Dataset Information

To what extent do typical components of shoulder clinical evaluation explain upper-extremity disability? A cross-sectional study.

ABSTRACT:

Background

Physical therapists use several evaluation measures to identify the most important factors related to disability. However, the degree to which these evaluation components explain shoulder disability is not well known and that may detract clinicians from the best clinical reasoning.

Objective

To determine how much evaluation components explain shoulder function.

Methods

Eighty-one individuals with unilateral shoulder pain for at least four weeks and meeting clinical exam criteria to exclude cervical referred pain, adhesive capsulitis, and shoulder instability, participated in this study. Several typical clinical evaluation components were assessed as potential independent variables in a regression model using the Disabilities of the Arm, Shoulder, and Hand (DASH) score as a proxy to shoulder function. Two multivariate models were built to include (1) evaluation components from physical exam plus clinical history and (2) a model considering all previous variables and magnetic resonance imaging (MRI) data.

Results

Pain catastrophizing was the best variable in the model explaining at least 10% of the DASH variance. Sex and lower trapezius muscle strength explained considerably less of shoulder function. The MRI data did not improve the model performance.

Conclusion

The complexity of shoulder function is not independently explained by pathoanatomical abnormalities. Psychological aspects may explain more of shoulder function even when combined with physical components in some patients.

SUBMITTER: Barreto RPG

PROVIDER: S-EPMC9193862 | biostudies-literature | 2022 Jul-Aug

REPOSITORIES: biostudies-literature

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Publications

To what extent do typical components of shoulder clinical evaluation explain upper-extremity disability? A cross-sectional study.

Barreto Rodrigo Py Gonçalves RPG Ludewig Paula M PM Braman Jonathan P JP Davenport Ernest E Ribeiro Larissa Pechincha LP Camargo Paula Rezende PR

Brazilian journal of physical therapy 20220602 4

<h4>Background</h4>Physical therapists use several evaluation measures to identify the most important factors related to disability. However, the degree to which these evaluation components explain shoulder disability is not well known and that may detract clinicians from the best clinical reasoning.<h4>Objective</h4>To determine how much evaluation components explain shoulder function.<h4>Methods</h4>Eighty-one individuals with unilateral shoulder pain for at least four weeks and meeting clinic ...[more]

PMID: 35691118

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Project description:Study designCross-sectional population-based study.PurposeThe study objective was to evaluate the coexistence of neck- and shoulder-disability, to establish normative scores for Neck Disability Index (NDI), Visual Analog Scale (VAS)-neck, VAS-arm, Quick Disability of Shoulder and Hand (Quick-DASH), and modified Constant score (mConstant score), and to determine the influence of psychological distress (Hospital Anxiety and Depression Scale [HADS]) on the disability measures. The authors also investigated the distribution of dysphagia across the population and its relation to the NDI scores.Overview of literatureSeveral factors can adversely influence the clinical outcomes after cervical surgeries. The interaction of neck and shoulder disability in the perspective of psychological distress is not well understood.MethodsProspective questionnaire-based assessment was performed for 1,000 participants. Questionnaires consisted of validated generic and disease-specific queries and specific questions. The survey included patients without pathologies of cervical spine/shoulders/upper extremities.ResultsMean age of participants was 39 years. The average neck VAS score was 1.2, NDI% was 7.3, arm VAS score was 0.8, Quick-DASH was 6.2, mConstant score was 70.7, HADS-A score was 4.9, and HADS-D score was 3.2. The psychological scores showed a significant correlation with neck- and shoulder-disability (p<0.0001, r=0.3 to r=0.5). However, correlations between neck (NDI%, neck VAS score) and shoulder disability (mConstant score, arm VAS score, Quick-DASH) were stronger (p<0.0001, r=0.5 to r=0.6). A body mass index >35 kg/m2 influenced shoulder-disability (p<0.005) and psychological distress (HADS-D score, p<0.00001). Limited neck rotation was present in those with higher age, psychological distress, neck and shoulder disability (p<0.001).ConclusionsNormative scores for neck and shoulder disability were established. The outcomes of cervical spine surgery can be normalized to these results. A better understanding of the interdependencies of neck and shoulder disability and psychological distress would enable superior decision-making and patient counseling.

