reis
- Department of Physiotherapy, Federal Institute of Rio de Janeiro, Rio de Janeiro, Brazil
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rafael Krasic Alaiti
- Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, Universidade de São Paulo, São Paulo, Brazil
- Research, Technology, and Data Science Unit, Projeto Superador, São Paulo, Brazil
| | - Gisele Harumi Hotta
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Rojas W, Vargas P, Droppelmann G, Jorquera C, Stöwhas K, Godoy A, García N. The Critical Shoulder Angle: A Significant Radiological Measure in Rotator Cuff vs. Glenohumeral Osteoarthritis in Chilean Patients-A Descriptive Cross-Sectional Study. J Clin Med 2024; 13:3408. [PMID: 38929939 PMCID: PMC11204370 DOI: 10.3390/jcm13123408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Shoulder pain is one of the most important musculoskeletal conditions affecting the upper extremities. Glenohumeral osteoarthritis (GHOA) and rotator cuff injuries (RCIs) are notable for their high prevalence. The critical shoulder angle (CSA) is a significant radiological measure for determining the diagnosis and progression of patients with these conditions. Although there are reports in the international literature about this measure, in our country, guideline values considering these two pathologies are unknown. Objective: Our objective was to assess patients diagnosed with GHOA and RCI using an AP X-ray view and the CSA. Methods: To conduct this, we identified differences between sexes and age categories. Fifty-nine adult patients with GHOA and RCI were included. CSA grades varied depending on the age category and type of injury evaluated. Results: Significant differences between the age ranges of 40 and 54 (p = 0.05), 55-69 (p = 0.001), and 70-84 (p = 0.017) were observed. Conclusions: Patients with RCI tended to be younger and have a higher CSA compared to those with GHOA. It is important to have more normative values and to continue monitoring the critical shoulder angle in these patients.
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Affiliation(s)
- Walter Rojas
- Clínica MEDS, Santiago 7691236, Chile; (W.R.); (P.V.); (K.S.); (N.G.)
- Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso 2540064, Chile;
| | - Pablo Vargas
- Clínica MEDS, Santiago 7691236, Chile; (W.R.); (P.V.); (K.S.); (N.G.)
| | - Guillermo Droppelmann
- Clínica MEDS, Santiago 7691236, Chile; (W.R.); (P.V.); (K.S.); (N.G.)
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Carlos Jorquera
- Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago 8580745, Chile;
| | - Katherine Stöwhas
- Clínica MEDS, Santiago 7691236, Chile; (W.R.); (P.V.); (K.S.); (N.G.)
- Facultad de Medicina, Escuela de Kinesiología, Universidad Finis Terrae, Santiago 7501014, Chile
| | - Alejandro Godoy
- Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso 2540064, Chile;
| | - Nicolás García
- Clínica MEDS, Santiago 7691236, Chile; (W.R.); (P.V.); (K.S.); (N.G.)
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Vries TMBD, Deen WE, Lucas C. Does the Keele STarT MSK tool predict the risk of poor outcome in non-specific shoulder complaints in primary care in a Dutch population? Physiotherapy 2024; 123:38-46. [PMID: 38266396 DOI: 10.1016/j.physio.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/03/2023] [Accepted: 10/17/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES The Keele STarT MSK tool is a questionnaire to identify the prognostic factors for musculoskeletal conditions, such as shoulder complaints, developed by Keele University, UK. This study assessed whether the Keele STarT MSK tool can predict the risk of poor outcome in non-specific shoulder complaints in a Dutch population. DESIGN Multicentre prospective cohort study. SETTING Fourteen primary care physiotherapy clinics in the Netherlands participated in this study. PARTICIPANTS In total, 180 patients with non-specific shoulder complaints with complete data from the Keele STarT MSK tool (baseline), Short-Form 12 Health Survey (SF-12), Shoulder Pain and Disability Index (SPADI), Numeric Pain Rating Score (NPRS) and Global Perceived Effect (GPE) scale at week 6, week 12 or endpoint were included. Data were collected from January 2019 to January 2020. Of these, 180 patients were eligible for the study. Of these, 139 completed the study and were included in the analysis. MAIN OUTCOME MEASURES Poor outcome was defined as: SF-12 score ≤33 (physical health), SPADI score ≥30% (disability in activity), NPRS score ≥3 (pain intensity) and GPE scale score ≥3 (patient-reported recovery). RESULTS The area under the receiver operating characteristic curves for prediction of outcome were excellent for the SF-12, acceptable for the SPADI and NPRS, and showed no discrimination for the GPE scale. The optimal cut-off value for the Keele STarT MSK score to discriminate between low and medium/high risk groups was ≥5. CONCLUSIONS The Keele STarT MSK tool is able to predict the risk of poor outcome in patients with non-specific shoulder complaints in primary care physiotherapy clinics. Further research is needed to establish whether stratified care (subgrouping and targeted treatment) is more efficient. CONTRIBUTION OF PAPER.
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Affiliation(s)
| | - W E Deen
- Zorgtopics, Baarn, the Netherlands
| | - C Lucas
- Department of Epidemiology and Data Science, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Kuniki M, Iwamoto Y, Konishi R, Kuwahara D, Yamagiwa D, Kito N. Neural Drive and Motor Unit Characteristics of the Serratus Anterior in Individuals With Scapular Dyskinesis. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2024; 24:148-158. [PMID: 38825997 PMCID: PMC11145323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE Scapular dyskinesis is one of the causes of shoulder disorders and involves muscle weakness in the serratus anterior. This study investigated whether motor unit (MU) recruitment and firing property, which are important for muscle exertion, have altered in serratus anterior of the individuals with scapular dyskinesis. METHODS Asymptomatic adults with (SD) and without (control) scapular dyskinesis were analyzed. Surface electromyography (sEMG) waveforms were collected at submaximal voluntary contraction of the serratus anterior. The sEMG waveform was decomposed into MU action potential amplitude (MUAPAMP), mean firing rate (MFR), and recruitment threshold. MUs were divided into low, moderate, and high thresholds, and MU recruitment and firing properties of the groups were compared. RESULTS High-threshold MUAPAMP was significantly smaller in the SD group than in the control group. The control group also exhibited recruitment properties that reflected the size principle, however, the SD group did not. Furthermore, the SD group had a lower MFR than the control group. CONCLUSIONS Individuals with scapular dyskinesis exhibit altered MU recruitment properties and lower firing rates of the serratus anterior; this may be detrimental to muscle performance. Thus, it may be necessary to improve the neural drive of the serratus anterior when correcting scapular dyskinesis.
