Clinimetric testing supports the use of 5 questionnaires adapted into Brazilian Portuguese for patients with shoulder disorders

The Validity and Responsiveness of the Patient-Specific Functional Scale in Patients With First Carpometacarpal Osteoarthritis

PURPOSE

The purpose of this study was to assess the content, construct, and discriminative validity and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with thumb carpometacarpal arthritis.

METHODS

Data were collected at Xpert Clinics, comprising 34 outpatient hand surgery and hand therapy clinics in the Netherlands. We included 267 patients for content validity and 323 patients for construct validity and responsiveness. The PSFS items were classified into the International Classification of Function Core Set for Hand Conditions to assess content validity. We used hypothesis testing to investigate the construct validity and responsiveness. The Michigan Hand Outcomes Questionnaire was used as a comparator instrument. The standardized response mean was calculated to evaluate the magnitude of change. For discriminative validity, we used independent t tests to discriminate between satisfied and dissatisfied patients.

RESULTS

We classified 98% of the PSFS items in the International Classification of Function "activities" and "participation" domains, indicating good content validity. Two of six hypotheses for construct validity and three of six hypotheses for responsiveness were confirmed. The standardized response mean for the PSFS was 0.57 (0.46-0.68) and 0.47 (0.35-0.58) for the Michigan Hand Outcomes Questionnaire total score. The mean PSFS score showed good discriminative validity because it could distinguish between satisfied and dissatisfied patients at the 3-month follow-up.

CONCLUSIONS

The PSFS scores showed good content and discriminative validity in patients with first carpometacarpal arthritis. Hypothesis testing for responsiveness and construct validity indicates that the PSFS measures a unique construct different from the Michigan Hand Outcomes Questionnaire.

CLINICAL RELEVANCE

The PSFS may be a useful scale for measuring the patient-specific status of individuals with thumb carpometacarpal arthritis.

Cross-cultural adaptation and psychometric properties of the Italian version of the Patient-Specific Functional Scale (PSFS) in subjects with shoulder pain

PURPOSE

To cross-culturally adapt the Patient-Specific Functional Scale (PSFS) into Italian and study its classic psychometric properties in subjects with shoulder pain (SP).

MATERIALS AND METHODS

The PSFS was translated into Italian and administered to 109 SP subjects. Acceptability (time to administer, floor and ceiling effects), reliability (internal consistency [Cronbach's alpha], test-retest reliability [Intraclass Correlation Coefficient (ICC)], and measurement error [Standard Error of Measurement (SEM), Minimal Detectable Change, (MDC)]), were assessed. Moreover, construct validity was investigated through a-priori hypothesis testing, comparing the PSFS with the Disability of the Shoulder, Arm and Hand (DASH) scale, 36-item Short Form Health Survey (SF-36) and Numeric Pain Rating scale (NPRS).

RESULTS

The PSFS was successfully adapted into Italian, and its acceptability was satisfied. Internal consistency was high (Cronbach's alpha = 0.925), and test-retest reliability was good (ICC = 0.866, 95% CI = 0.749-0.931). A SEM of 0.7 points and an MDC of 1.9 points were obtained. We observed moderate evidence for construct validity, with 4/6 correlations between other measures being respected.

CONCLUSION

This study provided reliability and validity of the PSFS in a sample of Italian SP subjects. Future studies should assess the responsiveness of using the PSFS as an outcome measure to capture clinical changes after treatment.

Linking patient reported shoulder outcomes to the international classification of functioning, disability and health

PURPOSE

To link the items from shoulder-specific Patient Reported Outcome Measures (PROMs) to the International Classification of Functioning, Disability and Health (ICF) domains and categories, and to determine if the items fit into the ICF framework.

MATERIALS AND METHODS

The Brazilian versions of the Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST) and Western Ontario Rotator Cuff Index (WORC) were linked to the ICF by two researchers independently. Agreement between raters was determined by calculating the Kappa Index.

RESULTS

Fifty-eight items from the PROMs were linked to eight domains and 27 categories of ICF. The PROMs covered components of body functions, activities, and participation. Components of body structure and environmental factors were not covered by any of the PROMs. ​There was substantial agreement between raters when linking the OSS (Kappa index = 0.66), SPADI (Kappa index = 0.92), SST (Kappa index = 0.72) and WORC (Kappa index = 0.71).

CONCLUSIONS

WORC and SST were the PROMs that covered the highest number of ICF domains (seven and six, respectively). However, SST is short and may be less time consuming in a clinical assessment. Clinicians can benefit from this study to decide which shoulder-specific PROM may be more adequate according to the clinical demand.Implications For RehabilitationWestern Ontario Rotator Cuff Index was the shoulder-specific Patient Reported Outcome Measure (PROM) that best showed a broader view of functionality through the International Classification of Functioning, Disability and Health (ICF) domains that can influence shoulder pain and disability.Simple Shoulder Test seems to be the most recommended shoulder-specific PROM considering the number of domains covered by the ICF and the clinical evaluation time consumption.Shoulder Pain and Disability Index fails to provide a broader view of functioning through other ICF domains that may influence shoulder pain and disability.

Cervical sensitivity, range of motion and strength in individuals with shoulder pain: A cross-sectional case control study

OBJECTIVES

To assess whether cervical sensitivity, range of motion (ROM) and strength are impaired in individuals with shoulder pain and how they interact with sociodemographic and clinical data.

METHODS

Forty-eight individuals with shoulder pain and 48 asymptomatic matched ones were included. Pressure pain thresholds (PPTs) in cervical region and tibialis anterior muscles, ROM of cervical flexion, extension, lateral flexions and rotations and cervical muscle strength of flexion, extension and lateral flexions were assessed. Between-groups comparisons and a logistic multiple regression model were performed.

RESULTS

The symptomatic group showed lower and not meaningful PPTs in trapezius of the unaffected/unmatched side, both sternocleidomastoid muscles, and tibialis anterior and reduced ROM in cervical extension (MD = -9.00°) when compared to the asymptomatic group. No differences were identified in muscle strength. Reduced PPT of the trapezius and reduced cervical extension ROM together accounted for 40.2% of the variance of the chance of presenting shoulder pain.

CONCLUSION

Individuals with shoulder pain have more, but not clinically relevant, cervical sensitivity and lower cervical extension than asymptomatic individuals. The lower the PPT of the upper trapezius and the cervical extension ROM, the higher was the chance to present shoulder pain. Regional interdependence between cervical spine and shoulder may explain cervical physical function alterations in shoulder pain.

Scapular movement training is not superior to standardized exercises in the treatment of individuals with chronic shoulder pain and scapular dyskinesis: randomized controlled trial

PURPOSE

To investigate whether scapular movement training (SMT) is superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain.

METHODS AND METHODS

A total of 64 individuals with chronic shoulder pain were randomly assigned to receive 16 sessions of SMT or SE over 8 weeks. Outcome measures included three-dimensional scapular kinematics, muscle activity of scapulothoracic muscles, pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes. Kinematics and muscle activity were assessed at baseline and after treatment, and self-reported measurements at baseline, 4, 8, and 12 weeks.

