Shoulder Disability Questionnaire Research Articles

The Shoulder Disability Questionnaire differentiated well between high and low disability levels in patients in primary care, in a cross-sectional study

Objectives To investigate the usefulness of the Shoulder Disability Questionnaire (SDQ) for cross-sectional discriminative purposes, we assessed the discriminative ability of items, internal consistency, content validity, and construct validity. Study Design and Setting Two hundred patients recruited in primary and secondary care identified their chief functional limitations, scored their shoulder pain, and completed the SDQ. Two physical therapists assessed the range of motion, muscle force, and scored the severity of disability. Results Comparison of the chief functional limitations of the patients with the SDQ items confirmed the content validity of the SDQ. Cronbach's α describing the internal consistency was 0.79. Construct validity was confirmed for patients with different levels of pain, range of active abduction, muscle force, ability to perform activities in daily life, and the severity of disability scored by the physical therapists. However, the differences in the SDQ-score between extreme groups were less evident in the secondary care population. In patients in the secondary care rheumatology clinic, the discriminative ability of most SDQ items was very limited. Conclusion The presented results suggest that the SDQ appears to be a useful discriminative instrument, especially in the primary care setting.

A prospective double blind placebo-controlled randomized trial of ultrasound in the physiotherapy treatment of shoulder pain

To compare the effectiveness of manual therapy and ultrasound (US) with manual therapy and placebo ultrasound (placebo US) in the treatment of new episodes of unilateral shoulder pain referred for physiotherapy. In a multicentre, double blind, placebo-controlled randomized trial, participants were recruited with a clinical diagnosis of unilateral shoulder pain from nine primary care physiotherapy departments in Birmingham, UK. Recruitment took place from January 1999 to September 2001. Participants were 18 yrs old and above. Participants all received advice and home exercises and were randomized to additionally receive manual therapy plus US or manual therapy plus placebo US. The primary outcome measure was the Shoulder Disability Questionnaire (SDQ-UK). Outcomes were assessed at baseline, 2 weeks, 6 weeks and 6 months. Analysis was by intention to treat. A total of 221 participants (mean age 56 yrs) were recruited. 113 participants were randomized to US and 108 to placebo US. There was 76% follow up at 6 weeks and 71% at 6 months. The mean (95% CI) reduction in SDQ scores at 6 weeks was 17 points (13-26) for US and 13 points (9-17) for placebo US (P = 0.06). There were no statistically significant differences at the 5% level in mean changes between groups at any of the time points. The addition of US was not superior to placebo US when used as part of a package of physiotherapy in the short-term management of shoulder pain. This has important implications for physiotherapy practice.

The impact of selective neck dissection on shoulder and cervical spine movements

Objective To investigate the deficits in function following a function-preserving neck dissection by comparing operative versus non-operative sides for cervical spine and shoulder movements in combination with patient self-completed questionnaires. Participants A consecutive cohort of 63 outpatients following levels I–III unilateral selective neck dissection were approached and all agreed to participate in the study. Methods Clinical examination included assessment of shoulder, shoulder girdle and cervical spine ranges of movement, measured by goniometry, tape measure and a cervical measurement system. Patient self-completed questionnaires included the University of Washington quality of life questionnaire (UW-QoL), the neck dissection impairment index and the shoulder disability questionnaire. Results Following unilateral selective neck dissection there was significant loss of shoulder flexion and abduction in the operated side compared to the non-operated side but not in regard to the other cervical spine and shoulder measurements. The loss of shoulder flexion averaged 9° (95% confidence interval: 3–14°) and the loss of shoulder abduction averaged 8° (95% confidence interval: 2–14°). The UW-QoL shoulder domain clearly identified patients with poor cervical spine and shoulder function. Conclusion This study emphasizes the problems patients encounter even with a function-preserving neck dissection. The UW-QoL questionnaire can aid physiotherapists to screen patients needing early intervention and further assessments.

Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up)

The 2-year results of a randomized, prospective, controlled trial of minimally displaced proximal humeral fractures treated either by immediate physiotherapy (group A) or after 3 weeks of immobilization (group B) are reported. At 1 year shoulder disability, as measured with the Croft shoulder disability questionnaire, was found in 42.8% of patients in group A and 72.5% in group B (P < .01). By 2 years, shoulder disability in group A remained unchanged (43.2%) but had reduced in group B (59.5%). This difference was not statistically significant. Immediate physiotherapy after a minimally displaced proximal humeral fracture results in faster recovery, with maximal functional benefit being achieved at 1 year. Delayed rehabilitation by 3 weeks of shoulder immobilization produces a slower recovery, which continues for at least 2 years after the time of injury.

A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial

BackgroundSubacromial impingement syndrome (SIS) is the most frequently recorded shoulder disorder. When conservative treatment of SIS fails, a subacromial decompression is warranted. However, the best moment of referral for surgery is not well defined. Both early and late referrals have disadvantages – unnecessary operations and smaller improvements in shoulder function, respectively. This paper describes the design of a new interdisciplinary treatment strategy for SIS (TRANSIT), which comprises rules to treat SIS in primary care and a well-defined moment of referral for surgery.Methods/DesignThe effectiveness of an arthroscopic subacromial decompression versus usual medical care will be evaluated in a randomized controlled trial (RCT). Patients are eligible for inclusion when experiencing a recurrence of SIS within one year after a first episode of SIS which was successfully treated with a subacromial corticosteroid injection. After inclusion they will receive injection treatment again by their general practitioner. When, after this treatment, there is a second recurrence within a year post-injection, the participants will be randomized to either an arthroscopic subacromial decompression (intervention group) or continuation of usual medical care (control group). The latter will be performed by a general practitioner according to the Dutch National Guidelines for Shoulder Problems. At inclusion, at randomization and three, six and 12 months post-randomization an outcome assessment will take place. The primary outcome measure is the patient-reported Shoulder Disability Questionnaire. The secondary outcome measures include both disease-specific and generic measures, and an economic evaluation. Treatment effects will be compared for all measurement points by using a GLM repeated measures analyses.DiscussionThe rationale and design of an RCT comparing arthroscopic subacromial decompression with usual medical care for subacromial impingement syndrome are presented. The results of this study will improve insight into the best moment of referral for surgery for SIS.

An evaluation of the shoulder domain of the University of Washington quality of life scale

The aim of this study was to compare the shoulder domain in the University of Washington quality of life (UW-QoL) scale with two shoulder-specific questionnaires. Methods We did a cross-sectional survey of 100 consecutive outpatients who had had operations on the head and neck for cancer using the UW-QoL, the neck dissection impairment index, and the shoulder disability questionnaire. Results The types of neck dissection were none ( n = 12), unilateral selective ( n = 63), bilateral selective ( n = 17), and radical or modified radical ( n = 8). There were significant correlations among the three questionnaires. The worst scores were found in the group who had modified radical or radical neck dissection. Although responses were similar between those who had no neck dissection and those who had unilateral level 3 neck dissection, a few patients reported considerable dysfunction after selective neck dissection. Conclusion Although the UW-QoL shoulder domain is limited to one of four responses, our results support the conclusion that it is sufficiently sensitive to screen for dysfunction of the shoulder.

Therapeutic effect of pulsed electromagnetic field in conservative treatment of subacromial impingement syndrome