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Affiliation(s)
- Masahiro Kuniki
- Graduate School of Medical Welfare Sciences, Medical Engineering, Hiroshima International University, Higashi-hiroshima, Hiroshima, Japan
| | - Yoshitaka Iwamoto
- Department of Neuromechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Rei Konishi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-hiroshima, Hiroshima, Japan
| | - Daisuke Kuwahara
- Graduate School of Medical Welfare Sciences, Medical Engineering, Hiroshima International University, Higashi-hiroshima, Hiroshima, Japan
| | - Daiki Yamagiwa
- Graduate School of Medical Welfare Sciences, Medical Engineering, Hiroshima International University, Higashi-hiroshima, Hiroshima, Japan
| | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-hiroshima, Hiroshima, Japan
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Valenzuela-Rios C, Arias-Buría JL, Rodríguez-Jiménez J, Palacios-Ceña M, Fernández-de-las-Peñas C. Effects of Adding Four Sessions of Ultrasound-Guided Percutaneous Electrical Nerve Stimulation to an Exercise Program in Patients with Shoulder Pain: A Randomized Controlled Trial. J Clin Med 2024; 13:3171. [PMID: 38892882 PMCID: PMC11172917 DOI: 10.3390/jcm13113171] [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: 05/02/2024] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
Objective: Percutaneous electrical nerve stimulation (PENS) appears to be effective for the treatment of musculoskeletal pain. The aim of this trial was to investigate the effects on disability and pain, as well as on the psychological aspects of adding PENS into an exercise program in patients with subacromial pain syndrome. Methods: A randomized, parallel-group clinical trial was conducted. Sixty patients with subacromial pain were allocated into exercise alone (n = 20), exercise plus PENS (n = 20), or exercise plus placebo PENS (n = 20) groups. Patients in all groups performed an exercise program twice daily for 3 weeks. Patients allocated to the PENS group also received four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves. Patients allocated to the exercise plus placebo PENS received a sham PENS application. The primary outcome was related disability (Disabilities of the Arm, Shoulder, and Hand, DASH). Secondary outcomes included mean pain, anxiety levels, depressive symptoms, and sleep quality. They were assessed at baseline, one week after, and one and three months after. An analysis was performed using intention-to-treat with mixed-models ANCOVAs. Results: The results revealed no between-group differences for most outcomes (related disability: F = 0.292, p = 0.748, n2p = 0.011; anxiety: F = 0.780, p = 0.463, n2p = 0.027; depressive symptoms: F = 0.559, p = 0.575, n2p = 0.02; or sleep quality: F = 0.294, p = 0.747, n2p = 0.01); both groups experienced similar changes throughout the course of this study. Patients receiving exercise plus PENS exhibited greater improvement in shoulder pain at one month than those in the exercise (Δ -1.2, 95%CI -2.3 to -0.1) or the placebo (Δ -1.3, 95%CI -2.5 to -0.1) groups. Conclusions: The inclusion of four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves into an exercise program did not result in better outcomes in our sample of patients with subacromial pain syndrome at one and three months after treatment.
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Affiliation(s)
- Claudia Valenzuela-Rios
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28933 Móstoles, Madrid, Spain;
| | - José L. Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Madrid, Spain; (J.L.A.-B.); (J.R.-J.); (M.P.-C.)
| | - Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Madrid, Spain; (J.L.A.-B.); (J.R.-J.); (M.P.-C.)
| | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Madrid, Spain; (J.L.A.-B.); (J.R.-J.); (M.P.-C.)
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Madrid, Spain; (J.L.A.-B.); (J.R.-J.); (M.P.-C.)
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11
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Arulkumar S, Neuchat EE, Ly E, Ly AI, Fahimipour K, Desai MJ. Peripheral Nerve Stimulation of the Shoulder: A Technical Primer. J Pain Res 2024; 17:1725-1733. [PMID: 38751996 PMCID: PMC11095401 DOI: 10.2147/jpr.s446901] [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: 10/27/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Scapulalgia or shoulder pain accounts for 16% of all musculoskeletal complaints in the healthy adult population and becomes more common as we age. When this pain exceeds 3 months in duration, it is deemed to be chronic, and typically treated in an escalating manner. Spanning a continuum of conservative and non-conservative measures, chronic shoulder pain treatments range from rest and physical therapy to surgery. Since each patient presents with a unique spectrum of symptoms a customized treatment plan is often required. Over the lifetime of many of these patients, a variety of treatment options are required. One of these treatment options, peripheral nerve stimulation (PNS), is a minimally invasive procedure in which an electrical impulse is delivered through a percutaneously implanted, small caliber electrode to a peripheral nerve proximal to the lesion which interferes with the pain signals. Over the past several years, significant growth of PNS in the treatment of chronic neuropathic pain has been observed. However, the procedural techniques have not been well described. The foundation of long-term, minimally invasive percutaneous PNS in patients with chronic shoulder pain, and procedural techniques for stimulating the suprascapular and axillary nerves using fluoroscopy or ultrasonography will be described in this report.
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Affiliation(s)
- Sailesh Arulkumar
- Department of Anesthesiology, SSM Health, St. Anthony’s Hospital, Oklahoma City, OK, USA
| | - Elisa E Neuchat
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Eric Ly
- Department of Anesthesiology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Austin Ingwei Ly
- The University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Kiana Fahimipour
- Department of Anesthesiology; Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA, USA
| | - Mehul J Desai
- International Spine Pain & Performance Center, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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12
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Cunha M, Silva M, Sousa V, Vaz R, Azevedo MJ, Zão A. Age-Related Variations in Breast Cancer Complications: Insights from Physical Medicine and Rehabilitation Clinical Practice. Cureus 2024; 16:e59745. [PMID: 38841007 PMCID: PMC11152361 DOI: 10.7759/cureus.59745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Background Breast cancer patients often experience complications related to the disease or its treatment. With the rising average life expectancy, age is becoming less of a factor in treatment decisions for this condition. This study aims to evaluate differences in breast cancer complications among various age groups in patients referred to a hospital's physical medicine and rehabilitation (PMR) department. Methodology A retrospective study was conducted among all breast cancer patients evaluated in a PMR department between November 2019 and March 2021. Data were collected from patients' clinical files. SPSS® version 24 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results We assessed 85 patients with a mean age of 56 years, finding that shoulder pain was the primary referral reason, reported by 85.9% of patients, followed by lymphedema in 32% of cases. Patients aged 56-65 years exhibited greater deficits in shoulder mobility compared to those between 66 and 75 years old, as well as greater functional limitations compared to other age groups. Most patients reported symptoms post-surgery, with an average delay of 24 months in PMR consultation. Despite this, nearly all patients (89.3%) reported clinical improvement following interventions. Conclusions We found that individuals in the 56-65-year age group were more prone to develop functional and shoulder mobility limitations. Despite delayed consultation, the majority of patients experienced clinical improvement, highlighting the intervention effectiveness of PMR interventions. These findings suggest that age alone may not be a determining factor in the reported breast cancer sequelae, implying the influence of other contributing factors in patient management. Further research is needed to elucidate the underlying mechanisms contributing to the diverse burden of disease sequelae observed across different age groups and to devise tailored interventions.