RESULTS

SMT significantly (p < 0.05) decreased scapular internal rotation during arm elevation and lowering at sagittal and scapular planes (mean difference [MD]: ranged from 2.8 to 4.1°), and at lower angles of arm elevation and lowering at the frontal plane (MD: 3.4° and 2.4°, respectively), increased upper trapezius (UT) activity (MD: 10.3%) and decreased middle trapezius (MT) (MD: 60.4%) and serratus anterior (MD: 9.9%) activity during arm lowering compared to SE. Both groups significantly improved pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes over 4 weeks, which was sustained over the remaining 8 weeks.

CONCLUSIONS

SMT is not superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03528499Implications for rehabilitationScapular movement training (SMT) showed small and likely not clinically relevant changes in scapular kinematics and muscle activity compared to standardized exercises.SMT and standardized exercises presented similar improvements in pain, disability, fear-avoidance beliefs, kinesiophobia, and self-perceived change in health condition immediately following 4-weeks of treatment, which was sustained over the following 8 weeks.The changes in patient-reported outcome measures are unlikely to be associated with changes in scapular kinematics and electromyographic activity.Clinicians should consider other factors than scapular movement during the treatment of patients with shoulder pain.

Measurement Properties' Evaluation of the Arabic Version of the Patient-Specific Functional Scale in Patients with Multiple Sclerosis

Purpose: The aim of this study was to assess the reliability and validity of the Arabic version of the patient-specific functional scale (PSFS-Ar) in patients with multiple sclerosis (MS) disorder. Materials and Methods: Reliability and validity were examined in patients with multiple sclerosis using a longitudinal cohort study design. One hundred (N = 100) patients with MS were recruited to examine the PSFS-Ar, test-retest reliability (using the interclass correlation coefficient model 2,1 (ICC_2,1)), construct validity (using the hypothesis testing method), and floor-ceiling effect. Results: A total of 100 participants completed the PSFS-Ar (34% male, 66% female). The PSFS-Ar showed an excellent test-retest reliability score (ICC_2,1 = 0.87; 95% confidence interval, 0.75-0.93). The SEM of the PSFS-Ar was 0.80, while the MDC₉₅ was 1.87, indicating an acceptable measurement error. The construct validity of the PSFS-Ar was 100% correlated with the predefined hypotheses. As hypothesized, the correlation analysis revealed positive correlations between the PSFS-Ar and the RAND-36 domains of physical functioning (0.5), role limitations due to physical health problems (0.37), energy/fatigue (0.35), and emotional well-being (0.19). There was no floor or ceiling effect in this study. Conclusions: The study results showed that the PSFS-Ar is a self-reported outcome measure that is useful for detecting specific functional difficulties in patients with multiple sclerosis. Patients are able to express and report a variety of functional limitations easily and effectively, as well as to measure their response to physical therapy. The PSFS-Ar is, therefore, recommended for use in Arabic-speaking countries for clinical practice and research for patients with multiple sclerosis.

Cross-cultural adaptation, reliability and validation of the Gillette Functional Assessment Questionnaire (FAQ) into Brazilian Portuguese in patients with cerebral palsy

BACKGROUND

The purpose of this study was to translate, cross-culturally adapt and validate the Gillette Functional Assessment Questionnaire (FAQ) into Brazilian Portuguese.

METHODS

The translation and cross-cultural adaptation was carried out in accordance with international recommendations. The FAQ was applied to a sample of 102 patients diagnosed with cerebral palsy (CP). Construct validity was assessed using Spearman's correlation coefficient (rho), and the FAQ score was correlated with the Functional Mobility Scale (FMS) and Gross Motor Function Classification Scale (GMFCS). A subsample of 50 patients was used to assess reliability using intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable difference (MDD). Ceiling and floor effects were also evaluated.

RESULTS

The Brazilian version of the FAQ showed excellent test-retest reliability by the assessment of the physiotherapist (ICC = 0.99) and respondent (ICC = 0.97), as well as excellent inter-examiner reliability (ICC = 0.94). The SEM was 0.23 (physiotherapist), 0.47 (respondent) and 0.64 (inter-examiner), while the MDD was 0.64 (physiotherapist), 1.29 (respondent) and 1.76 (inter-examiner). The classification of gross motor function showed a high correlation with the FAQ applied by the physiotherapist (rho = -0.89) and by the respondent (rho = -0.87). The FMS-5 m was highly correlated with the FAQ applied by the physiotherapist and the respondent (rho = 0.88 and rho = 0.87, respectively). The FMS-50 and FMS-500 presented very high correlation with the FAQ applied by the physiotherapist (rho = 0.91 for both) and high correlation with the FAQ applied by the respondent (rho = 0.89 and rho = 0.88, respectively). The Brazilian version of the FAQ did not present the ceiling and floor effects.

CONCLUSION

The FAQ presented adequate psychometric properties in patients with CP, indicating that it is possible to use it as a measure of functional gait mobility in Brazil.

Intra- and interrater reliability of belt-stabilized hand-held dynamometer in scapular protraction strength tests in individuals with shoulder pain

PURPOSE

Scapular protraction strength can be evaluated using a hand-held dynamometer (HHD). However, it is necessary to measure the reliability of HHD in individuals with shoulder pain and to minimize the limitations related to the evaluator and the low methodological quality cited in previous studies. This study assessed, with methodological enhancement, the intra- and interrater reliability of belt-stabilized HHD in the assessment of scapular protraction strength in individuals with shoulder pain.

METHOD

Fifty individuals with unilateral symptoms of subacromial pain syndrome (20 men, aged 40.5 ± 15.3 years) were evaluated in two sessions using the belt-stabilized HHD for maximum isometric strength of scapular protraction with the individual in the sitting and supine positions. Reliability values were obtained using the intraclass correlation coefficient with the standard error of measurement (SEM and %SEM) and the minimal detectable change (MDC).

RESULTS

The intra- and interrater HHD reliability were excellent for all measurements ranging from 0.88 to 0.96 (SEM = 2.0-4.0 kg; %SEM 12 to 17; MDC = 6-11 kg).

CONCLUSION

Belt-stabilized HHD is reliable for the assessment of scapular protraction strength in individuals with subacromial pain syndrome in both the sitting and supine positions.

Cross-Cultural Adaptation and Clinimetric Testing of Functional Rating Index (FRI) Outcome Measure into the Arabic Language

Background

The Functional Rating Index (FRI) is a self-report scale widely used to determine the level of disability in low back pain (LBP) populations.

Objectives

This study was aimed at conducting the cross-cultural adaptation of the FRI-Arabic version (FRI-Ar) and testing the clinometric properties of FRI-Ar.

Methods

The cross-cultural adaptation process was used to develop the FRI-Ar. This study included acute and subacute LBP patients. Each patient was asked to complete the questionnaires at three time points: baseline, 24-hour follow-up, and two-week follow-up. The questionnaires used were FRI-Ar, Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), Numerical Pain Rating Scale (NPRS), Global Perceived Effect Scale (GPE), and Patient-Specific Functional Scale (PSFS). Statistical analysis was carried out to measure the instrument's reliability, validity, and responsiveness.

Results

The FRI was cross-culturally adapted to the Arabic language, and the adapted version was validated. Two hundred patients completed the questionnaires at the baseline; however, 120 patients completed the questionnaires at 24-hour and two-week follow-up. Cronbach's alpha, interclass correlation coefficient (ICC_2,1), standard error of measurement (SEM), and minimal detectable change (MDC_95%) for the FRI-Ar were observed as 0.85, 0.85, 1.17 (2.9%), and 3.24, respectively. The FRI-Ar showed a moderate positive correlation only with the RMDQ, ODI, and NPRS (p < 0.05). Also, it showed the responsiveness with a small effect size (ES = 0.29) and standardized response mean (SRM = 0.44).

