Which Remote Rehabilitation Interventions Work Best for Chronic Musculoskeletal Pain and Depression? A Bayesian Network Meta-Analysis.

OBJECTIVE: To evaluate the effectiveness of remote rehabilitation interventions for people living with chronic musculoskeletal pain and depression. DESIGN: A systematic review with network meta-analysis (NMA) of randomized controlled trials. LITERATURE SEARCH: We searched the Cochrane Central Register of Controlled Trials, CINAHL, EMBASE, LILACS MEDLINE, PSYNDEX, and PsycINFO databases from inception to May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials that evaluated the effectiveness of remote rehabilitation interventions in people with chronic musculoskeletal pain and depression. DATA SYNTHESIS: We used Bayesian random-effects models for the NMA. Effect estimates were comparisons between rehabilitation interventions and waitlist. We performed a sensitivity analysis based on bias in the randomization process, large trials (>100 patients per arm) and musculoskeletal condition. RESULTS: Fifty-eight randomized controlled trials involving 10 278 participants (median sample size: 137; interquartile range [IQR]: 77-236) were included. Interactive voice response cognitive behavioral therapy (CBT; standardized mean difference [SMD] -0.66, 95% credible interval [CrI] -1.17 to -0.16), CBT in person (SMD -0.50, 95% CrI -0.97 to -0.04), and mobile app CBT plus exercise (SMD -0.37, 95% CrI -0.69 to -0.02) were superior to waitlist at 12-week follow-up for reducing pain (> 98% probability of superiority). For depression outcomes, Internet-delivered CBT and telecare were superior to waitlist at 12-week follow-up (SMD -0.51, 95% CrI -0.87 to -0.13) (> 99% probability of superiority). For pain outcomes, the certainty of evidence ranged from low to moderate. For depression outcomes, the certainty of evidence ranged from very low to moderate. The proportion of dropouts attributed to adverse events was unclear. No intervention was associated with higher odds of dropout. CONCLUSION: Interactive voice response CBT and mobile app CBT plus exercise showed similar treatment effects with in-person CBT on pain reduction among people living with chronic musculoskeletal pain and depression had over 98% probability of superiority than waitlist control at 12-week follow-up. Internet-delivered CBT and telecare had over 99% probability of superiority than waitlist control for improving depression outcomes at 12-week follow-up. J Orthop Sports Phys Ther 2024;54(6):1-16. Epub 26 February 2024. doi:10.2519/jospt.2024.12216.

Exploratory and confirmatory factor analysis of the new region-generic version of Fremantle Body Awareness-General Questionnaire.

BACKGROUND: As the field of pain evaluation grows, newer and more targeted tools are being published for patient-centric evaluation of specific aspects of the pain experience. The Fremantle Back Awareness Questionnaire (FreBAQ) is intended to capture alterations in bodily awareness or perception. To date only region-specific (back, neck, shoulder, knee) versions have been published. OBJECTIVES: The purpose of our study was to report on the properties of a new region-generic version of the FreBAQ, the FreBAQ-general. Structural validity, internal consistency, and convergent validity against external criteria were evaluated in a sample of Canadian military veterans with chronic pain, with results compared against those published for the region-specific FreBAQ versions. METHODS: Eligible participants were those that had prior military service, were at least 18 years of age and self-identified as having chronic pain. We used a split-sample approach to Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) on independent random samples. Factor structure, internal consistency, and associations with external criteria were used to compare against prior versions. RESULTS: 328 respondents (74% of consented) completed at least 7 of the 9 FreBAQ-general questions. EFA and CFA on two independent samples offered support for both 6- and 7-item versions. Comparisons against the external criteria (pain severity, interference, catastrophizing) indicated no statistical superiority of one over the other, so in the interest of parsimony the 6-item FreBAQ-general was endorsed. CONCLUSIONS: The Fremantle Body Awareness Questionnaire (FreBAQ-general) showed psychometric properties very much in alignment with those previously reported for the region-specific versions, and sound factorial validity accomplished with fewer items (6 vs. 9). We believe this version can be implemented in practice for those seeking a shorter scale without the need to have multiple region-specific versions on hand, though suggest that those seeking direct comparability with previously published work will still wish to use the original versions.