Project description:Stroke-induced upper-extremity paralysis affects a substantial portion of the population, necessitating effective rehabilitation strategies. This study aimed to develop an automated program, incorporating the item response theory, for rehabilitation in patients with post-stroke upper-extremity paralysis, focusing on the ReoGo-J device, and to identify suitable robot parameters for robotic rehabilitation. ReoGo-J, a training device for upper-extremity disorders including 71 items, was administered to over 300 patients with varying degrees of post-stroke upper-extremity paralysis. Each item was rated on a three-point scale (0, very difficult; 1, adequate; 2, very easy). The results were analyzed using the graded response model, an extension of the two-parameter logistic model within the framework of the item response theory, to grade the training items based on ability of the patients. The relationship between the predicted ability, an indicator of the predicted ability the paralyzed upper-extremity to perform an item in the item response theory analysis (higher numbers indicate higher ability, lower numbers indicate lower ability), and the items in the Fugl-Meyer assessment (FMA), which indicate the degree of paralysis, was analyzed using Pearson's correlation coefficient. This study included 312 patients with post-stroke upper-extremity paralysis. The predicted ability (θ) of the tasks included in the original ReoGo-J test for forward reaching, reaching for mouth, rotational reaching, radial reaching (2D), abduction reaching, reaching in eight directions, radial reach (3D), and reaching for head ranged from - 2.0 to - 0.8, - 1.3 to - 0.8, - 1.0 to - 0.1, - 0.7 to 0.3, - 0.2 to 0.4, - 0.4 to 0.6, - 0.1 to 0.6, and 0.5 to 0.6, respectively. Significantly high correlations (r = 0.80) were observed between the predicted ability of all patients and the upper-extremity items of shoulder-elbow-forearm in the FMA. We have introduced an automated program based on item response theory and determined the order of difficulty of the 71 training items in ReoGo-J. The strong correlation between the predicted ability and the shoulder-elbow-forearm items in FMA may be used to ameliorate post-stroke upper-extremity paralysis. Notably, the program allows for estimation of appropriate ReoGo-J tasks, enhancing clinical efficiency.Trial registration: https://www.umin.ac.jp/ctr/index-j.htm (UMIN000040127).

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Project description:BackgroundFly-fishing requires rhythmic, coordinated movements to successfully cast a fly line. Previous studies have shown that the biomechanical demands of fly-casting may cause some individuals to develop upper extremity pain or injuries.PurposeTo report the rates, trends, and contributing factors of upper extremity pain and overuse injuries in a sample of North American recreational fly-fishers.Study designDescriptive epidemiology study.MethodsParticipants were reached via 3 popular online fly-fishing forums in April 2019. Each consenting North American participant over 18 years of age was given a link to a unique survey that recorded his or her demographic and orthopaedic histories, fly-fishing experience, equipment, casting techniques, upper extremity pain after fly-fishing, and chronic outcomes.ResultsThe 162 fly-fishers included were 63.3 (± 11.5) years of age, and 95.1% were men. In total, 59 (36.4%) reported experiencing upper extremity pain immediately after fly-fishing. Pain was rated a 4.0 (interquartile range, 3.0-6.0) on a 10-point Likert scale, commonly lasting less than 1 day (45.0%) or between 1 day and 1 week (45.0%). The majority (62.7%) reported not needing to see a medical provider for their pain/soreness. Those who did most commonly received diagnoses of elbow or rotator cuff tendinitis. Pain/soreness was associated with casting in an elliptical/sidearm fashion, compared with overhead or 2-handed casting (P = .006) using a weighted line or added weight (split-shot, weighted heads, etc) (P = .034) and with grip styles where the hand was pronated compared with being in a more neutral position (P = .046). The mean shortened version of the Disabilities of the Arm, Shoulder and Hand score was 10.8 (± 11.5). Higher scores were associated with a history of self-reported upper extremity orthopaedic injuries (B = 6.059 [95% CI, 2.476-9.642]; SE, 1.814; P = .001) and having had surgery for these injuries (B = 8.484 [95% CI, 4.454-12.513]; SE, 0.314; P < .001).ConclusionIn this sample of recreational fly-fishers, no aspects of fly-fishing were associated with long-term upper extremity disability, and only a little more than a third reported having transient pain immediately after fishing. Casting style, using weighted lines or added weight, and grip style were all associated with pain. These are modifiable risk factors that can be adjusted to reduce the risk of upper extremity pain immediately after fly-fishing.

Dataset Information

To what extent do typical components of shoulder clinical evaluation explain upper-extremity disability? A cross-sectional study.

Background

Objective

Methods

Results

Conclusion

Publications

To what extent do typical components of shoulder clinical evaluation explain upper-extremity disability? A cross-sectional study.

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