Conclusion

The FRI-Ar was developed, and it showed good reliability and validity. However, it revealed the responsiveness with the small change. It can evaluate both pain and functional limitations in acute and subacute LBP patients. Before using it in the Arabic population with acute and subacute LBP, it is recommended to conduct further research to test internal and external responsiveness using an external criterion with a more extended follow-up period and suitable interventions.

Measurement Properties of the Patient-Specific Functional Scale and Its Current Uses: An Updated Systematic Review of 57 Studies Using COSMIN Guidelines

OBJECTIVE

To systematically review measurement properties, including acceptability, feasibility, and interpretability, and current uses of the Patient-Specific Functional Scale (PSFS).

DESIGN

Systematic review of a patient-reported outcome measure using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines.

LITERATURE SEARCH

We searched 11 databases from January 2010 to July 2020 for articles on measurement properties or use of PSFS.

STUDY SELECTION CRITERIA

Published primary articles without language restrictions.

DATA SYNTHESIS

Two independent reviewers screened all records, extracted data, and performed risk of bias assessments using COSMIN guidelines. We qualitatively synthesized findings for each measurement property in musculoskeletal and nonmusculoskeletal conditions, and 2 reviewers independently performed Grading of Recommendations Assessment, Development and Evaluation assessments. This study was preregistered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/42UZT).

RESULTS

Of the 985 articles screened, we included 57 articles on measurement properties and 255 articles on the use of PSFS. The PSFS had sufficient test-retest reliability in musculoskeletal (22 studies, 845 participants, low-to-moderate certainty) and nonmusculoskeletal conditions (6 studies, 197 participants, very low certainty), insufficient construct validity as a measure of physical function (21 studies, 2 945 participants, low-to-moderate certainty), and sufficient responsiveness (32 studies, 13 770 participants, moderate-to-high certainty). The standard error of measurement ranged from 0.35 to 1.5. The PSFS was used in 87 unique health conditions, some without prior evidence of validity.

CONCLUSION

The PSFS is an easy-to-use, reliable, and responsive scale in numerous musculoskeletal conditions, but the construct validity of PSFS remains uncertain. Further study of the measurement properties of the PSFS in nonmusculoskeletal conditions is necessary before clinical use. J Orthop Sports Phys Ther 2022;52(5):262-275. Epub: 05 Feb 2022. doi:10.2519/jospt.2022.10727.

Laser-Pointer assisted angle reproduction test (LP-ART): reliability, performance, and correlation with shoulder pain and disability in patients with subacromial pain syndrome

INTRODUCTION

The proprioception plays an important role in the stability of the shoulder joint. However, clinical practice lacks reliable and user-friendly tools.

OBJECTIVES

To evaluate the intra- and inter-rater reliability of the Laser-Pointer assisted Angle Reproduction Test (LP-ART), to analyze the difference in proprioception between the symptomatic and asymptomatic shoulders, and to investigate if there is a correlation between the LP-ART and the pain intensity assessed by 11-point Numerical Rating Pain Scale (NRPS) and the level of shoulder disability and pain assessed by the Disability Index and Shoulder Pain (SPADI - BR).

METHODS

Fifty patients (age = 56.2 ± 10.4 years) performed the LP-ART at 90° of shoulder flexion.

RESULTS

The intra and interrater reliability of the LP-ART measurements was moderate (Intraclass Correlation Coefficient_2,3 = 0.41 to 0.65) for both shoulders, symptomatic and asymptomatic. There was no difference in the absolute angular deviation between shoulders (mean difference of 0.4°, P = .581). The absolute angular deviation was not significantly correlated with the pain intensity (rs = 0.007, P = .962) and the SPADI - BR (r_s = 0.022, P = .881).

CONCLUSION

The LP-ART measurement showed moderate reliability in participants with subacromial pain syndrome. The active joint position sense was not different between symptomatic and asymptomatic shoulders, and there was no correlation between proprioception and the pain intensity and shoulder pain and disability level.

A comparison between measurement properties of four shoulder-related outcome measures in Nepalese patients with shoulder pain

Purpose

The Patient-Specific Functional Scale (PSFS), Disability of the Arm, Shoulder and Hand (DASH), Quick-DASH, and Shoulder Pain and Disability Index (SPADI) are frequently used instruments in shoulder functional assessment. They are available in Nepali and all but the PSFS has been validated for shoulder assessment. Therefore, the aim of this study was to validate the Nepali PSFS in shoulder pain patients and to compare validity, reliability, and responsiveness of all four instruments to provide a recommendation for their use.

Method

Patients attending physiotherapy completed the Nepali PSFS at baseline and follow-up (1–3 weeks). It was tested for reliability using internal consistency (Cronbach’s α), intraclass correlation coefficient (ICC), construct validity by hypothesis testing and responsiveness by anchor-based method using Area Under the Curve (AUC). The instruments were compared based on reported measurement properties and patients’ preference.

Results

156 patients enrolled at baseline and 121 at follow-up. The PSFS showed sufficient reliability (α = 0.70, ICC = 0.82), construct validity (all three hypotheses met) and responsiveness (AUC = 0.83). Measurement property comparison demonstrated adequate reliability and validity, while PSFS was the most responsive instrument. Patients favoured the verbal rating scale of the DASH/Quick-DASH. The DASH had a lower completion rate for ‘culturally sensitive’ and ‘uncommon’ activities.

Conclusion

The Nepali PSFS is a reliable, valid, and responsive instrument in shoulder functional assessment. The combined use of the Quick-DASH or SPADI with the PSFS is recommended for a comprehensive assessment of Nepali shoulder pain patients in clinical and research settings. They are shorter, more appropriate to the Nepali context and provide balanced self-evaluation.

Measurement properties of the Brazilian versions of Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia in individuals with shoulder pain

PURPOSE

To verify the measurement properties of the Brazilian versions of Fear-avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK) in individuals with shoulder pain.

METHODS

Individuals with shoulder pain (>18 years) were included in this study. Structural validity was verified by exploratory factor analysis, which was used to identify dimensionality of the FABQ and TSK. Test-retest reliability was assessed with intraclass correlation coefficient(3,1) and internal consistency with Cronbach's alpha. Floor or ceiling effects were also investigated. Responsiveness was verified by effect sizes and area under the receiver operating characteristic curve (AUC).

RESULTS

Exploratory factor analysis identified two and one factor in the FABQ and TSK, respectively. FABQ and TSK presented moderate to good reliability and adequate internal consistency (Cronbach's alpha > 0.70). The floor effect was present in one factor of the FABQ. The FABQ and TSK showed small to moderate effect sizes and did not show adequate AUC.

CONCLUSION

FABQ and TSK are multidimensional and unidimensional instruments, respectively. Those instruments presented moderate to good reliability and the responsiveness was considered to be suboptimal in individuals with shoulder pain.

Pain-related fear phenotypes are associated with function of the upper limbs in individuals with shoulder pain

OBJECTIVE

To identify and describe phenotypes related to kinesiophobia, fear-avoidance, and pain catastrophizing, and determine clinical and demographic characteristics related to each phenotype as a function of self-reported function of the upper limbs in individuals with shoulder pain.