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Affiliation(s)
- Mafalda Cunha
- Physical Medicine and Rehabilitation, Unidade Local de Saúde Alto Ave, Guimarães, PRT
| | - Marco Silva
- Physical Medicine and Rehabilitation, Unidade Local de Saúde Alto Ave, Guimarães, PRT
| | - Vitor Sousa
- Physical Medicine and Rehabilitation, Unidade Local de Saúde Alto Ave, Guimarães, PRT
| | - Rui Vaz
- Physical Medicine and Rehabilitation, Unidade Local de Saúde Alto Ave, Guimarães, PRT
| | - Maria João Azevedo
- Physical Medicine and Rehabilitation, Unidade Local de Saúde Alto Ave, Guimarães, PRT
| | - Ana Zão
- Physical Medicine and Rehabilitation, Unidade Local de Saúde de Santo António, Porto, PRT
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13
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Kang JY, Kim D, Kim H, Ha IH, Lee YJ. Health Care Utilization for Common Shoulder Disorders: Analysis of the 2010-2019 National Patient Sample Data from the Health Insurance Review and Assessment Service in Korea. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:744. [PMID: 38792927 PMCID: PMC11122813 DOI: 10.3390/medicina60050744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024]
Abstract
Background and Objective: The aim of this study was to analyze trends in surgical and non-surgical service utilization for common shoulder disorders in Korea from 2010 to 2019. Methods and Materials: This retrospective, cross-sectional, descriptive study utilized National Patient Sample data from the Health Insurance and Review Assessment Service (HIRA) of Korea. These data constitute a 2% sample out of the entire Korean population and include data for a variety of parameters instrumental for health care research. Patients with at least one medical service use for rotator cuff syndrome or tear, impingement syndrome, or adhesive capsulitis between January 2010 and December 2019 were included. Trends in healthcare utilization by disorder type, patient demographics, seasonal service use, and treatment details were examined. Results: There was an upward trend in the total number of patients and costs for shoulder disorders, from 35,798 patients and USD 5,485,196 in 2010 to 42,558 and USD 11,522,543 in 2019, respectively. The number of patients aged ≥60 and hospital visits increased. March had the highest number of claims. Physical therapy was the most common non-surgical procedure, while nerve block claims more than doubled. Opioid prescription rates also tripled. Surgical treatments were dominated by shoulder rotator cuff repair and acromioplasty. Conclusions: There was a significant increase in healthcare utilization for shoulder disorders, marked by rising costs and patient numbers. The use of nerve blocks and opioids notably increased. These data are valuable for clinicians, researchers, and policymakers.
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Affiliation(s)
- Jin-Young Kang
- Jaseng Hospital of Korean Medicine, Seoul 06110, Republic of Korea;
| | - Doori Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea (I.-H.H.)
| | - Huijun Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea (I.-H.H.)
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea (I.-H.H.)
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea (I.-H.H.)
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14
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Silveira A, Lima C, Beaupre L, Chepeha J, Jones A. Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis. PLoS One 2024; 19:e0294014. [PMID: 38683828 PMCID: PMC11057978 DOI: 10.1371/journal.pone.0294014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/24/2023] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Exercise therapy (ET) is frequently an early treatment of choice when managing shoulder pain, yet evidence on its efficacy to expedite recovery is inconsistent. Moreover, the value of adding adjunct therapies (i.e. injections, manual therapy, electrotherapy) to ET is currently unclear. This study combined both direct and indirect evidence across studies on the effectiveness of ET with/without adjunct therapies compared to usual medical care for adults with chronic shoulder pain. METHODS AND FINDINGS Using a network meta-analysis, randomized control trials comparing ET along with adjunct therapies were identified in MEDLINE, Embase, CINAHL, Sportdiscus, CENTRAL, Conference Proceedings Citation Index-Science, clinicaltrials.gov, and association websites. Outcomes included pain, range of motion (ROM), and health-related quality of life (HRQL) measures in adult patients with chronic shoulder pain. Data analysis used a Frequentist hierarchical model. CINeMA tool assessed the confidence in the results and Cochrane Risk of Bias tool assessed quality of studies. 54 studies primarily from Europe (40.38%) included 3,893 participants who were followed up to 52 weeks. Shoulder-specific ET (Mean difference (MD) = -2.1; 95% confidence interval (CI) = -3.5 to -0.7) or in combination with electro-physical agents (MD = -2.5; 95% CI = -4.2 to -0.7), injections (MD = -2.4; 95% CI = -3.9 to-1.04) or manual therapy (MD = -2.3; 95% CI = -3.7 to -0.8) decreased pain compared to usual medical care. Trends with ROM and HRQL scores were seen; however, only Manual Therapy (MD = -12.7 and 95% CI = -24.4 to -1.0) achieved meaningfully important changes. Sensitivity analysis excluding studies with high risk of bias showed similar results, with exception of injections that did not reach significance (MD = -1.3; 95% CI = -4.3 to 1.7). CONCLUSION(S) Shoulder-specific ET provided pain relief up to 52 weeks. Adjunct therapies to shoulder-specific ET added little value in reducing pain. The quality of evidence varied between moderate and very low.
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Affiliation(s)
- Anelise Silveira
- University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Camila Lima
- University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Lauren Beaupre
- University of Alberta, Faculty of Rehabilitation Sciences, Edmonton, Alberta, Canada
- University of Alberta, Collaborative Orthopaedic Research, Edmonton, Alberta, Canada
| | - Judy Chepeha
- University of Alberta, Collaborative Orthopaedic Research, Edmonton, Alberta, Canada
| | - Allyson Jones
- University of Alberta, Faculty of Rehabilitation Sciences, Edmonton, Alberta, Canada
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15
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Chen X, Cha L, Xuan Z, Zhang W. The effect of joint position sense therapy on chronic shoulder pain with central sensitization. Medicine (Baltimore) 2024; 103:e37786. [PMID: 38608097 PMCID: PMC11018202 DOI: 10.1097/md.0000000000037786] [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: 01/24/2024] [Accepted: 03/13/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Chronic shoulder pain is a common musculoskeletal problem associated with unreleased pain and functional dysfunction that can evolve into central sensitization. Some forms of manual therapy may exacerbate pain and central sensitization. This study investigated the impact of joint position sense therapy (JPST), a moderate joint proprioception training technique, on central sensitization, shoulder functional dysfunction, and pain in patients with chronic shoulder pain compared with more intense exercises or aggressive manual therapies. METHODS We assessed the pressure pain threshold (PPT) in 30 patients with and 30 patients without chronic shoulder pain. The assessment focused on 4 muscle sites: deltoid, upper trapezius, brachioradialis, and tibialis anterior. Thirty patients with chronic shoulder pain were randomly divided into the JPST and control groups. The JPST group underwent additional shoulder joint position-sense training. The efficiency outcomes were the disabilities of the arm, shoulder, and hand questionnaire, visual analog scale (VAS), and PPT, evaluated at baseline and after the intervention. RESULTS Significant differences were observed in the PPT values at the brachioradialis (P < .05), deltoid (P < .01), and trapezius (P < .001) among the non-chronic and chronic groups, but not in the tibialis anterior muscle (P > .05). Although both control and JPST interventions effectively improved the disabilities of the arm, shoulder, and hand questionnaire score, pain intensity, and PPT values in the upper limb, the outcomes in the JPST group were significantly different from those in the control group. CONCLUSIONS Generalized hyperalgesia changes limited to the upper limbs were observed in patients with chronic shoulder pain. JPST has beneficial effects on pain control and functional dysfunction in patients with chronic shoulder pain.