Subacromial impingement syndrome (SIS) is a frequent cause of shoulder pain. Our purpose in this double-blinded, randomized, and controlled study was to demonstrate whether the pulsed electromagnetic field (PEMF) provides additional benefit when used with other conservative treatment modalities in acute phase rehabilitation program of SIS. Forty-six patients with unilateral shoulder pain who had been diagnosed as having SIS were included in this trial. The cases were randomly separated into two groups. All cases received a treatment program for 3 weeks consisting of Codman's pendulum exercises and subsequent cold pack gel application on shoulders with pain 5 times a day, restriction of daily activities that require the hands to be used over the head, and meloxicam tablet 15 mg daily. One group was given PEMF; the other group was given sham PEMF daily, 25 min per session, 5 days per week for 3 weeks. Shoulder pain during rest and activity and which causes disturbance of sleep was evaluated using a visual analogue scale, and total Constant score investigated shoulder function. Daily living activities were evaluated by shoulder disability questionnaire. Results were assessed before and after treatment. When compared with the baseline values, significant improvements in all these variables were observed at the end of the treatment in both groups (p<0.05). No significant difference between treatments was observed for any of these variables (p>0.05). There is no convincing evidence that electromagnetic therapy is of additional benefit in acute phase rehabilitation program of SIS.

Responsiveness of isokinetic dynamometry parameters, pain and activity level scores to evaluate changes in patients with capsulitis of the shoulder

Objective: To determine the responsiveness to change of isokinetic dynamometry of the shoulder and to compare this responsiveness with outcome measures of pain and activity level. Design: Responsiveness was evaluated as the change in outcome after intra articular steroid injection in patients with capsulitis of the shoulder. Effect sizes of all outcome measures, quantified as standardized response means, were compared. Relationships between change scores of shoulder function and activities were assessed. Subjects: Ten patients with unilateral capsulitis of the shoulder. Main outcome measures: Muscle strength and active range of motion were measured by isokinetic dynamometry. We then calculated involved/uninvolved ratios of the maximal peak torques of abduction, adduction, external and internal rotation, active range of motion of abduction and external rotation. In addition, pain was scored using the numeric rating scale (NRS-101) and activity level was scored using the Shoulder Disability Questionnaire. Results: The standardized response mean of all outcome parameters was equal to or greater than 0.8, except for active range of motion of abduction. No significant differences between the standardized response means were found. There is a significant correlation between the change scores of NRS-101 and Shoulder Disability Questionnaire. No significant correlations were found between the change scores of NRS-101 and Shoulder Disability Questionnaire on the one hand, and involved/uninvolved ratios of peak torques and active range of motion on the other. Conclusions: Responsiveness of all outcome measures is good. Parameters of isokinetic dynamometry may provide additional information as compared with the usual outcome measures of pain and functional level.

Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial

In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobilization techniques are an important part of the intervention. The purpose of this study was to compare the effectiveness of high-grade mobilization techniques (HGMT) with that of low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis of the shoulder. One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or =50% decrease in passive joint mobility relative to the nonaffected side were enrolled in this study. Subjects randomly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint, and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone. The duration of treatment was a maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at baseline and at 3, 6, and 12 months by a masked assessor. Primary outcome measures included active and passive range of motion and shoulder disability (Shoulder Rating Questionnaire [SRQ] and Shoulder Disability Questionnaire [SDQ]). An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year, respectively. Overall, subjects in both groups improved over 12 months. Statistically significant greater change scores were found in the HGMT group for passive abduction (at the time points 3 and 12 months), and for active and passive external rotation (at 12 months). A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation, SRQ, and SDQ with greater change scores in the HGMT group. In subjects with adhesive capsulitis of the shoulder, HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs, with the overall differences between the 2 interventions being small.

Physiotherapy rehabilitation in patients with massive, irreparable rotator cuff tears