METHODS

One hundred and seventy-seven individuals with shoulder pain participated in this study. Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Numerical Pain of Rating Scale, and the angular onset of pain during the elevation of the arm were measured in all participants. A cluster analysis was performed considering kinesiophobia, fear-avoidance, and pain catastrophizing, then clinical and demographic characteristics of clusters were used to model individual's chance to belong to one of the clusters as a function of DASH.

RESULTS

Two clusters were identified based on kinesiophobia, fear-avoidance, and pain catastrophizing. The cluster with worse pain-related fear profile presented (p < 0.05) higher age, worse function, and higher pain intensity. This same cluster was also associated with involvement of the dominant side (OR = 2.10, 95% CI = 1.03, 4.41) and worse function (OR = 0.96, 95% CI = 0.94, 0.98).

CONCLUSION

This study identified that individuals with worse pain-related fear profile were older, with worse function, and higher pain intensity. Worse function and involvement of the dominant side were associated with the phenotype with a worse pain-related fear condition.

Brazilian version of the OSTRC Questionnaire on health problems (OSTRC-BR): translation, cross-cultural adaptation and measurement properties

BACKGROUND

The Oslo Sports Trauma Research Center - Questionnaire on Health Problems (OSTRC-QHP) has been shown to be a valid and reliable questionnaire for monitoring athletes with acute, overuse, and illness problems.

OBJECTIVES

To translate and cross-culturally adapt the OSTRC-QHP into Brazilian-Portuguese (OSTRC-BR), and investigate the measurement properties of this version.

METHODS

The original (Norwegian) questionnaire was translated and culturally adapted following existing guidelines. Measurement properties of the OSTRC-BR were investigated in 134 athletes followed for 13 weeks. Reliability was analyzed via internal consistency and test-retest reliability. Responsiveness was assessed by effect size (ES) estimations, correlation of the OSTRC-BR severity score with the Global Perceived Effect scale (GPE) and the Numeric Pain Rating Scale (NPRS), and by the Receiver Operating Characteristic (ROC) Curve test based on the area under the curve (AUC).

RESULTS

The OSTRC-QHP has been translated and cross-culturally adapted successfully. The Cronbach's alpha was 0.93 (95% CI: 0.92, 0.94). Intrarater reliability (ICC_2,1) of 0.96 (95% CI: 0.94, 0.98) was classified as excellent. ES estimation showed large effects (1.14 to 1.39). OSTRC-BR correlation was moderate (0.58 to 0.72) with the GPE and substantial (0.84 to 0.89) with the NPRS. The AUC values were above 0.70 when analysing all types of health problems.

CONCLUSIONS

The OSTRC-BR presented adequate measurement properties. The OSTRC-BR is a valid, reliable, responsive, and, therefore, an adequate tool for monitoring Brazilian athletes from different sports during training and competitions.

Comparison of low level and high power laser combined with kinesiology taping on shoulder function and musculoskeletal sonography parameters in subacromial impingement syndrome: a Randomized placebo-controlled trial

Background: Subacromial impingement syndrome (SAIS) is a common cause of shoulder pain. The effects of physiotherapy modalities including low-level laser (LLL) and high power laser (HPL) on the SAIS have mostly been evaluated by the subjective outcome variables accompanied with the controversial findings and none of them has compared a combination of these two modalities, yet.Objectives: The present study was conducted to evaluate the effects of low-level laser (LLL) and high power laser (HPL) combined with kinesiology taping (KT), on the pain, function, and musculoskeletal ultrasound (MSKUS) parameters in the SAIS.Methods: Thirty patients with SAIS were randomly divided into the LLL-KT, HPL-KT, and sham-KT groups, respectively. Patients received seven treatment sessions. Visual analogue scale (VAS), shoulder pain and disability index (SPADI), MSKUS parameters were measured before and 48 hours after the treatment cessation.Results: Pain intensity significantly reduced in the LLL-KT (-2.43 (0.97)), HPL-KT (-3.43 (1.99)), and sham-KT (-2.43 (1.62)) (P < .01). All the SPADI subscales are significantly reduced in all the groups (P < .05), except for the pain in the sham-KT (P = .06). Significant improvements were only observed in the diameters of biceps (P < .05), supraspinatus tendon thickness in short and long axes (P < .05), occupation ratio (P = .004), and echogenicity (P = .03) in the HPL-KT. Although the acromiohumoral distance (AHD) significantly increased in all the groups including the sham-KT (P < .01), supraspinatus tendon thickness significantly decreased (P < .05), and echogenicity increased (P = .003) just in the HPL-KT.Conclusions: Kinesiology taping method alone is an effective intervention. Nevertheless, adding the analgesic and anti-inflammatory effects of both LLL and HPL to KT seems to result in better improvement of the pain, function, and MSKUS parameters in the SAIS. Findings of this study suggested that the HPL is more beneficial than the LLL or KT alone for management of the patients with SAIS.

Cross-cultural adaptation and measurement properties of the Arabic version of the Patient-Specific Functional Scale in patients with lower extremity musculoskeletal disorders

PURPOSE

To cross-culturally adapt the Patient-Specific Functional Scale (PSFS) into Arabic language and to examine its measurement properties in patients with lower extremity musculoskeletal disorders.

MATERIALS AND METHODS

The original English version of the PSFS was cross-culturally adapted into modern standard Arabic language following Beaton's guidelines. Patients with lower extremity musculoskeletal disorders (N = 116) were recruited to examine the test-retest reliability, measurement error, floor and ceiling effects, and construct validity of the Arabic PSFS. Construct validity was tested by examining eight predefined correlational hypotheses.

RESULTS

Participants in the current study indicated that the Arabic PSFS was clear and understandable. The Arabic PSFS had very good test-retest reliability (ICC = 0.86) with no floor or ceiling issues. The standard error of measurement and the minimal detectable change of the Arabic PSFS were 0.64 and 1.49 points respectively indicating acceptable measurement error. The majority of the predefined construct validity hypotheses (75%) were supported by the results justifying the construct validity of the Arabic PSFS.

CONCLUSIONS

The Arabic PSFS is a comprehensible and easy to use measure. The Arabic PSFS has very good test-retest reliability, acceptable measurement error, and evidence supporting its construct validity as measure of activity limitation in patients with lower extremity musculoskeletal disorders.Implications for rehabilitationRehabilitation specialist can confidently interpret patient's score in the Arabic PSFS to represent the extent of activity limitation.Patients with unchanged clinical status will have similar scores in the Arabic PSFS with repeated administrations of the scale over time.The Arabic PSFS can be used in daily clinical practice and in research studies to measure activity limitation in Arabic-speakers with lower extremity musculoskeletal disorders.The Arabic PSFS enables rehabilitation specialist to quantify activity limitation in a way that is relevant to the culture and life style of Arabic-speakers.

Efficacy of low-level laser therapy combined with exercise for subacromial impingement syndrome: A randomised controlled trial

OBJECTIVE

To investigate the effect of low-level laser therapy (LLLT) combined with exercise on shoulder pain and disability in patients with subacromial impingement syndrome (SIS).

DESIGN

Randomised controlled trial.

SETTING

Pontifical Catholic University.