Effectiveness of instrument-assisted soft tissue mobilization for the management of upper body, lower body, and spinal conditions. An updated systematic review with meta-analyses.

PURPOSE: To critically appraise randomized controlled trials (RCTs) on Instrument-Assisted Soft Tissue Mobilisation (IASTM) and quantify the effects of IASTM compared with other treatment in individuals with or without pathologies on function, pain, and range of motion. MATERIALS AND METHODS: We search four electronic databases from January 1999 to January 2022 and included RCTs of healthy participants/athletes and people with upper, lower, or spinal conditions, who received IASTM versus other active treatment for clinical outcomes (function, pain, and range of motion). RESULTS: Forty-six RCTs were considered eligible for data analysis. Effects of IASTM plus other treatment versus other treatment on function and pain intensity were not statistically significant or clinically meaningful (very low quality, SMD -0.28, 95% CI -0.66 to 0.09) and (very low quality, SMD -0.05, 95% CI -0.53 to 0.43) at up to one-year follow-up respectively. No clinically meaningful improvements were found on range of motion outcomes. Out of the 46 included RCTs, only 10 assessed and reported IASTM-related adverse events. CONCLUSION: Evidence of very low-quality certainty does not support the efficacy of IASTM in individuals with or without various pathologies on function, pain, and range of motion in the management of upper body, lower body, or spinal conditions. IMPLICATIONS FOR REHABILITATIONThe included RCTs had a high risk of bias and were assessed as very-low quality evidence for all the included outcomes.IASTM does not lead to clinically meaningful improvements in function, pain, or range of motion in individuals with upper body, lower body, and spinal conditions.The publication of IASTM trials in suspected predatory journals is increasing.The available evidence on IASTM does not support its use to improve function, pain, or range of motion in individuals with upper body, lower body, and spinal conditions.Health care practitioners should consider other evidence-based management strategies (physical activity and exercise) to improve function, pain, or range of motion in individuals with musculoskeletal injuries and disorders.Given the rise of publications on IASTM in suspected predatory journals, health care practitioners should be judicious to examine the legitimacy of a journal when searching for evidence on IASTM treatment technique.

Performance of 5-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction in the STABILITY Study: A Subgroup Analysis.

BACKGROUND: Anterior cruciate ligament (ACL) reconstructions (ACLRs) with graft diameters <8mm have been shown to have higher revision rates. The 5-strand (5S) hamstring autograft configuration is a proposed option to increase graft diameter. PURPOSE: To investigate the differences in clinical outcomes between 4-strand (4S) and 5S hamstring autografts for ACLR in patients who underwent ACLR alone or concomitantly with a lateral extra-articular tenodesis (LET) procedure. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Data from the STABILITY study were analyzed to compare a subgroup of patients undergoing ACLR alone or with a concomitant LET procedure (ACLR + LET) with a minimum graft diameter of 8mm that had either a 4S or 5S hamstring autograft configuration. The primary outcome was clinical failure, a composite of rotatory laxity and/or graft failure. The secondary outcome measures consisted of 2 patient-reported outcome scores (PROs)-namely, the ACL Quality of Life Questionnaire (ACL-QoL) and the International Knee Documentation Committee (IKDC) score at 24 months postoperatively. RESULTS: Of the 618 patients randomized in the STABILITY study, 399 (228 male; 57%) fit the inclusion criteria for this study. Of these, 191 and 208 patients underwent 4S and 5S configurations of hamstring ACLR, respectively, with a minimum graft diameter of 8mm. Both groups had similar characteristics other than differences in anthropometric factors-namely, sex, height, and weight, and Beighton scores. The primary outcomes revealed no difference between the 2 groups in rotatory stability (odds ratio [OR], 1.19; 95% CI, 0.77-1.84; P = .42) or graft failure (OR, 1.13; 95% CI, 0.51-2.50; P = .76). There was no significant difference between the groups in Lachman (P = .46) and pivot-shift (P = .53) test results at 24 months postoperatively. The secondary outcomes revealed no differences in the ACL-QoL (P = .67) and IKDC (P = .83) scores between the 2 subgroups. CONCLUSION: At the 24-month follow-up, there were no significant differences in clinical failure rates and PROs in an analysis of patients with 4S and 5S hamstring autografts of ≥8mm diameter for ACLR or ACLR + LET. The 5S hamstring graft configuration is a viable option to produce larger-diameter ACL grafts.