Massive rotator cuff tears provide a challenge for effective rehabilitation. Work has been ongoing at Torbay Hospital, Devon since 2000 to develop an exercise programme for the management of this patient group. This programme has been evaluated in a pilot study and a further randomised controlled trial is currently taking place which will enable us to estimate the treatment effect. This paper discusses the background to the development of the rehabilitation programme, the programme itself and the results of the pilot study. The pilot study was an evaluation of the rehabilitation programme. This study examined the effectiveness of a physiotherapy regime for the treatment of patients with massive rotator cuff tears. Patients identified through primary and secondary care referrals to physiotherapy with a clinical diagnosis of a massive rotator cuff tear underwent an ultrasound scan to confirm the diagnosis. A massive cuff tear was one where the leading edge of the tear had retracted past the glenoid margin. The clinical diagnosis was based on the presence of some or all of the following signs: positive humeral thrust on elevation, gross weakness and wasting of supraspinatus and infraspinatus, infraspinatus lag and rupture of the long head of biceps. Eligible patients were invited to take part in the study and informed consent was obtained. The baseline assessment was carried out and then the patient undertook the treatment programme. Outcome measures were reassessed 12 weeks from the baseline assessment. A cohort study of 10 patients evaluating the change from baseline to twelve weeks in the shoulder function of patients undergoing a programme of anterior deltoid strengthening and functional rehabilitation. The outcome measures used were the Oxford Shoulder Disability Questionnaire (OSDQ) and SF36. The OSDQ is validated for use with the UK population and has 12 questions with 5 point responses. The lowest (best) score is 12 and the highest (worse) score is 60. Scores on the OSDQ improved with all patients. The mean improvement was 9 (range 3 to 16, standard deviation 10.3). The SF36 showed an improvement in the pain scores for all patients (mean 22 points) and an overall improvement of 10 points for the sections on role limitation due to physical health. There was an overall decline in perceived general health (9 points) and in role limitation due to emotional health (23 points). As all 10 patients showed improved scores on the OSDQ, in spite of the long-standing nature of many of their shoulder problems, this rehabilitation programme was shown to improve shoulder function in this group of patients. The variation shown in the quality of life scores reflects the age group of this cohort who had a mean age of 75.5 years. All patients deemed their pain and function to have improved over the three-month period.

B‐mode and power Doppler sonographic findings in the long bicipital tendon in ankylosing spondylitis

AbstractObjectives: The aim of this study was to assess B‐mode and power Doppler ultrasound findings of long head of biceps tendon in patients with ankylosing spondylitis (AS).Methods: Anthropometric measurements were carried out and disease activity and functional status were evaluated with BASDAI, BASFI, Dougados Functional Index (DFI) and Articular Index (DAI) in 30 patients with AS. The Shoulder Disability Questionnaire (SDQ) was performed. Pressure pain threshold (PPT) was measured on bilateral long head of biceps tendon and B‐mode and power Doppler ultrasound were carried out. Focal changes (hypoechogenic areas within the tendon), calcification of the tendon, and fluid collection inside or outside the tendon sheath at bicipital groove (peritendinous hypoechoic rim) and vascularity of the peritendinous region were assessed. A cumulative ultrasound score (CUSS) was obtained.Results: Focal changes were present in five tendons of four patients. Calcification of the tendon was present in three tendons of three patients. Biceps tendon sheath effusion (peritendinous hypoechoic rim) was observed in 10 tendons of eight patients. Thirteen tendons of eight patients had discernible flow signals, six were inside the tendon sheath (within the hypoechoic rim) and seven were outside the tendon sheath. Cumulative US score correlated significantly with DFI and ESR. There was not a significant correlation between CUSS and total PPT.Conclusion: Ultrasound examination of the long head of biceps tendon gives detailed information of the tendon and PDUS has the potential to be able to show inflammatory activity of the tendon.

Development of a Spanish-Language Version of the Shoulder Disability Questionnaire