SUBJECTS

We enrolled 120 subacromial impingement syndrome patients.

INTERVENTION

Groups I (n = 42), II (n = 42) and III (n = 36) were treated with Low-level laser therapy and exercise, exercise only and Low-level laser therapy only, respectively. Interventions were conducted three times a week for 8 weeks.

MAIN OUTCOME MEASURES

The primary outcome was the change in shoulder pain and disability index (SPADI). Secondary outcomes included changes in the numeric pain rating scale and medication intake.

RESULTS

Average ages of patients in groups I, II and III were 51.9 ± 8.7 years, 56.0 ± 10.4 years and 54.2 ± 7.1 years, respectively. Pain scores at baseline (P = 0.829), 2 months (P = 0.057) and 3 months follow-ups (p = 0.004) were 6.8 (4.7-7.7), 0.2 (0.0-0.5) and 0.3 (0.0-1.0) for group I; 6.6 (5.7-8.0), 0.5 (0.2-2.0) and 0.2 (0.0-3.3) for group II; and 6.5 (5.1-7.4), 2.4 (0.1-6.7) and 4.0 (2.0-5.0) for group III, respectively. SPADI scores at baseline (P = 0.029), 2 months (P < 0.001) and 3 months follow-ups (P = 0.001) were 60.8 (37.7-70.8), 3.8 (0.0-10.8) and 2.3 (0.8-10.8) for group I; 61.5 (41.5-71.5), 9.2 (3.8-29.2) and 14.2 (1.5-38.0) for the group II; and 73.3 (59.2-80.8), 34.2 (16.9-54.6) and 33.1 (22.3-49.2) for the group III, respectively.

CONCLUSION

Low-level laser therapy combined with exercises reduce pain intensity, improve shoulder function and reduces pain intensity and medication intake over 3 months.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02725749.

Psychometric properties of Patient-Specific Functional Scale in patients with upper extremity disorders. A systematic review

PURPOSE

To identify, critically appraise, and synthesise the measurement properties of Patient-Specific Functional Scale (PSFS) in patients with upper extremity musculoskeletal disorders.

METHODS

Medline, Embase, PubMed, and Google Scholar databases from January 1999 to November 2020 were searched. Prospective measurement studies that included patients with upper extremity musculoskeletal disorders, that reported on the psychometric properties of PSFS were included. We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) 2018 guideline for systematic reviews to appraise the studies.

RESULTS

Fourteen eligible studies were included. Three studies with adequate-very good quality and sufficient properties indicated excellent intra-class correlation coefficients (ICC) (≥0.75) in patients with shoulder pain (mean age 48 ± 11 years), multiple shoulder disorders (mean age 55 ± 16 years), and hand osteoarthritis (mean age 64 ± 9 years). The construct validity estimates of PSFS were moderate, when compared with Upper Extremity Functional Index (UEFI) (r = 0.50) and Numeric Pain Rating Scale (NPRS) (r = 0.51) in patients with combined upper extremity musculoskeletal disorders (shoulder/upper arm, wrist/hand and elbow/forearm).

CONCLUSIONS

The patient-specific functional scale can be considered as a reliable, valid, and responsive tool in assessing functional change in patients with shoulder disorders/pain.Implications for rehabilitationThe Patient-Specific Functional Scale (PSFS) can be considered as: • a reliable outcome measure in assessing functional change in patients with shoulder pain and hand osteoarthritis; • a valid measure in assessing functional limitation in patients with upper extremity disorders; • a measure that is sensitive to change (displays longitudinal validity) in assessing functional change in patients with upper extremity disorders and in patients with shoulder pain; and • a responsive outcome measure in assessing functional change in patients with upper extremity disorders.

Measurement properties of translated versions of the Shoulder Pain and Disability Index: A systematic review

PURPOSE

To summarise measurement properties of translated versions of the Shoulder Pain and Disability Index (SPADI) and to assess their methodological quality.

METHODS

Relevant studies testing measurement properties of translated versions of the SPADI in non-specific shoulder pain participants were included from 11 databases (August 2020). Two reviewers independently screened articles and assessed individual measurement property risk of bias using the COSMIN checklist as very good, adequate, doubtful or inadequate. For each measurement property results were pooled and rated sufficient, insufficient, or inconsistent. Synthesised evidence was graded as high, moderate, low or very low (GRADE approach).

RESULTS

Thirty-four studies (21 languages and 26 different versions) were included from 4402 articles. A total of 141 measurement properties were reported with 60 rated as very good or adequate. These included; internal consistency (19), test-retest reliability (4), construct validity (6), structural validity (10), measurement error (5), responsiveness (9), and cross-cultural validity (2). Comprehensibility was adequate in the Chinese, German, Nepali, Spanish and Urdu versions. Only the Danish, Dutch and Nepali versions confirmed all, or all but one, of their measurement properties with sound methodology. Pooled results of all measurement properties except structural validity were rated as sufficient. Quality of evidence was graded moderate to high with downgrading due to inconsistent results.

CONCLUSION

Overall evidence suggests the SPADI is valid, reliable and responsive in translated form but less than half the measurement properties tested were of adequate quality. Further testing is required in many languages particularly in; test-retest reliability, measurement error and construct validity.

Effects on shoulder pain and disability of teaching patients with shoulder pain a home-based exercise program: a randomized controlled trial

Objective:

To investigate the effect on shoulder pain and disability of teaching patients with shoulder pain how to undertake a home-based exercise program.

Design:

A randomized controlled trial conducted from September 2015 to January 2016.

Setting:

Participants’ home.

Participants:

Sixty participants with shoulder pain who were waiting for physiotherapeutic treatment.

Interventions:

The control group ( n = 30) received minimal education about their shoulder condition and instructions to continue their activities as normal. The intervention group ( n = 30) received a two-month home exercise program with one-hour sessions delivered by a physiotherapist to begin and one month after the program for exercise instructions.

Main measures:

The primary outcome was change in the Shoulder Pain and Disability Index (SPADI). The secondary outcomes included change in the numeric pain rating scale and medication intake for pain relief.

Results:

The patients’ average age was 54.3 (13.8) years. SPADI scores at baseline were 60.9 (16.5) in the intervention and 64.7 (15.3) in the control group. After two months, the SPADI scores decreased to 18.8 (28.6) and to 61.4 (24.0), respectively, in the intervention and control groups with an estimated mean difference of 40.0, effect size: 1.61. The intervention group showed a reduced pain intensity (estimated mean difference: 3.7, effect size: 2.43) and medication intake (chi-square: 0.001). The number needed to treat was 1.2 for one patient to have a SPADI score <20.

Conclusion:

Teaching patients with shoulder pain how to undertake a home-based exercise program improved shoulder function and reduced pain intensity and medication intake over two months.

Responsiveness and minimal important change of the QuickDASH and PSFS when used among patients with shoulder pain

Background

The Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) and the Patient-Specific Functional Scale (PSFS) are commonly used outcome instruments for measuring self-reported disability in patients with shoulder pain. To date, few studies have evaluated the responsiveness and estimated their minimal important change (MIC). Further assessment will expand the current knowledge and improve the interpretability of these instruments in clinical and research practice. The purpose of this prospective cohort study with 3 months follow-up was to evaluate the responsiveness of the QuickDASH and PSFS in patients with shoulder pain, and to estimate their MICs by using two different anchor-based methods.