Psychometric Properties of the Patient-Specific Functional Scale in Patients with Low Back Pathology: A Systematic Review and Meta-Analysis.

Purpose: This systematic review and meta-analysis identifies, critically appraises, synthesizes, and meta-analyses the reported psychometric properties of the Patient-Specific Functional Scale (PSFS) in patients with low back pain or pathology. Method: The MEDLINE, Embase, PubMed, and Google Scholar databases were searched from their inception to September 2019. We included prospective measurement studies that reported on the psychometric properties (reliability, validity, responsiveness) of the PSFS in people with low back pain or pathology. We followed the COnsensus-based Standards for the selection of health Measurement INstruments 2018 guideline for systematic reviews. We performed both quantitative and qualitative syntheses in which the results were summarized on the basis of the reported measurement properties and study quality. Results: Ten eligible studies were included. The pooled PSFS reliability measure was excellent (intra-class correlation coefficient = 0.89; 95% CI: 0.75, 0.95). Validity measures displayed correlations that ranged from -0.47 to 0.69 when compared with other patient-reported outcome measures (PROMs) or other tests. Eight studies had assessed the responsiveness of the PSFS. Effect sizes reported were large (≥ 0.91). Conclusions: The PSFS is a reliable, valid, and responsive PROM for patients with low back pain or pathology.

Objectif : procéder à la détermination, à l'évaluation critique, à la synthétisation et à la méta-analyse des propriétés psychométriques déclarées de l'échelle fonctionnelle propre aux patients (PSFS) ayant des douleurs ou une pathologie dorsales. Méthodologie : les chercheurs ont consulté les bases de données MEDLINE, Embase, PubMed et Google Scholar depuis leur création jusqu'en septembre 2019. Ils ont inclus les études de mesures prospectives sur les propriétés psychométriques (fiabilité, viabilité, réactivité) du PSFS chez les personnes souffrant de douleurs ou d'une pathologie dorsales. Ils ont respecté les directives COSMIN 2018 sur les normes consensuelles pour la sélection d'instruments de mesure de la santé en vue d'analyses systématiques. Ils ont effectué à la fois une synthèse quantitative et une synthèse qualitative dans lesquelles ils ont résumé les résultats en fonction des propriétés métriques déclarées et de la qualité des études. Résultats : dix études admissibles ont été retenues. La mesure de fiabilité regroupée de la PSFS était excellente, avec un coefficient de corrélation intraclasse de 0,89 (IC à 95 % : 0,75, 0,95). Les mesures de validité ont révélé des corrélations entre −0,47 et 0,69 par rapport à d'autres mesures de résultats déclarées par les patients (PROM) ou d'autres tests. Huit études ont évalué les mesures de réactivité du PSFS. Les ampleurs de l'effet déclarées étaient importantes, à 0,91 ou plus. Conclusion : la PSFS est une PROM fiable, valide et réactive chez les patients ayant des douleurs ou des pathologies lombaires.

The clinical outcome of physiotherapy after reversed shoulder arthroplasty: a systematic review.