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Affiliation(s)
- Xin Chen
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Lisi Cha
- Department of Rehabilitation Therapy, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Zhi Xuan
- Department of Rehabilitation Therapy, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Weiming Zhang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University Medical School, Shanghai, China
- Department of Rehabilitation Therapy, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
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16
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Alghamdi AA, Alfaqih MH, Alfaqih EH, Alamri MA, Alfaqih LH, Mufti HH, Almadani MS. The Prevalence of Shoulder Pain and Awareness of Frozen Shoulder Among the General Population in Taif City, Saudi Arabia. Cureus 2024; 16:e58229. [PMID: 38745787 PMCID: PMC11092289 DOI: 10.7759/cureus.58229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Background The global prevalence of shoulder pain varies widely across countries. Additionally, shoulder pain and frozen shoulder can significantly affect patients' quality of life due to high levels of pain and disability. Objective This study aimed to investigate the prevalence of shoulder pain and its risk factors. It also aims to assess the level of knowledge regarding frozen shoulders and its related factors in Taif City, Saudi Arabia. Methods A cross-sectional observational study was conducted in Taif City in December 2023 using a validated questionnaire comprised of socio-demographic characteristics, the prevalence of shoulder pain, and the awareness of frozen shoulders. Results A total of 378 participants enrolled in the study, with 54.8% being male and 62.7% being graduates and having jobs equally distributed among office (24.9%) and in the field (24.9%). Most participants were smokers (75.9%) and did not engage in body-building activities (79.6%). Around 26.5% of them had diabetes. The prevalence of shoulder pain was 32.8%. Aging from 35 to 44 years (p<0.001), having a higher salary from 6000 to 10000 SAR (p<0.001), retirement (p<0.001), engaging in body-building activities (p=0.035), having diabetes (p<0.001), and having other comorbidities (p<0.001) are significantly impacted having shoulder pain. Increased knowledge about the frozen shoulder is correlated with aging from 25-34 (p=0.026), smoking (p=0.002), engaging in bodybuilding (p<0.001), having diabetes (p=0.010), and having other medical conditions (p=0.010). Conclusion The study has shown that shoulder pain is prevalent among Taif City's population. Nevertheless, a low level of knowledge was observed. Therefore, enhancing the national educational programs is needed to increase public awareness of frozen shoulders.
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Affiliation(s)
| | | | - Eyad H Alfaqih
- General Practice, King Abdulaziz Specialist Hospital, Jeddah, SAU
| | | | | | - Hussein H Mufti
- Orthopaedics, King Abdulaziz Specialist Hospital, Jeddah, SAU
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17
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Tauqeer S, Arooj A, Shakeel H. Effects of manual therapy in addition to stretching and strengthening exercises to improve scapular range of motion, functional capacity and pain in patients with shoulder impingement syndrome: a randomized controlled trial. BMC Musculoskelet Disord 2024; 25:192. [PMID: 38431547 PMCID: PMC10908164 DOI: 10.1186/s12891-024-07294-4] [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: 08/17/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The current study aimed to measure the effectiveness of manual therapy in addition to stretching and strengthening exercises in patients with shoulder impingement syndrome to improve functional capacity, pain, and scapular range of motion. METHODS This is a single-blinded randomized controlled trial. Thirty-two participants with chronic shoulder impingement syndrome were randomly allocated into two groups. Both groups received stretching and strengthening exercises while the treatment group was given manual therapy additionally. Treatment was started after the patients signed an informed consent form. The data were collected from the University of Lahore Teaching Hospital between March 2022 and December 2022. The study aimed to measure pain using a numeric pain rating scale, functional capacity was assessed by the disability of the arm and shoulder, and goniometry was used for scapular ranges, i.e., scapular protraction and upward rotation. Each treatment session lasted 45 min for the treatment group and 30 min for the control group. The treatment comprised five days a week for four weeks, after which post-intervention measurements were taken. RESULTS Thirty-two participants were enrolled in the study, and 16 were divided into each group. The mean age of the participants in the treatment group was 38.19 ± 7.31 while the comparison group was 35.69 ± 7.98. An independent sample t-test was run on the data with a 95% confidence interval, statistically significant results were obtained, i.e., p-value < 0.05, post-intervention in the treatment group. Both groups have significantly improved functional capacity and scapular protraction (p < 0.005), however, pain and scapular upward rotation were not found statistically significant in the control group (p > 0.05). CONCLUSION The addition of manual therapy along with exercise therapy showed clinical and statistical significant results for pain, functional capacity, and scapular range of motion. It demonstrated superior effects than exercise therapy alone for the chronic condition of SIS. TRIAL REGISTRATION The trial was registered in the Iranian Registry of Clinical Trials ( https://www.irct.ir/ ) with the registration number: IRCT20230526058291N1, (Date: 12/08/2023).
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Affiliation(s)
- Sana Tauqeer
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Ayesha Arooj
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan.
| | - Hammad Shakeel
- University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
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18
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Kjær BH, Cools AM, Johannsen FE, Trøstrup J, Bieler T, Siersma V, Magnusson PS. To allow or avoid pain during shoulder rehabilitation exercises for patients with chronic rotator cuff tendinopathy-Study protocol for a randomized controlled trial (the PASE trial). Trials 2024; 25:135. [PMID: 38383459 PMCID: PMC10880378 DOI: 10.1186/s13063-024-07973-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Rotator cuff (RC) tendinopathy is the most reported shoulder disorder in the general population with highest prevalence in overhead athletes and adult working-age population. A growing body of evidence support exercise therapy as an effective intervention, but to date there are no prospective randomized controlled trials addressing pain as an intervention variable. METHODS A single-site, prospective, pragmatic, assessor-blinded randomized controlled superiority trial. Eighty-four patients aged 18-55 years with chronic (symptom duration over 3 months) RC tendinopathy are randomized 1:1 to receive shoulder exercise during which pain is either allowed or avoided. The intervention period lasts 26 weeks. During that period, participants in both groups are offered 8 individual on-site sessions with an assigned sports physiotherapist. Participants perform home exercises and are provided with a pain and exercise logbook and asked to report completed home-based exercise sessions and reasons for not completing sessions (pain or other reasons). Patients are also asked to report load and the number of sets and repetitions per sets for each exercise session. The logbooks are collected continuously throughout the intervention period. The primary and secondary outcomes are obtained at baseline, 6 weeks, 26 weeks, and 1 year after baseline. The primary outcome is patient-reported pain and disability using the Shoulder PAin and Disability Index (SPADI). Secondary outcomes are patient-reported pain and disability using Disability Arm Shoulder and Hand short-form (Quick DASH), and shoulder pain using Numeric Pain Rating Scale. Objective outcomes are shoulder range of motion, isometric shoulder muscle strength, pain sensitivity, working ability, and structural changes in the supraspinatus tendon and muscle using ultrasound. DISCUSSION The results of this study will contribute knowledge about the treatment strategies for patients with RC tendinopathy and help physiotherapists in clinical decision-making. This is the first randomized controlled trial comparing the effects of allowing pain versus avoiding pain during shoulder exercises in patients with chronic RC tendinopathy. If tolerating pain during and after exercise proves to be effective, it will potentially expand our understanding of "exercising into pain" for this patient group, as there is currently no consensus. TRIAL REGISTRATION ClinicalTrials.gov NCT05124769. Registered on August 11, 2021.