Methods

Patients with shoulder pain recruited at a multidisciplinary hospital outpatient clinic completed the QuickDASH and PSFS at baseline and at 3 months follow-up. The responsiveness was evaluated by using a criterion approach with the area under the receiver operating characteristic curve (AUC) and a construct approach by testing 9 a-priori hypotheses. The MIC was assessed using two anchor-based MIC methods.

Results

134 patients participated at baseline and 117 (87.3%) at 3 months follow-up. The AUC was acceptable for both QuickDASH (0.75) and PSFS (0.75). QuickDASH met 7 (77.8%) and PSFS 8 (88.9%) of the hypotheses. None of the instruments showed signs of floor and ceiling effects. The MIC estimates ranged from 10.8 to 13.6 for QuickDASH and from 1.9 to 2.0 for PSFS, depending on the method used.

Conclusion

This study demonstrates that both the QuickDASH and PSFS are responsive measures of disability in patients with shoulder pain. The estimated MIC values were presented.

Altered Scapular Time Series in Individuals With Subacromial Pain Syndrome

Altered scapular movement in subacromial pain syndrome has been demonstrated using discrete data reduction approach. However, this approach does not consider the data collinearity and variability, and scapular translations are poorly investigated in symptomatic individuals. The purpose of this study was to investigate the scapular rotation and translation of asymptomatic individuals and those with subacromial pain syndrome during arm motions using principal component analysis. Scapulothoracic kinematics were evaluated in 47 participants with subacromial pain syndrome and 50 asymptomatic individuals. The symptomatic group had increased range of scapular anterior/posterior tilt during arm elevation (P = .01, effect size = .59) and arm lowering (P < .01, effect size = .61), and increased range of scapular forward/backward translation during arm lowering (P < .01, effect size = .60) compared with the asymptomatic group. In addition, the symptomatic group had a reduced difference in anterior tilt angular velocities between the early-arm and mid-arm lowering phases and between the mid- and late-arm lowering phases compared with the asymptomatic group (P = .03, effect size = .44). This study demonstrated that scapular anterior/posterior tilt motion and angular velocity and scapular forward/backward translation of symptomatic individuals were different from asymptomatic individuals when considering the entire arm movement.

Patient-Reported and Objectively Measured Function Before and After Reverse Shoulder Arthroplasty

BACKGROUND AND PURPOSE

Documenting functional outcomes after reverse shoulder arthroplasty (RSA) is critical to advancing patient care. The interplay been self-reported and objectively measured outcome measures has not been widely described. The utilization of wearable devices to document upper extremity limb activity is a new approach for objectively measuring outcomes. Therefore, the purpose of this study was to evaluate changes in pain, and self-reported function and objectively measured limb activity after RSA. We also assessed the influence of pain on self-reported function and objectively measured limb activity to determine the impact of pain on outcomes after RSA.

MATERIALS

This study implemented a prospective, repeated-measures design. Fourteen patients undergoing RSA underwent testing before surgery, and 2 and 12 months after surgery. Patient-reported instruments included pain, Disabilities of Arm, Shoulder and hands (DASH), and physical component summary (PCS) of the 36-Item Short Form Health Survey. Objective limb activity (mean activity value, m/s/min epoch; inactive time, %; low activity, %; and high activity, %) was captured with triaxial accelerometers worn on the upper and lower arm. A repeated-measures ANOVA tested for differences across time. The Spearman rank-order correlation was calculated to evaluate the influence of pain on DASH, PCS scores, and mean limb activity.

RESULTS

Patient-reported measures improved after surgery (pain, P < .01; DASH, P < .01; PCS, P = .01). No change in limb activity was found at 1 year compared with preoperative values for mean (forearm, P = 1.00; arm, P = .36), inactivity (forearm, P = .33; arm, P = .22), low (forearm, P = .77; arm, P = .11) or high (forearm, P = 1.00; arm, P = .20) activity. There was a relationship between pain and DASH scores 1 year after surgery (P = .04) but not before surgery (P = .16), or 2 months after surgery (P = .30). There was no relationship between pain and PCS scores at any time point (preoperative, P = .97; 2 months, P = .21; 1 year, P = .08) nor pain and limb activity (forearm: preoperative, P = .36; 2 months, P = .67; 1 year, P = .16; arm: preoperative, P = .97; 2 months, P = .59; 1 year, P = .51).

CONCLUSIONS

RSA reduced pain and enhanced patient-perceived function. Objectively measured upper extremity limb activity is not different 1 year after surgery compared with preoperative levels.

LEVEL OF EVIDENCE

III.

Patients with Subacromial Pain Syndrome Present no Reduction of Shoulder Proprioception: A Matched Case-Control Study

BACKGROUND

Shoulder pain is common among patients with musculoskeletal pain and the prevalence of patients with subacromial pain syndrome (SAPS) is high. Despite the high prevalence, there is a lack of an extensive evaluation of the proprioception acuity in patients with SAPS. Knowledge of the proprioceptive deficit would assist clinicians in the proper treatment and may offer an alternative explanation for the mechanisms underlying SAPS, which are poorly understood.

OBJECTIVE

To compare the proprioceptive function of the shoulder in patients with SAPS and matched controls.

STUDY DESIGN

Matched case-control study.

SETTING

Physical Functional Rehabilitation Service of an outpatient clinic.

PARTICIPANTS

A total of 32 consecutive patients with SAPS who sought physical therapy for shoulder pain and 32 healthy participants (control group) matched for age, sex, and handedness.

INTERVENTIONS

All participants completed a questionnaire containing sociodemographic information, pain intensity and characteristics, the Numerical Pain Rating Scale, and the Shoulder Pain and Disability Index.

MAIN OUTCOME MEASUREMENTS

The proprioceptive assessment was performed through kinesthesia, passive joint position sense (PJPS), and the active joint position sense (AJPS).

RESULTS

The groups showed no statistically significant differences in kinesthesia, PJPS, and AJPS for internal or external rotation. The proprioceptive acuity was not associated with pain intensity or functional disability in patients with SAPS.

CONCLUSIONS

Participants with SAPS did not present proprioceptive deficits in a pain-free motion of medial and lateral rotation when compared to their matched controls. The proprioceptive deficit may not be involved with the mechanisms underlying SAPS and seems not to interfere with the clinical outcomes of patients with SAPS.

LEVEL OF EVIDENCE

Level III.

Scapular-focused exercise treatment protocol for shoulder impingement symptoms: Three-dimensional scapular kinematics analysis

BACKGROUND

The present study aimed to describe the effects of a periscapular strengthening and neuromuscular training protocol in three-dimensional scapular kinematics and resting positioning in participants with shoulder impingement symptoms. Self-reported function was also evaluated.

METHOD

The study group comprised 50 subjects with shoulder impingement syndrome (control group, n=25; treatment group, n=25). The treatment group underwent 8weeks of neuromuscular training and periscapular strengthening. Scapular kinematics was measured using an electromagnetic tracking device, and the Brazilian version of the Shoulder Pain and Disability Index (SPADI-Br) questionnaire was carried out before and after the treatment.