PURPOSE: The purpose of this systematic review was to analyze the current literature on the clinical outcomes of physiotherapy (PT) program after reversed total shoulder arthroplasty (rTSA) and to summarize the improvements in this population. METHODS: A search was performed in four databases (MEDLINE, Embase, PubMed, Google Scholar) from its inception to 30 April 2020. Data were extracted to describe the study design and rehab programs. The quality of evidence was assessed as high, moderate, and low-level according to the Evaluation of Quality of an Intervention Study critical appraisal criteria. RESULTS: There were 22 eligible studies including two randomized controlled trials, four prospective cohort studies, 10 retrospective reviews, five case-series, and one case-control study, with the sample sizes ranging from 9 to 474 patients followed for 1-10 years. All studies indicated substantial improvement in patients after PT program in terms of functional outcomes and forward flexion. CONCLUSIONS: High-quality RCTs are required to provide more conclusive results. We identified substantial variation in the post-operative PT programs except for the progressive mobilization strategy and the common management following surgery to increase the soft tissue healing within 4-6 weeks.Implications for RehabilitationThe reverse shoulder arthroplasty (rTSA) has been widely utilized for patients with rotator cuff arthropathy, primary arthritis, and proximal fractures.A successful outcome of rTSA is not only depending on the surgical management, but also depended on physiotherapy (PT) programs.Our systematic review concluded that a 12-week PT program starting with immobilization for 4-6 weeks, followed by 3-4 phases PT exercises including PROM, AAROM, AROM, and strength training was recommended as common management for patients received rTSA.Due to the huge variation in the included studies, the evidence of PT protocol in our study was not sufficient to summarize the better clinical practice suggestions regarding rTSA rehabilitation.

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.

Rasch analysis of the firefighters' critical incident inventory questionnaire.

BACKGROUND: The Critical Incident Inventory (CII) was developed to assess stressful exposures in firefighters and emergency service workers. The CII includes six subscales: trauma to self, victims known to fire-emergency worker, multiple casualties, incidents involving children, unusual or problematic tactical operations, and exposure to severe medical trauma. OBJECTIVES: To examine the construct validity of all subscales of the Critical Incident Inventory (CII) by assessing the unidimensionality of the scales, and the interval properties of CII subscales by examining fit to the Rasch model and ordering of item thresholds. METHODS: This was a secondary data analysis based on survey data collected from a sample of 390 firefighters. RESULTS: Item 4 and Item 20 were removed with the confirmation of unacceptable fit residual. This revised version of the CII showed satisfactory fit to the Rasch model by non-significant Chi-square test and acceptable level of item fit. We rescored the CII original version and considered all items as only dichotomous response options where 0 represented the original no experience, and 1 presents the combination of experiencing 1, 2, 3 cases. CONCLUSION: The re-appraisal of the revised version CII indicated a satisfactory level of Rasch model fit.

Joint Protection Programmes for People with Osteoarthritis and Rheumatoid Arthritis of the Hand: An Overview of Systematic Reviews.

Purpose: Joint protection has been introduced as a self-management strategy for people with rheumatoid arthritis (RA) and osteoarthritis (OA) of the hand. The purpose of this study was to conduct an overview of systematic reviews (SRs) and critically appraise the evidence to establish the current effectiveness of joint protection for people with hand RA and OA. Method: A comprehensive search was conducted of six databases from January 2008 to May 2018. SRs that evaluated the effectiveness of joint protection for people with hand arthritis were eligible for inclusion. The A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 checklist was used to assess the methodological quality of each SR. Results: Nine SRs were included: two were rated as high quality, and seven were rated as low quality. Seven of the nine did not take into account risk of bias when interpreting or discussing their findings, six did not assess publication bias, and five did not register their protocol. The high-quality reviews found no clinically important benefit of joint protection for pain, hand function, and grip strength levels. The low-quality reviews reported improvements in function, pain, grip strength, fatigue, depression, self-efficacy, joint protection behaviours, and disease symptoms in people with RA. Conclusions: High-quality evidence from high-quality reviews found a lack of any clinically important benefit of joint protection programmes for pain, hand function, and grip strength outcomes, whereas low-quality evidence from low-quality reviews found improvements in these outcomes.