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Affiliation(s)
- Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - Ann M Cools
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, B3, Entrance 46, 9000, Gent, Belgium
| | - Finn E Johannsen
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Jeanette Trøstrup
- The Danish Clinical Quality Program-National Clinical Registries (RKKP), Regionshuset Aarhus, Hedeager 3, 8200 Aarhus N, Aarhus, Denmark
| | - Theresa Bieler
- Department of Physical and Occupational Therapy, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Volkert Siersma
- Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Oster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - Peter S Magnusson
- Department of Physical and Occupational Therapy, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery, University Hospital Bispebjerg Frederiksberg (BFH), Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
- Department of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Lowry V, Lavigne P, Zidarov D, Matifat E, Cormier AA, Desmeules F. A Systematic Review of Clinical Practice Guidelines on the Diagnosis and Management of Various Shoulder Disorders. Arch Phys Med Rehabil 2024; 105:411-426. [PMID: 37832814 DOI: 10.1016/j.apmr.2023.09.022] [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: 02/02/2023] [Revised: 07/20/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To perform a systematic review of clinical practice guidelines (CPGs) covering the management of common shoulder disorders. DATA SOURCES A systematic search of CPGs on specific shoulder disorders was conducted up to August 2022 in relevant databases. STUDY SELECTION Twenty-six CPGs on rotator cuff (RC) tendinopathy, RC tear, calcific tendinitis, adhesive capsulitis, glenohumeral (GH) instability, GH osteoarthritis, or acromioclavicular disorders published from January 2008 onward were screened and included. DATA EXTRACTION CPGs methodological quality was assessed with the AGREE II checklist. All recommendations from CPGs were extracted and categorized by shoulder disorder and care components (evaluation, diagnostic imaging, medical, rehabilitation, and surgical treatments). After semantic analysis of the terminology, recommendations for each shoulder disorders were classified by 2 reviewers into "recommended," "may be recommended," or "not recommended." Disagreements were resolved by discussion until reviewers reached consensus. DATA SYNTHESIS Only 12 CPGs (46%) were of high quality with major limitations related to the applicability and editorial independence of the guidelines. The initial evaluation of shoulder pain should include patient's history, subjective evaluation focused on red flags, and clinical examination. Magnetic resonance imaging is usually not recommended to manage early shoulder pain, and recommendations for X-rays are conflicting. Acetaminophen, oral non-steroidal anti-inflammatory drugs, and rehabilitation including exercises were recommended or may be recommended to treat all shoulder pain disorders. Guidelines on surgical management recommendations differed; for example, 6 CPGs reported that acromioplasty was recommended or may be recommended in chronic RC tendinopathy, whereas 4 CPGs did not recommend it. CONCLUSIONS Recommendations vary for diagnostic imaging, conservative vs surgical treatment to manage shoulder pain, although several care components are consensual. The development of evidence-based, rigorous CPGs with a valid methodology and transparent reporting is warranted to improve overall shoulder pain care.
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Affiliation(s)
- Véronique Lowry
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada.
| | - Patrick Lavigne
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada; Surgery Department, Medicine Faculty, University of Montreal, Montreal, Canada
| | - Diana Zidarov
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Interdisciplinary Rehabilitation Montreal Research Center (CRIR), Montreal, Canada; Montreal University Institute for Physical Impairment Rehabilitation (IURDPM), Montreal, Canada
| | - Eveline Matifat
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada
| | | | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada
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20
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Flowers DW, Swanson BT, Shaffer SM, Clewley DJ, Riley SP. Is there 'trustworthy' evidence for using manual therapy to treat patients with shoulder dysfunction?: A systematic review. PLoS One 2024; 19:e0297234. [PMID: 38236928 PMCID: PMC10796022 DOI: 10.1371/journal.pone.0297234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/01/2024] [Indexed: 01/22/2024] Open
Abstract
The primary objective of this review was to create a 'trustworthy,' living systematic review and meta-analysis for the application of manual therapy interventions in treating patients with shoulder dysfunction. Included studies were English-language randomized controlled trials published between 1/1/2010 and 8/3/2023, with searches performed in: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), CINHAL, ProQuest Nursing & Allied Health, EBSCO Medline, and PEDro. The population of focus included adults 18 years and older with musculoskeletal impairments related to shoulder dysfunction. Our primary outcomes included pain and region-specific outcome measures. We excluded trials, including participants having shoulder dysfunction resulting from surgery, radicular pain, instability/dislocation, fracture, lymphedema, and radiation. Our screening methodology was based upon a previously published 'trustworthy' systematic review protocol. This included the application of our PICOTS criteria in addition to screening for prospective clinical trial registration and following of prospective intent, as well as assessment of PEDro scores, risk-of-bias ratings, GRADE scoring, and examination of confidence in estimated effects. Twenty-six randomized controlled trials met our PICOTS criteria; however, only 15 of these were registered. Only three were registered prospectively. Two of these did not have discussions and conclusions that aligned with their primary outcome. The remaining single study was found to have a high risk-of-bias, meaning the remainder of the protocol could not be employed and that no randomized controlled trials could undergo further assessment or meta-analysis. The results of this systematic review indicate there are no 'trustworthy' randomized controlled trials examining the effectiveness of manual therapy interventions for the treatment of patients with shoulder dysfunction, as defined by the prospectively established methodology. Therefore, these findings signal that creating a 'trustworthy,' living systematic review on this clinically relevant topic is not yet possible due to a lack of 'trustworthy' randomized controlled trials.
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Affiliation(s)
- Daniel W. Flowers
- Doctor of Physical Therapy Program, Louisiana State University Health Sciences Center at Shreveport, Shreveport, Louisiana, United States of America
| | - Brian T. Swanson
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut, United States of America
| | - Stephen M. Shaffer
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut, United States of America
| | - Derek J. Clewley
- Doctor of Physical Therapy Division, School of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Center for Excellence in Manual and Manipulative Therapy, Duke University, Durham, North Carolina, United States of America
| | - Sean P. Riley
- Hartford Healthcare Rehabilitation Network, Glastonbury, Connecticut, United States of America
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Beltrán SP, Batista GDA, Dos Passos MHP, da Silva HA, Locks F, Cappato de Araújo R. Effects of a workplace-based exercise program on shoulder pain and function in fruit workers: A randomized controlled trial. Work 2024; 77:1143-1151. [PMID: 38007632 DOI: 10.3233/wor-230085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Shoulder pain affects millions of workers worldwide and is considered one of the leading causes of absenteeism and presenteeism. Therefore, using exercises in the work environment emerges as a strategy to prevent or reduce shoulder pain. OBJECTIVE The objective of this study was to evaluate the effects of a workplace-based exercise program on shoulder pain and function in fruit workers. METHODS This was an 8-week parallel two-arm randomized controlled trial. Forty-four fruit workers who reported chronic shoulder pain were randomized to an Experimental Group (EG) or Control Group (CG). The EG was submitted to a program of resistance and stretching exercises for eight weeks, twice a week. The CG received a booklet with muscle stretching and mobility exercises. The primary outcome was shoulder pain intensity; the secondary outcomes were Shoulder Pain and Disability Index (SPADI) and perceived global effect. RESULTS Both groups showed reductions in pain intensity EG: 4.26 (95% CI 2.78-5.74) and CG: 3.74 (95% CI 1.98-5.50) points. The SPADI results showed an average reduction of 17.76 (CI 95% 3.10-32.43) for the EG and 18.39 (CI 95% 3.66-33.13) for the CG. The mean value of the perceived global effect for the CG was 3.45±2.01, and for the EG, the mean was 4.13±1.24. No differences were observed between groups in any outcome analyzed. CONCLUSION Both groups showed significant changes in the analyzed outcomes. However, the workplace-based exercise program was not superior to the exercise booklet.