FINDINGS

In the resting position, treated subjects had lower (p<0.01) internal rotation of the scapula compared to the control group, with a large effect size (2.4). On the coronal plane, the treated group had less scapular upward rotation (p<0.01) and less internal rotation (p<0.05), with a medium effect size. On the sagittal plane, the treated group had less internal rotation (p<0.01), less upward rotation (p<0.05), and less scapular anterior tilt (p<0.01), with a medium effect size. On the scapular plane, a reduction in upward rotation (p<0.01) after the intervention was observed, with a large effect size. Moreover, a reduction in the total SPADI-Br score was found, with a mean difference of 32.4 [24.4; 40.4] points (p<0.01) after the implementation of the protocol and a large effect size (2.0).

INTERPRETATION

The results provide biomechanical support for the clinical rationale for indicating therapeutic exercises focused on the periscapular muscles to improve scapular dynamics.

Bilateral changes in 3-D scapular kinematics in individuals with chronic stroke

BACKGROUND

Stroke can lead to altered scapular motion that may limit the ability to perform activities of daily living. The aims were to evaluate scapular kinematics of individuals with chronic stroke and the correlation with paretic arm function.

METHODS

Scapular kinematics was assessed in thirty-four individuals (Chronic stroke=17; controls=17) during arm elevation and lowering in scapular and self-selected planes, and during hair combing. The use of the paretic arm to perform activities of daily living was assessed by the Motor Activity Log (MAL-30). Scapular kinematics was compared among paretic and non-paretic arms, and controls. Correlation between scapular kinematics and MAL-30 was also verified.

FINDINGS

Paretic and non-paretic arms showed increased scapular internal rotation (p<0.05) during arm lowering in the scapular plane, and during arm elevation and lowering in the self-selected plane compared to controls. Increased internal rotation (p<0.05) was also found in the paretic arm during hair combing compared to controls. Increased scapular anterior tilt (p<0.05) was observed in the paretic arm during arm elevation while performing the activity of hair combing and during arm elevation and lowering in the scapular and self-selected planes compared to controls. The non-paretic arm showed increased anterior tilt (p<0.05) during arm elevation and lowering in self-selected plane compared to controls. No difference in scapular upward rotation among neither arms, nor correlation between scapular kinematics and MAL-30 were found (p>0.05).

INTERPRETATION

Individuals with chronic stroke showed bilateral scapular kinematics alterations. However, these alterations are not correlated with paretic arm function.

Shoulder pain in adolescent athletes: prevalence, associated factors and its influence on upper limb function

BACKGROUND

Sports that require the constant use of an upper limb demand the maximum kinetic chain efficiency in this segment. Immaturity of the musculoskeletal system, followed by failure in motor skills can expose adolescents to major reports of pain complaints, particularly for the shoulder.

OBJECTIVE

To evaluate the prevalence of shoulder pain in adolescent athletes and identify possible factors associated with the complaint.

METHOD

A total of 310 athletes, of both sexes and aged between 10 and 19 years old participated on this study. The subjects filled out a questionnaire with personal, sports and upper limb function (Quick-DASH) questions. We evaluated the height, body mass, shoulder rotation range and stability of the upper limb using the CKCUES-test. The association between pain and the variables was analyzed using multilevel modeling logistic regression. We used the Mann-Whitney test for comparing between pain and function.

RESULTS

The prevalence of shoulder pain was 43.5%. Athletes between 15 and 19 years, handball and judo practitioners, are 1.86, 2.14 and 3.07 more likely to report shoulder pain, respectively, when compared with other sports and ages. Shoulder pain reduced function scores (p<0.001) and increased changes in the range of motion (p<0.04).

CONCLUSION

Shoulder pain is highly prevalent and is associated especially with older adolescent athletes of handball and judo, and affects the levels of function and the range of the shoulder.

Health professionals identify components of the International Classification of Functioning, Disability and Health (ICF) in questionnaires for the upper limb

BACKGROUND:

Several Brazilian studies have addressed the International Classification of Functioning, Disability and Health (ICF), but few have analyzed the knowledge of the health professionals with regards to the ICF.

OBJECTIVE:

To verify whether the classification of the items in the Brazilian-Portuguese versions of The Shoulder Pain and Disability Index (SPADI) and The Disabilities Arm, Shoulder and Hand (DASH) questionnaires, obtained from health professionals who worked with patients having upper limb injuries, could be related to ICF components as defined by others studies.

METHOD:

There were 4 participants for the group "professionals with high familiarity of the ICF (PHF)" and 19 for the group of "professionals with some or no familiarity of the ICF (PSNF)". The participants judged whether the items on the two questionnaires belonged to the ICF body function, body structure or activity-participation component, and marked a confidence level for each trial using a numerical scale ranging from zero to 10. The items were classified by the discriminant content validity method using the Student'st-test and the Hochberg correction. The ratings were compared to the literature by the percentage of agreement and Kappa coefficient.

RESULTS:

The percentage of agreement of the rating from the PSNF and the PHF groups with the literature was equal to or greater than 77%. For the DASH, the agreement of the PSNF and PHF groups with the literature were, respectively, moderate (Kappa=0.46 to 0.48) and substantial (Kappa=0.62 to 0.70).

CONCLUSIONS:

Health professionals were able to correlate the three components of the ICF for most items on the 2 questionnaires, demonstrating some ease of understanding the ICF components. However, the relation of concept of pain with body function component is not clear for professional and deserves a more attentive approach.

Measurement properties of the Brazilian version of the Penn Shoulder Score (PSS-Brazil): reliability, validity, and responsiveness

STUDY DESIGN

Clinical measurement.

OBJECTIVES

To determine the reliability, validity, and responsiveness of the Brazilian version of the Penn Shoulder Score (PSS-Brazil) in patients with shoulder dysfunctions.

BACKGROUND

Several questionnaires assessing shoulder dysfunctions are available in Brazil, but the measurement properties of most of them, such as the PSS, have not yet been tested.

METHODS

Internal consistency, measurement error, construct validity, and floor and ceiling effects were evaluated in 62 patients, 36 of whom completed the questionnaire at baseline and after 2 to 7 days to assess test-retest reliability. Responsiveness was determined with 50 patients who completed the questionnaire at an initial visit and after 4 weeks of physical therapy.

RESULTS

The PSS-Brazil displayed acceptable internal consistency, with a Cronbach alpha of .92. Test-retest reliability was excellent, with an intraclass correlation coefficient of 0.95; the standard error of measurement and minimal detectable change were 12.8 and 14.4 points, respectively. A high correlation was obtained between the PSS and the Shoulder Pain and Disability Index (0.96) and the Disabilities of the Arm, Shoulder and Hand questionnaire (0.86). There was moderate correlation between the PSS and its subscales and the pain and function subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey (0.40-0.68). There was high responsiveness, with an effect size of 0.95 and standardized response mean of 1.13 for patients with improvement of shoulder dysfunction, and adequate area under the curve of 0.81. No floor or ceiling effects were observed.

CONCLUSION

The PSS-Brazil is a reliable, valid, and responsive measure for assessing patients with shoulder dysfunction.

[Translation, cultural adaptation, validity and reliability of the shoulder rating questionnaire for use in Brazil]

OBJECTIVE

To translate and culturally adapt the Shoulder Rating Questionnaire (SRQ) to the Brazilian Portuguese language, and to determine its validity, reliability and sensitivity to change in patients with functional impairment of the shoulder.