Objectif : la protection articulaire est présentée comme une stratégie d'autogestion pour les personnes atteintes d'arthrite rhumatoïde (AR) et d'arthrose de la main. La présente étude visait à survoler les analyses systématiques (AS) et à procéder à une évaluation critique des données probantes afin d'établir l'efficacité actuelle de la protection articulaire pour les personnes ayant une AR et une arthrose de la main. Méthodologie : les chercheurs ont procédé à une recherche exhaustive de six basses de données entre janvier 2008 et mai 2018. Ils ont extrait les AS qui évaluaient l'efficacité de la protection articulaire des personnes atteintes d'arthrite de la main. Ils ont ensuite utilisé la liste AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews) pour évaluer la qualité méthodologique de chaque AS. Résultats : neuf AS ont été incluses : deux ont été classées comme de haute qualité et sept, de faible qualité. Sept des neuf ne tenaient pas compte du risque de biais au moment d'interpréter ou de présenter les résultats, six n'ont pas évalué les biais de publication et cinq n'ont pas enregistré leur protocole. Les analyses de qualité n'ont constaté aucun avantage d'importance clinique à la protection articulaire pour atténuer la douleur et préserver la fonction de la main et la force de préhension. Les analyses de basse qualité rendaient compte d'améliorations à la fonction, à la douleur, à la force de préhension, à la fatigue, à la dépression, à l'autoefficacité, aux comportements de protection articulaire et aux symptômes de maladie chez les personnes ayant une AR. Conclusions : selon les données de qualité d'analyses de qualité, les programmes de protection articulaire n'apportaient pas d'avantages importants sur le plan clinique en matière de douleur, de fonction de la main et de force de préhension, mais les données de faible qualité provenant d'analyses de faible qualité constataient des améliorations à l'égard de tous ces résultats.

The state of trial registrations in the field of Orthopaedics in years 2015-2020. A meta-epidemiological study.

Objective: To assess the extent and trends in registration of Orthopaedic randomized clinical trials (RCTs) between 2015 and 2020. Design: Epidemiological study. Primary publications of RCTs published in top Orthopaedic journals (ISI Journal Citation Reports 2019 rankings) between 2015 and 2020 were included in this meta-epidemiological study with no restrictions on patient population, intervention/control groups or outcome type. Independent reviewers in pairs were involved in RCT selection and data extraction. The proportion of RCTs published that were registered (prospectively or retrospectively) or not registered were reported using counts and percentages stratified by years for each journal. Results: A total of 474 primary RCTs were considered eligible. We identified 157 out of 474 RCTs (33% of RCTs across journals) that were reported to have been registered prospectively.The proportion of prospective RCT registrations had increased by 40% (10%-50%) between 2015 and 2020. On the other hand, the proportion of RCTs with no registrations were reduced by 29% (50%-21%) between 2015 and 2020. Conclusion: Prospective RCT registration in the past 5 years in the field of orthopaedic has increased, but 2/3 of published RCTs still failed to report prospective registration.

Psychometric properties of the single assessment numeric evaluation in patients with lower extremity pathologies. A systematic review.