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Affiliation(s)
- Sol Patricia Beltrán
- Universidad Santiago de Cali, Cali, Columbia
- Associated Graduate Program in Physical Education UPE/UFPB, University of Pernambuco, Recife, Brazil
| | - Gabriel de Amorim Batista
- Associated Graduate Program in Physical Education UPE/UFPB, University of Pernambuco, Recife, Brazil
| | | | - Hitalo Andrade da Silva
- Associated Graduate Program in Physical Education UPE/UFPB, University of Pernambuco, Recife, Brazil
| | - Francisco Locks
- Department of Physical Therapy, University of Pernambuco, Petrolina, Brazil
- Graduate Program in Rehabilitation and Functional Performance (PPGRDF), University of Pernambuco, Petrolina, Brazil
| | - Rodrigo Cappato de Araújo
- Associated Graduate Program in Physical Education UPE/UFPB, University of Pernambuco, Recife, Brazil
- Department of Physical Therapy, University of Pernambuco, Petrolina, Brazil
- Graduate Program in Rehabilitation and Functional Performance (PPGRDF), University of Pernambuco, Petrolina, Brazil
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22
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Testa EJ, Katz L, Zhang H, Chang K, Kutschke MJ, Dworkin M, Owens BD. Rotator Cuff Tears to Shoulder Instability: The Relationship Between Acromial Morphology and Shoulder Pathology. JBJS Rev 2024; 12:01874474-202401000-00004. [PMID: 38181125 DOI: 10.2106/jbjs.rvw.23.00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
» The acromion is a well-studied region of the scapula that has demonstrated substantial relationships to various shoulder pathologies.» Abnormal acromial morphology is associated with rotator cuff pathology, and our understanding of this risk factor inspired acromioplasty as an adjunctive treatment for rotator cuff tears.» The acromion is linked closely to shoulder kinematics and biomechanics, as it serves as the origin for the deltoid muscle.» In degenerative shoulder disease, eccentric glenohumeral osteoarthritis has been associated with a higher, flatter acromial roof.» Increasing literature is emerging connecting morphology of the acromion with shoulder instability.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Luca Katz
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Helen Zhang
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Kenny Chang
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Michael J Kutschke
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Myles Dworkin
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
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23
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Pavlou K, Savva C, Korakakis V, Pamboris GM, Karagiannis C, Ploutarchou G, Constantinou A. Blood Flow Restriction Training in Nonspecific Shoulder Pain: Study Protocol of a Crossover Randomised Controlled Trial. Sports (Basel) 2023; 11:197. [PMID: 37888524 PMCID: PMC10610701 DOI: 10.3390/sports11100197] [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: 09/02/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
"Nonspecific shoulder pain" encompasses various non-traumatic musculoskeletal shoulder disorders, diverging from diagnostic terminologies that refer to precise tissue-oriented clinical diagnosis. Blood flow restriction (BFR) training, involving partial arterial inflow and complete venous outflow restriction, has exhibited acute hypoalgesic effects primarily in healthy populations by increasing their pain thresholds. This study aims to examine whether a single BFR session with low-load exercises can alleviate pain perception among nonspecific shoulder pain patients. Conducted as a single-blind crossover randomised clinical trial, 48 adults (age range: 18 to 40) presenting with nonspecific shoulder pain will partake in two trial sessions. Random assignment will place participants into BFR or sham BFR groups and ask them to perform one exercise with BFR. Subsequently, participants will complete a shoulder girdle loading regimen comprising six exercises. The second session will involve participants switching treatment groups. Pain pressure thresholds (PPTs), shoulder pain and disability via the shoulder pain and disability index (SPADI), maximal voluntary isometric contraction (MVIC) of shoulder external rotators, pain during active abduction, and peak pain during shoulder external rotation will be evaluated using the numeric pain rating scale (NPRS). Immediate post-exercise assessments will include patient-perceived pain changes using the global rating of change scale (GROC) and participant-rated perceived exertion (RPE), employing a modified Borg's scale (Borg CR10) post-BFR or sham BFR exercise session. Each session will encompass three assessment periods, and a combination of mixed-effect models and descriptive statistics will underpin the analysis. This protocol was approved by Cyprus National Bioethics Committee (ΕΕΒΚ/2023/48), and was registered in ClinicalTrials.gov (Registration number: NCT05956288). Conclusion: The anticipated outcomes of this study illuminated the acute effects of BFR training on pain perception within the context of nonspecific shoulder pain, potentially advancing strategies for managing pain intensity using BFR techniques.
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Affiliation(s)
- Kyriakos Pavlou
- Department of Health Sciences, European University Cyprus, 1516 Nicosia, Cyprus; (G.M.P.); (C.K.); (G.P.); (A.C.)
| | - Christos Savva
- Department of Health Sciences, Frederick University, 3080 Limassol, Cyprus;
| | | | - George M. Pamboris
- Department of Health Sciences, European University Cyprus, 1516 Nicosia, Cyprus; (G.M.P.); (C.K.); (G.P.); (A.C.)
| | - Christos Karagiannis
- Department of Health Sciences, European University Cyprus, 1516 Nicosia, Cyprus; (G.M.P.); (C.K.); (G.P.); (A.C.)
| | - George Ploutarchou
- Department of Health Sciences, European University Cyprus, 1516 Nicosia, Cyprus; (G.M.P.); (C.K.); (G.P.); (A.C.)
| | - Antonis Constantinou
- Department of Health Sciences, European University Cyprus, 1516 Nicosia, Cyprus; (G.M.P.); (C.K.); (G.P.); (A.C.)
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Lowry V, Desmeules F, Zidarov D, Lavigne P, Roy JS, Cormier AA, Tousignant-Laflamme Y, Perreault K, Lefèbvre MC, Décary S, Hudon A. "I wanted to know what was hurting so much": a qualitative study exploring patients' expectations and experiences with primary care management. BMC Musculoskelet Disord 2023; 24:755. [PMID: 37749557 PMCID: PMC10521438 DOI: 10.1186/s12891-023-06885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The management of shoulder pain is challenging for primary care clinicians considering that 40% of affected individuals remain symptomatic one year after initial consultation. Developing tailored knowledge mobilization interventions founded on evidence-based recommendations while also considering patients' expectations could improve primary care for shoulder pain. The aim of this qualitative study is to explore patients' expectations and experiences of their primary care consultation for shoulder pain. METHODS In this qualitative study, participants with shoulder pain and having consulted a primary care clinician in the past year were interviewed. All the semi-structured interviews were transcribed verbatim, and inductive thematic analysis was performed to identify themes related to the participants' expectations and experiences of primary care consultations for shoulder pain. RESULTS Thirteen participants with shoulder pain were interviewed (8 women, 5 men; mean age 50 ± 12 years). Eleven of them initially consulted a family physician or an emergency physician, and two participants initially consulted a physiotherapist. Four overarching themes related to patients' expectations and experiences were identified from our thematic analysis: 1) I can't sleep because of my shoulder; 2) I need to know what is happening with my shoulder; 3) But… we need to really see what is going on to help me!; and 4) Please take some time with me so I can understand what to do!. Several participants waited until they experienced a high level of shoulder pain before making an appointment since they were not confident about what their family physician could do to manage their condition. Although some participants felt that their physician took the time to listen to their concerns, many were dissatisfied with the limited assessment and education provided by the clinician. CONCLUSIONS Implementing evidence-based recommendations while considering patients' expectations is important as it may improve patients' satisfaction with healthcare. Several participants reported that their expectations were not met, especially when it came to the explanations provided. One unexpected finding that emerged from this study was the waiting period between the onset of shoulder pain and when patients decided to consult their primary care clinician.
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Affiliation(s)
- Véronique Lowry
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4.