The Shoulder Disability Questionnaire (SDQ) is a validated shoulder functional scale that has not yet been translated into Spanish. The objective of this study was to develop and test the consistency of a Spanish translation of The Netherlands version of the SDQ (NSDQ). A backtranslation process was used to generate a Spanish version of the NSDQ, called the S-SDQ. Subsequently, both the NSDQ and S-SDQ were administered to 30 bilingual (English/Spanish) subjects. Finally, the S-SDQ was administered to 35 monolingual Spanish-speaking subjects with shoulder pain on 2 occasions. External consistency between NSDQ and S-SDQ scores in the bilingual subjects, and between scores for the 2 S-SDQ applications in the monolingual subjects was assessed using the intraclass correlation coefficient (Ri). Internal consistency of the S-SDQ was assessed with Cronbach's alpha coefficient. In the bilingual subjects, the Ri between the NSDQ and S-SDQ scores was 0.991 (95% confidence interval [CI], 0.981-0.995). In the monolingual Spanish-speaking patients with shoulder pain, the Ri between the 2 S-SDQ scores was 0.99 (95% CI, 0.997-0.999). The Cronbach's alpha coefficient for the S-SDQ was 0.99. A highly consistent Spanish version of the NSDQ, the S-SDQ, was developed. This can be confidently used in clinical care and research settings for measurement of the functional status of shoulder joint disorders in Spanish-speaking subjects.

Scapular Positioning in Patients With Shoulder Pain: A Study Examining the Reliability and Clinical Importance of 3 Clinical Tests

Nijs J, Roussel N, Vermuelen K, Souvereyns G. Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests. Objective To examine the interobserver reliability, internal consistency, and clinical importance of 3 clinical tests for the assessment of scapular positioning in patients with shoulder pain. Design Prospective repeated-measures design. Setting Private practices for physical therapy and hospital outpatient physical therapy divisions. Participants Twenty-nine patients with shoulder pain who were diagnosed by a physician as having a shoulder disorder. Interventions Not applicable. Main Outcome Measures Study participants filled in a visual analog scale for pain and the Shoulder Disability Questionnaire. Next, 2 assessors performed the following tests: measurement of the distance between the posterior border of the acromion and the table, measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and the lateral scapular slide test. Results The interobserver reliability coefficients were greater than .88 (intraclass correlation coefficients) for the measurement of the distance between the posterior border of the acromion and the table, were greater than .50 for the measurement of the distance from the medial scapular border to the fourth thoracic spinous processes, and were greater than .70 for the lateral scapular slide test. The Cronbach α coefficient for internal consistency for all tests was .88. No associations between the outcome of the tests and self-reported pain severity or disability were found. Conclusions These data provide evidence favoring the interobserver reliability of 2 of 3 tests for the assessment of scapular positioning in patients with shoulder pain. The clinical importance of the tests’ outcomes, however, is questionable.

Upper limb disability in HAVS cases—how does it relate to the neurosensory or vascular elements of HAVS?

Hand-arm vibration syndrome (HAVS) consists of vascular, neurosensory and musculoskeletal components, characterized by symptoms that include Raynaud's phenomenon, tingling and numbness in the hands. However, there has been little published data on the effects of HAVS on the capability to carry out normal daily tasks. We have investigated the application of the widely-used disability, arm, shoulder and hand (DASH) disability questionnaire that reflects functionality problems in the upper extremities, as well as symptoms, in a HAVS cohort. The cohort consisted of 118 males who, as a part of their health surveillance, had been referred for further assessment and Stockholm workshop staging. This process involved medical interview, physical examination and quantitative tests covering neurosensory function, manual dexterity and handgrip strength. The relationship between DASH outcome metric and a combination of quantitative tests reflecting a range of abnormalities found in HAVS, supports the validity of this questionnaire in HAVS studies. The data suggest that HAVS cases have a greater level of upper extremity disability compared with a general population. The study confirms that disability in HAVS is very largely related to sensorineural Stockholm workshop staging, rather than vascular staging. Any influence of vibration-induced Raynaud's phenomenon on upper extremity disability is related to the frequency of blanching attacks rather than their extent across the digits. This study strengthens the importance of identifying and preventing the exacerbation of the neurosenory component of HAVS, that unlike the blanching attacks of the vascular component does not have such an obvious pathognomic signal.