OBJECTIVES: To identify, critically appraise and synthesize the reported psychometric properties of the Single Assessment Numeric Evaluation in patients with lower extremity pathologies. DATA SOURCES: Medline, Embase, Scopus and CINAHL databases from inception till May 2019 were searched. STUDY SELECTION OR ELIGIBILITY CRITERIA: Studies that included patients with lower extremity pathologies that reported on the measurement properties of the Single Assessment Numeric Evaluation were included. DATA EXTRACTION: Individual studies were appraised by two independent authors to summarize the quality of available evidence, using the COSMIN 2018 guidelines for systematic reviews of patient reported outcome measures. The results were descriptively summarized and reported. DATA SYNTHESIS: Nine eligible studies were included. The Single Assessment Numeric Evaluation reliability measures indicated coefficients of variation <1% (doubtful quality; indeterminate properties). Validity measures displayed correlations of 0.51-0.88 between the Single Assessment Numeric Evaluation and International Knee Documentation Committee, Western Ontario/McMaster Universities Osteoarthritis Index, Knee Outcome Survey, and Revised Foot Function Index. Two measurement studies assessed the Single Assessment Numeric Evaluation responsiveness measures. Effect sizes of ≥1.75; and minimal clinically important differences of 7.0 (6 months) and 19.0 (12 months) follow ups were reported. CONCLUSION: Adequate quality evidence with sufficient measurement properties demonstrated that the Single Assessment Numeric Evaluation is a valid tool in assessing perception of condition in female participants with knee injuries and in military population patients with ankle sprains.Implications for rehabilitationSingle Assessment Numeric Evaluation is a valid and responsive tool in assessing perception of condition in female participants with knee injuries.Single Assessment Numeric Evaluation is a valid tool in assessing perception of condition in military population patients with ankle sprains.

Five- and six-strand hamstring grafts consistently produce appropriate graft diameters for anterior cruciate ligament reconstruction.

PURPOSE: Hamstring tendon graft diameter less than 8 mm has been correlated with an increased risk of anterior cruciate ligament reconstruction (ACLR) graft failure. The purpose of this study was to measure and compare the diameter of 3-, 4-, 5-, and 6-strand gracilis and semitendinosus (ST) hamstring tendon (HT) ACLR grafts, and to determine if there is a correlation between anthropometric data, HT length, and diameter of the HT ACLR graft. METHODS: Male patients (n = 78) undergoing primary or revision ACLR with a HT autograft between July 2018 and March 2020 were recruited. Pre-operative anthropometric data was collected. Gracilis and ST tendons were harvested and the length and diameter measured. The following HT graft configurations were prepared in each patient: triple ST; double gracilis + double ST; double gracilis + triple ST; triple gracilis + triple ST. Paired t-tests and Pearson's correlation coefficients were used to assess demographics, anthropometrics, graft diameter, and tendon length. A non-parametric test was used to compare femoral and tibial ACL graft diameters of the 3-, 4-, 5-, and 6-strand HT graft configurations. RESULTS: For the femoral end, 10%, 19%, 69% and 86% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5- and 6-strand HT graft configurations respectively. For the tibial end, 27%, 10%, 83%, and 92% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5-, and 6-strand HT graft configurations respectively. The largest increases in HT graft diameters were noted between the femoral end of 6- vs. 3-strand grafts (mean difference 1.7 ± 0.5 mm; p < 0.001) and between the tibial end of 6- vs. 4-strand grafts (mean difference 2.0 ± 0.5 mm; p < 0.001). Height and leg length were moderately positively correlated with ST tendon length (r = 0.54-0.51) and gracilis tendon length (r = 0.52-0.45), and thigh and shank lengths were moderately positively correlated with ST tendon length (r = 0.43 and 0.40, respectively). CONCLUSION: Traditional 4-strand HT ACL autografts in male patients undergoing ACLR in the United Arab Emirates result in graft diameters less than 8 mm in the majority of patients. LEVEL OF EVIDENCE: III.

Distribution of Number, Location of Pain and Comorbidities, and Determinants of Work Limitations among Firefighters.