METHODS

After translation and back-translation of the original version by four independent translators, the instrument was reviewed by a committee of experts and subsequently applied to eight patients with shoulder injury (target audience) to produce the Portuguese version. Then, this version was applied to 102 patients selected from four reference centers for functional treatment of the shoulder, who had a variety of clinical diagnoses, educational levels, socioeconomic, and cultural backgrounds. The evaluation was performed twice with an interval of four weeks between each application.

RESULTS

The Brazilian version of SRQ was equivalent in terms of semantics and showed good levels of reliability (Cronbach's Alpha=0.89 and ICC=0.83). The reproducibility was high (Spearman Correlation Coefficient=0.82) and validity of the items that ranged from 0.54 to 0.99 was considered excellent. The Cohen's d and T test for repeated measures showed that the instrument is able to monitor and track improvements in shoulder function.

CONCLUSION

Psychometric criteria were found, which justify the applicability of the Brazilian version of SRQ in individuals with shoulder functional impairments.

Evaluative measurement properties of the patient-specific functional scale for primary shoulder complaints in physical therapy practice

STUDY DESIGN

Clinical measurement, longitudinal.

OBJECTIVES

To assess the test-retest reliability, construct validity, and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with a primary shoulder complaint.

BACKGROUND

Health measurement outcomes have become increasingly important for evaluating treatment. Patient-specific questionnaires are useful tools for determining treatment goals and evaluating treatment in individual patients. These questionnaires have not yet been validated in patients with nonspecific shoulder pain.

METHODS

Patients completed the PSFS, the numeric pain rating scale, and the Shoulder Pain and Disability Index at baseline, and after 1 week and 4 to 6 weeks. Test-retest reliability was determined using intraclass correlation coefficients. To assess convergent validity, change scores of the PSFS were correlated with the numeric pain rating scale and Shoulder Pain and Disability Index change scores. Responsiveness was assessed by calculating the area under the curve, the minimal clinically important change, and minimal detectable change, using the global rating of change as an external criterion.

RESULTS

Fifty patients (37 men; mean age, 47.7 years) participated in the study. Reliability was high (intraclass correlation coefficient = 0.87; 95% confidence interval [CI]: 0.72, 0.94). The correlations between the change scores of the PSFS and those of the Shoulder Pain and Disability Index and numeric pain rating scale were 0.45 (95% CI: 0.17, 0.80) and 0.55 (95% CI: 0.29, 0.73), respectively. The area under the curve for the PSFS was 0.67 (95% CI: 0.51, 0.83). The minimal detectable change and minimal clinically important change were 0.97 and 1.29 points, respectively.

CONCLUSION

These results suggest that the PSFS is a reliable, valid, and responsive instrument that can be used as an evaluative instrument in patients with a primary shoulder complaint.

Assessing the patient-specific functional scale's ability to detect early recovery following total knee arthroplasty

BACKGROUND

The Patient-Specific Functional Scale (PSFS) has received considerable attention over the last 2 decades; however, validation studies have not examined its performance in patients after total knee arthroplasty (TKA).

OBJECTIVE

The purpose of this study was to investigate the ability of the PSFS to detect change in patients post-TKA by comparing PSFS change scores with Lower Extremity Functional Scale (LEFS) and pooled impairment change scores.

METHODS

One hundred thirty-three patients participating in a post-TKA exercise class were assessed at their initial and discharge visits. Initial assessments occurred within 28 days of arthroplasty; follow-up assessments occurred within 80 days of surgery. At both assessments, participants completed the PSFS, LEFS, and the P4 pain measure, and their knee range of motion (ROM) and extensor strength were measured. The ability to detect change was expressed as the standardized response mean (SRM) and as a correlation between the PSFS change scores and 2 reference standards: (1) LEFS change scores and (2) pooled impairment change scores. The pooled impairment measure consisted of pain, ROM, and strength change scores.

RESULTS

The SRMs were PSFS 4.60 (95% confidence interval [CI]=4.00, 5.36) for the PSFS and 2.28 (95% CI=2.04, 2.60) for the LEFS. The correlation between the PSFS and pooled impairment change scores was 0.12 (95% CI=-0.04, 0.25), and the correlation between the PSFS and LEFS changes scores was 0.18 (0.02, 0.34).

LIMITATIONS

The order of measure administration was not standardized, and fixed activity set does not reflect clinical application in many instances.

CONCLUSIONS

The results suggest that the PSFS is adept at detecting improvement in patients post-TKA but that the PSFS, like other patient-specific measures, is likely to be of limited value in distinguishing different levels of change among patients.

Motion of the shoulder complex in individuals with isolated acromioclavicular osteoarthritis and associated with rotator cuff dysfunction: part 1 - Three-dimensional shoulder kinematics

This study described the three-dimensional shoulder motion during the arm elevation in individuals with isolated acromioclavicular osteoarthritis (ACO) and ACO associated with rotator cuff disease (RCD), as compared to controls. Seventy-four participants (ACO=23, ACO+RCD=25, Controls=26) took part of this study. Disability was assessed with the DASH, three-dimensional kinematics were collected during arm elevation in the sagittal and scapular planes, and pain was assessed with the 11-point numeric pain rating scale. For each kinematic variable and demographic variables, separate linear mixed-model 2-way ANOVAs were performed to compare groups. Both ACO groups had higher DASH and pain scores. At the scapulothoracic joint, the isolated ACO group had greater internal rotation than control, and the ACO+RCD group had greater upward rotation than both other groups. At the sternoclavicular joint, both groups with ACO had less retraction, and the isolated ACO group had less elevation and posterior rotation. At the acromioclavicular joint, the isolated ACO group had greater upward rotation, and both ACO groups had greater posterior tilting. Patients with ACO had altered shoulder kinematics, which may represent compensatory responses to reduce pain and facilitate arm motion during arm elevation and lowering.

Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH)

STUDY DESIGN

Prospective, single-group observational design.

OBJECTIVES

To determine the minimal clinically important difference (MCID) for the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and its shortened version (QuickDASH) in patients with upper-limb musculoskeletal disorders, using a triangulation of distribution- and anchor-based approaches.

BACKGROUND

Meaningful threshold change values of outcome tools are crucial for the clinical decision-making process.

METHODS

The DASH and QuickDASH were administered to 255 patients (mean ± SD age, 49 ± 15 years; 156 women) before and after a physical therapy program. The external anchor administered after the program was a 7-point global rating of change scale.

RESULTS

The test-retest reliability of the DASH and QuickDASH was high (intraclass correlation coefficient model 2,1 = 0.93 and 0.91, respectively; n = 30). The minimum detectable change at the 90% confidence level was 10.81 points for the DASH and 12.85 points for the QuickDASH. After triangulation of these results with those of the mean-change approach and receiver-operating-characteristic-curve analysis, the following MCID values were selected: 10.83 points for the DASH (sensitivity, 82%; specificity, 74%) and 15.91 points for the QuickDASH (sensitivity, 79%; specificity, 75%). After treatment, the MCID threshold was reached/surpassed by 61% of subjects using the DASH and 57% using the QuickDASH.

CONCLUSION

The MCID values from this study for the DASH (10.83 points) and the QuickDASH (15.91 points) could represent the lower boundary for a range of MCID values (reasonably useful for different populations and contextual characteristics). The upper boundary may be represented by the 15 points for the DASH and 20 points for the QuickDASH proposed by the DASH website.