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada.
| | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
| | - Diana Zidarov
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada
- Institut Universitaire Sur La Réadaptation en Déficience Physique de Montréal (IURDPM), Montréal, Québec, Canada
| | - Patrick Lavigne
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
- Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation Et Intégration Sociale (Cirris), Quebec City, QC, Canada
| | - Audrey-Anne Cormier
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Medicine Faculty, University of Sherbrooke, Sherbrooke, Canada
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation Et Intégration Sociale (Cirris), Quebec City, QC, Canada
| | - Marie-Claude Lefèbvre
- Groupe de Médecine Familiale Universitaire (GMF-U) Maisonneuve-Rosemont, Montréal, Canada
| | - Simon Décary
- School of Rehabilitation, Medicine Faculty, University of Sherbrooke, Sherbrooke, Canada
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Anne Hudon
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada
- Centre de Recherche en Éthique (CRÉ), Montréal, QC, Canada
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25
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Koumantakis GA, Sifakis E, Stathis P, Gigourtakis S, Tatsios PI, Paraskevopoulos E, Moutzouri M, Vrouva S. Cross-Cultural Adaptation, Reliability, and Validity of the Greek Version of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ-GR) in Patients with Chronic Shoulder Pain. Healthcare (Basel) 2023; 11:2512. [PMID: 37761710 PMCID: PMC10531340 DOI: 10.3390/healthcare11182512] [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: 07/25/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Shoulder pain is one of the most common musculoskeletal pathologies. The association of shoulder pain with impaired proprioception and bodily self-awareness called for the cross-cultural adaptation of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ) in Greek. The FreSHAQ is a relatively new self-assessment 9-item scale for impaired somatic awareness in patients with shoulder pain. The study included 100 participants (54 women) between 20 and 80 years old, with chronic shoulder pain (>3 months duration), able to comprehend and speak Greek, and recruited from three private physical therapy practices. The cross-cultural adaptation process was followed to develop the Greek version of the questionnaire (FreSHAQ-GR). Further testing for construct validity via exploratory factor analysis and correlational analysis with the Shoulder Pain and Disability Index (SPADI), the Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH), the pain catastrophizing scale (PCS), a pain intensity visual analog scale (PI-VAS) in the last week, and the demographic characteristics followed. Test-retest reliability of the FreSHAQ-GR in a sub-sample of patients (n = 25) was tested upon repeated completion of the scale after a week and examined with the intraclass correlation coefficient (ICC2,1), the standard error of the measurement (SEM), and the minimum detectable change (MDC) indices. The internal consistency of the scale was also assessed. The factor analysis revealed that the scale comprised one factor relevant to shoulder awareness but with fewer items (first 6 items) than the original FreSHAQ. Additionally, the FreSHAQ-GR (both versions) demonstrated statistically significant correlations (Spearman's r) with participants' age (r = -0.31/-0.29, p < 0.002), the PI-VAS (r = 0.54/0.52, p < 0.001), the SPADI total score and both of its subscales (r = 0.39-0.45/0.34-0.39, p < 0.001), the QuickDASH (r = 0.37/0.34, p < 0.001), and the PCS (r = 0.50/0.40, p < 0.001). The questionnaire's internal consistency (Cronbach's α/McDonald's ω) was 0.833/0.827 for the 9-item and 0.871/0.867 for the 6-item FreSHAQ-GR. Test-retest reliability was excellent for both versions of the FreSHAQ-GR (ICC2,1(95% CI) = 0.97/0.98 (0.91-0.99/0.94-0.99), and with a low error margin (SEM = 1.31/0.94 and MDC95% = 3.63/2.61). Therefore, the FreSHAQ-GR (6-item version) possesses very good measurement properties and can be administered to Greek-speaking patients with chronic shoulder pain.
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Affiliation(s)
- George A. Koumantakis
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | - Emmanouil Sifakis
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | - Panagiotis Stathis
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | | | - Petros I. Tatsios
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | - Eleftherios Paraskevopoulos
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | - Maria Moutzouri
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | - Sotiria Vrouva
- Department of Physical Therapy, 401 Army General Hospital of Athens, 11525 Athens, Greece;
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Aldaihan MM, Alnahdi AH. Responsiveness of the Arabic Quick Disabilities of the Arm, Shoulder and Hand in Patients with Upper Extremity Musculoskeletal Disorders. Healthcare (Basel) 2023; 11:2507. [PMID: 37761704 PMCID: PMC10530924 DOI: 10.3390/healthcare11182507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
This study aimed to examine the responsiveness of the Arabic Disabilities of the Arm, Shoulder and Hand short version (Quick-DASH) in patients with upper extremity musculoskeletal disorders. Participants with upper extremity musculoskeletal disorders (N = 88) under physical therapy care were assessed at initial visit and later at a follow-up visit, and they completed the Arabic Quick-DASH, DASH, Numeric Pain Rating Scale (NPRS), Global Assessment of Function (GAF), and the Global Rating of Change Scale (GRC). Responsiveness of the Arabic Quick-DASH was assessed by examining six pre-defined hypotheses. Consistent with the pre-defined hypotheses, the Arabic Quick-DASH changes scores exhibited significant positive correlation with the change in DASH (r = 0.98), GAF (r = 0.67), NPRS (r = 0.72), and the GRC (r = 0.78). As hypothesized, the Arabic Quick-DASH showed a large effect size above the pre-determined level (ES = 1.61, SRM = 1.49) in patients who reported improved upper extremity function. The Arabic Quick-DASH change score discriminated between patients who reported improvement versus no improvement in upper extremity function (area under the receiver operating characteristic curve = 0.90). The results supported 100% (six out of six) of the pre-defined hypotheses. The Arabic Quick-DASH demonstrated sufficient responsiveness where all the pre-defined hypotheses were supported, leading to the established validity of the Arabic Quick-DASH change score as a measure of change in upper extremity function and symptoms. The minimal importance change in the Arabic Quick-DASH needs to be determined in future studies.
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Affiliation(s)
| | - Ali H. Alnahdi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
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27
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Pichené-Houard A, Sirveaux F, Clerc-Urmès I, Paris N, Michel B, Jacquot A, Martinet N, Claudon L, Paysant J, Wild P. Predictive factors of return-to-work trajectory after work-related rotator cuff syndrome: A prospective study of 96 workers. Am J Ind Med 2023; 66:759-774. [PMID: 37460254 DOI: 10.1002/ajim.23511] [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: 02/09/2023] [Revised: 05/10/2023] [Accepted: 06/07/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Sustained return to work after surgery for work-related rotator cuff syndrome (WRRCS) remains quite difficult. The main purpose of the present study was to identify predictive factors of a return-to-work (RTW) trajectory. METHODS A total of 96 workers with WRRCS were identified by 4 surgeons. They were followed prospectively before and after the surgery, until 1 year after RTW, or for 20 months after surgery when they did not. Participants completed a series of standardized questionnaires related to working conditions, health, and beliefs, and performed functional tests at the inclusion time. During the follow-up period, they were regularly asked about their working conditions (present or not at work), activity (normal or lightened physical duties) and schedules (full- or part-time job). Statistical analysis was based on single- and multiple-factor models of prediction of the workers' trajectory. RESULTS Three trajectories of RTW were distinguished, considering RTW and absenteeism that occurred during the follow-up: stable, unstable, and non-RTW. The median age of the sample was 49.5 [45.0-54.0], with 67.7% of workers employed in highly physically demanding jobs. In the multiple factor model, three factors were highly predictive of the trajectory: perceived health before surgery, having had a repaired ruptured-rotator-cuff tendinopathy, and the level of physical demand of the job. CONCLUSION Three easy-to-collect predictive factors of RTW trajectory have been identified. They may be useful for healthcare professionals and care givers to identify vulnerable workers' risk of occupational dropout after arthroscopic surgery for rotator cuff tendinopathy.