Les échelles d'incapacité fonctionnelle de l'épaule : revue systématique

Objectives. – To identify all available shoulder disability questionnaires designed to measure physical functioning and to examine those with satisfactory clinimetric quality. Methods. – We used the Medline database and the “ Guide des outils de mesure de l'évaluation en médecine physique et de réadaptation” textbook to search for questionnaires. Analysis took into account the development methodology, clinimetric quality of the instruments and frequency of their utilization. We classified the instruments according to the International Classification of Functioning, Disability and Health. Results. – Thirty-eight instruments have been developed to measure disease-, shoulder- or upper extremity-specific outcome. Four scales assess upper-extremity disability and 3 others shoulder disability. We found 6 scales evaluating disability and shoulder pain, 7 scales measuring the quality of life in patients with various conditions of the shoulder, 14 scales combining objective and subjective measures, 2 pain scales and 2 unclassified scales. Older instruments developed before the advent of modern measurement development methodology usually combine objective and subjective measures. Recent instruments were designed with appropriate methodology. Most are self-administered questionnaires. Conclusion. – Numerous shoulder outcome measure instruments are available. There is no “gold standard” for assessing shoulder function outcome in the general population.

A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis

To assess the effectiveness of intra-articular triamcinolone injection and physiotherapy singly or combined in the treatment of adhesive capsulitis of the shoulder. Eighty patients with adhesive capsulitis of less than 6 months duration were randomized to one of four groups: Group A, injection of triamcinolone 20 mg and eight sessions of standardized physiotherapy; Group B, injection of triamcinolone 20 mg alone; Group C, placebo injection and eight sessions of standardized physiotherapy; or Group D, placebo injection alone. All subjects were given an identical home exercise programme. Outcome measures were assessed at 6 weeks and 16 weeks. The primary outcome measure was Shoulder Disability Questionnaire (SDQ) score. Secondary outcomes were measurement of pain using a visual analogue scale (VAS), global disability using VAS and range of passive external rotation. A two-way analysis of variance was used to explore the effects of corticosteroid injection and physiotherapy. At 6 weeks, the SDQ had improved significantly more in the groups receiving corticosteroid injection (P = 0.004). Physiotherapy improved passive external rotation at 6 weeks (P = 0.02) and corticosteroid injection improved self-assessment of global disability at 6 weeks (P = 0.04). There was no interaction effect between injection and physiotherapy. At 16 weeks, all groups had improved to a similar degree with respect to all outcome measures. Corticosteroid injection is effective in improving shoulder-related disability, and physiotherapy is effective in improving the range of movement in external rotation 6 weeks after treatment.

Effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints

An operant behavioural and time-contingent graded exercise therapy program was developed to improve functional ability irrespective of pain experience in patients with chronic shoulder complaints. The clinical effectiveness of graded exercise therapy compared to usual care was evaluated in a randomised clinical trial. Assessments were carried out before and after 12 weeks of treatment. Performance of daily activities was measured by two outcome measures: the main complaints instrument and the Shoulder Disability Questionnaire (SDQ). Patients were eligible for participation if they had suffered from shoulder complaints for at least three months. Patients suffering from systemic diseases, referred pain or severe biomedical or psychiatric disorders were excluded. Patients (n = 176) were randomised and allocated either to graded exercise therapy (n = 87) or usual care (n = 89). Graded exercise therapy led to greater improvement in the performance of daily activities than usual care. However, only mean differences between groups in performance of activities related to the main complaints reached statistical significance (p = 0.049; 95% CI 0.0 to 15.0). The observed beneficial effects were considered to be small to moderate (calculated effect sizes: 0.30 for the main complaints instrument and 0.07 for the SDQ). Subgroup analysis showed larger improvements on the mean complaints instrument in patients not reporting pain reduction over time. Graded exercise therapy seems to be less effective in restoring performance of daily activities as assessed by the SDQ in patients showing a painful arc during physical examination. Results showed that graded exercise therapy is more effective in restoring the ability to daily activities in patients with chronic shoulder complaints than usual care, although beneficial effects are small.

An introduction to the use of outcomes questionnaires in osteopathic practice

Abstract Background: Outcomes assessment and management is rapidly becoming a necessary part of daily osteopathic practice. Third-party payers such as workers compensation schemes, motor vehicle accident compensation schemes and health insurance companies are increasingly encouraging that osteopaths incorporate the use of outcomes assessment into their practice. Purpose: To provide an outline of the common outcome measurement questionnaires that are of particular relevance to osteopathic practice. Each of the following outcome questionnaire is reviewed: Patient Specific Functional Scale, Neck Disability Index, Upper Extremity Functional Index, Shoulder (Croft) Disability Questionnaire, Shoulder Pain and Disability Index, Oswestry Low Back Pain/Disability Questionnaire, Roland-Morris Disability Questionnaire, Lower Extremity Functional Index, McGill Pain Questionnaire. Discussion: Selection of appropriate questionnaires and basic terminology is outlined. Implementation of the questionnaires into daily practice, their interpretation, recording and tracking of results is also discussed. Conclusions: This paper presents a number of common outcomes questionnaires that are reliable, valid and suitable for use in everyday osteopathic practice. They are generally well understood by the patient, time-efficient, easily scored by the clinician and thus, the use of these questionnaires should not be a burden on practice administration, the practitioner or the patient.

Mesure de l'incapacité fonctionnelle de l'épaule chez le sportif : revue systématique

Objectives. – To identify all available shoulder disability questionnaires and to examine those that could be used for athlete. Methods. – We systematically reviewed the literature in Medline using the keywords shoulder, function, scale, index, score, questionnaire, disability, quality of life, assessment, and evaluation. We searched for scales used for athletes with the keywords scale name AND (sport OR athlete). Data were completed by using the “Guide des Outils de Mesure et d’Evaluation en Médecine Physique et de Réadaptation” textbook. Analysis took into account the clinimetric quality of the instruments and the number of items specifically related to sports. Results. – A total of 37 instruments have been developed to measure disease-, shoulder-specific or upper extremity specific outcome. Older instruments were developed before the advent of modern measurement methods. They usually combined objective and subjective measures. Recent instruments were designed with use of more advanced methods. Most are self-administered questionnaires. Fourteen scales included items assessing sport activity. Four of these scales have been used to assess shoulder disability in athlete. Six scales have been used to assess such disability but do not have specific items related to sports. Conclusion. – There is no gold standard for assessing shoulder outcome in the general population and no validated outcome instruments specifically for athletes. We suggest the use of ASES, WOSI and WORC scales for evaluating shoulder function in the recreational athletes. The DASH scale should be evaluated in this population. The principal criterion in evaluating shoulder function in the high level athlete is a return to the same level of sport performance. Further studies are required to identify measurement tools for shoulder disability that have a high predictive value for return to sport.

Adding Ultrasound in the Management of Soft Tissue Disorders of the Shoulder: A Randomized Placebo-Controlled Trial

There is still a lack of evidence about the beneficial effects of ultrasound (US) intervention for the management of soft tissue problems. Thus, this study was designed to assess the effectiveness of US over a placebo intervention when added to other physical therapy interventions and exercise in the management of shoulder disorders. Forty patients who were diagnosed by ultrasonography or magnetic resonance imaging to have a periarticular soft tissue disorder of the shoulder were randomly assigned to either a group that received true US (n=20; mean time since onset of pain=8.7 months, SD=8.8, range=1-36) or a group that received sham US (n=20; mean time since onset of pain=8.1 months, SD=10.8, range=1-42). Besides true or sham US (10 minutes), superficial heat (10 minutes), electrical stimulation (15 minutes), and an exercise program (15-30 minutes) were administered to both groups 5 days each week for 3 weeks. Subjects showed within-group improvements in pain, range of motion, Shoulder Disability Questionnaire scores, and Health Assessment Questionnaire scores with the intervention, but the differences did not reach significance when compared between the groups. The results suggest that true US, compared with sham US, brings no further benefit when applied in addition to other physical therapy interventions in the management of soft tissue disorders of the shoulder.