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Affiliation(s)
- Anne Pichené-Houard
- Département Homme au Travail, Institut National de Recherche et de Sécurité (INRS), Vandoeuvre-lès-Nancy Cedex, France
| | - François Sirveaux
- Pôle lorrain de chirurgie de l'appareil locomoteur, Centre Chirurgical Emile Gallé, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Isabelle Clerc-Urmès
- Département Homme au Travail, Institut National de Recherche et de Sécurité (INRS), Vandoeuvre-lès-Nancy Cedex, France
| | | | - Blaise Michel
- Clinique Louis Pasteur, service de chirurgie orthopédique, Essey-lès- Nancy, France
| | - Adrien Jacquot
- Clinique Louis Pasteur, service de chirurgie orthopédique, Essey-lès- Nancy, France
| | - Noël Martinet
- Institut Régional de Médecine Physique et de Réadaptation de Nancy, Centre Louis Pierquin, UGECAM du Nord-Est, Nancy, France
| | - Laurent Claudon
- Département Homme au Travail, Institut National de Recherche et de Sécurité (INRS), Vandoeuvre-lès-Nancy Cedex, France
| | - Jean Paysant
- Institut Régional de Médecine Physique et de Réadaptation de Nancy, Centre Louis Pierquin, UGECAM du Nord-Est, Nancy, France
| | - Pascal Wild
- Département Homme au Travail, Institut National de Recherche et de Sécurité (INRS), Vandoeuvre-lès-Nancy Cedex, France
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28
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Pak SS, Janela D, Freitas N, Costa F, Moulder R, Molinos M, Areias AC, Bento V, Cohen SP, Yanamadala V, Souza RB, Correia FD. Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial. J Med Internet Res 2023; 25:e49236. [PMID: 37490337 PMCID: PMC10474513 DOI: 10.2196/49236] [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: 05/22/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Chronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP. OBJECTIVE The aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP. METHODS We conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. RESULTS A total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (-1.8, 95% CI -13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events. CONCLUSIONS This study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528.
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Affiliation(s)
- Sang S Pak
- Department of Physical Therapy and Rehabilitation, University of California San Francisco, San Francisco, CA, United States
| | | | - Nina Freitas
- Department of Physical Therapy and Rehabilitation, University of California San Francisco, San Francisco, CA, United States
| | | | - Robert Moulder
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | | | | | | | - Steven P Cohen
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | | | - Richard B Souza
- Department of Physical Therapy and Rehabilitation, University of California San Francisco, San Francisco, CA, United States
| | - Fernando Dias Correia
- Sword Health Inc, Draper, UT, United States
- Department of Neurology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Nasr AJ, Pierson CJ, Tzen YT, Khazzam M, Jain NB, Lin YS. Emerging Role of Quantitative Ultrasound-Based Imaging Techniques for Characterizing Rotator Cuff Tears: A Scoping Review. Diagnostics (Basel) 2023; 13:2011. [PMID: 37370906 DOI: 10.3390/diagnostics13122011] [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: 05/11/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Rotator cuff myosteatosis following cuff tears is very common and one of the most important prognostic factors in clinical management. Quantitative ultrasound-based imaging techniques (QUBIT) are frequently used along with magnetic resonance imaging (MRI) to evaluate rotator cuff fatty degeneration. However, the examination of rotator cuff tissue integrity by QUBIT is lacking a standardized imaging protocol and procedural methodologies. In this scoping review, we synthesized the current state of QUBIT against the reference imaging modalities in patients with rotator cuff tears. The literature search was extracted from 963 studies, with 22 studies included in the final review in accordance with the preferred reporting items for systematic reviews and meta-analyses extensions for scoping reviews. The selected studies included human participants and focused on measuring at least one prognostic or diagnostic factor using ultrasonography-based imaging with reference to MRI. The findings suggest both conventional B-mode ultrasound and shear wave elastography imaging were comparable to MRI-based imaging techniques for the evaluation of fatty infiltration and rotator cuff tear characterization. This review establishes guidelines for reporting shoulder-specific QUBIT aimed at developing a standardized imaging protocol. The objective was to enhance the diagnostic and prognostic capabilities of QUBIT in the clinical setting.
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Affiliation(s)
- Andrew J Nasr
- Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Chris J Pierson
- Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Yi-Ting Tzen
- Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Michael Khazzam
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Nitin B Jain
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Yen-Sheng Lin
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
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Alnahdi AH. Responsiveness of the Arabic Upper Extremity Functional Index in Patients with Upper Extremity Musculoskeletal Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4370. [PMID: 36901380 PMCID: PMC10001837 DOI: 10.3390/ijerph20054370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to examine the ability of the Arabic Upper Extremity Functional Index (UEFI) to detect change over time in upper extremity function (responsiveness) in patients with upper extremity musculoskeletal disorders. Patients receiving physical therapy care for their upper extremity musculoskeletal disorders completed the Arabic UEFI; Disabilities of the Arm, Shoulder and Hand (DASH); Numeric Pain Rating Scale (NPRS); Global Assessment of Function (GAF); and the Global Rating of Change Scale (GRC) at the initial visit and later at a follow-up assessment. Responsiveness was examined by testing predefined hypotheses regarding the correlations between the change scores in the Arabic UEFI and the other measures. The Arabic UEFI change scores demonstrated a significant positive correlation with the change in the DASH (r = 0.94), GAF (r = 0.65), NPRS (r = 0.63), and GRC (r = 0.73), which was in line with the predefined hypotheses. The Arabic UEFI change scores demonstrated a pattern of correlation with changes in other outcome measures that are consistent with the argument that the Arabic UEFI change scores represent a change in upper extremity function. The responsiveness of the Arabic UEFI was supported, and its use to monitor changes in upper extremity function in patients with upper extremity musculoskeletal disorders was supported.
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Affiliation(s)
- Ali H Alnahdi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
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Reliability of coracohumeral distance and subcoracoid tendons in subacromial pain syndrome. Sci Rep 2023; 13:2383. [PMID: 36765167 PMCID: PMC9918475 DOI: 10.1038/s41598-023-29601-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
This study investigated the intra-rater reliability of a novice ultrasound (US) examiner and the inter-rater reliability of two examiners (novice, expert) in the measures of coracohumeral distance at rest (CHD) and at 60° of elevation without (CHD60) or with weights (CHD60w), tendon thickness of the long head of the biceps (LHB) and subscapularis (SCP). Twenty-one patients with subacromial pain syndrome (SAPS) and 20 asymptomatic participants were included. Intra and inter-rater reliability were tested with intraclass-correlation-coefficient (ICC), differences between raters were analyzed with Bland-Altman plots. Intra-rater reliability for CHD, CHD60 and CHD60w was excellent (ICC = 0.97-0.98) in asymptomatic participants, and good-to-excellent (0.88-0.93) in SAPS, while intra-rater reliability for LHB and SCP was good-to-excellent in asymptomatic participants (0.88-0.97) and in SAPS (0.90-0.92). Inter-rater reliability for CHD, CHD60 and CHD60w was moderate-to-good (0.70-0.90) in asymptomatic participants and good (0.85-0.87) in SAPS, in contrast inter-rater reliability for LHB and SCP was poor in asymptomatic participants (0.10-0.46) and poor-to-moderate (0.49-0.61) in SAPS. Bland-Altman plots revealed systematic and/or proportional bias for tendons' thickness. A novice showed good-to-excellent intra-rater reliability in all US measures, whereas in comparison to an expert a novice can measure reliably CHD, CHD60 and CHD60w, but not LHB and SCP, where more training is recommended.
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