INTRODUCTION: The unique demands of firefighting results in acute, recurrent, or chronic pain complications. We aimed to describe the percentage distribution of number and location of painful sites among FFs and determine whether work limitations differed based on the number or location of painful sites, age, and/or sex. METHODS: About 325 firefighters completed a work limitation questionnaire (WLQ-26) and a checklist to indicate painful regions of the body using either a paper format or an online survey. A one-way ANOVA was employed to analyze the transformed work limitation scores; this was a two-sided test with a significance level of <0.05, to determine if work limitations differed among firefighters based on the number or location of painful sites, age, and/or sex. RESULTS: The data analyzed consisted of 325 (men = 216, women = 109) FFs in total. The percentage distribution of the number of painful sites in our study cohort was 43% no pain, 17% one painful site, 19% two painful sites, and 21% three or more painful sites. The percentage distribution of the locations of painful sites was 43% no pain, 41% spine, 9% lower extremity, and 7% upper extremity. An estimated 31% of FFs (n = 102) reported non-MSK comorbidities with 23% (n = 76) reporting at least one non-MSK comorbidity and 8% (n = 26) reported having two or more comorbidities. FFs > 45 years of age experienced more physical work limitations than FFs ≤ 45years (mean difference: 0.74/10; 95% CI .19-1.29; p = 0.008). CONCLUSIONS: The majority of firefighters reported having at least one painful site and indicated the spine as the most common painful location. Age, the number of painful sites, and location of pain were identified as a potential contributor to physical/mental and work output limitations.

Prevalence of musculoskeletal symptoms among Canadian firefighters.

BACKGROUND: Musculoskeletal symptoms (MSSs) remain the most frequently reported type of injuries sustained during fire-ground operations in firefighters. However, there is a paucity of reports concerning the prevalence estimates of MSSs among female firefighters and different fire services across Canada. OBJECTIVES: To assess the point prevalence of self-reported MSSs, stratified by age and sex in a cohort of active duty firefighters from across Canada, and to determine whether age, sex or length of service can be used to predict the likelihood of the number of MSSs sustained. METHODS: We recruited 390 firefighters (272 males, 118 females). To identify the prevalence of self-reported rates of MSSs, firefighters were asked to complete a standardized 11-item questionnaire that asked, "Please indicate whether you have experienced pain in any body region within the last week", with response options that included "Yes", "No", and "Head", "Neck", "Shoulder", "Arm/Elbow/Hand", "Back", "Stomach/Abdomen", "Upper Thigh", "Knee", "Lower Leg", "Foot", "Other, please specify". RESULTS: Among the 390 full-time firefighters, 212 (54%) indicated to have experienced some type of MSSs within the last week. The most prevalent region-specific MSSs included, 123 (32%) in the back region, 92 (24%) in the shoulder region, 74 (19%) in the neck region and 70 (18%) in the knee region. In addition, women indicated a 1.6 times greater likelihood of sustaining ≥2 MSSs when controlling for individual differences in age and years of service. CONCLUSIONS: The point prevalence of MSSs in a cohort of full-time firefighters was 54% (55% males; 53% females). Women experienced a 1.4-1.6 times greater likelihood of sustaining MSSs when controlling for individual differences in age and years of service.

Prevalence of exposure to critical incidents in firefighters across Canada.

BACKGROUND: Firefighters partake in and are exposed to a range of potentially traumatic events throughout their careers and the impact of such critical events could last a life time. Therefore, capturing such lifetime exposures is necessary for supporting firefighter health. OBJECTIVE: To estimate the prevalence of critical incidents in firefighters across Canada and determine whether the number of critical events varied based on age, gender, years of service; and to integrate our prevalence estimates using meta-analysis with previous studies to provide a pooled estimate. METHODS: We recruited 464 firefighters. Firefighters were asked to complete a self-report Critical Incident Inventory (CII) survey that included questions on exposure to critical events throughout their firefighting careers. Individual CII items were summarized as percentages, number of exposures, the total number and percentages of exposures to each of the six CII sub-scales. We also performed a multivariate enter regression analysis with the CII total score as dependant variable, and age, gender, years of service as independent variables, to estimate if the number of critical incidents among firefighters varied based on age, gender and years of service. RESULTS: Among the 390 full-time firefighters, 376 (96.4%) indicated exposure to some type of critical incident. More specifically, 351 (90%) reported a "respond to incident involving one or two deaths", and 314 (81%) reported a "respond to incident involving multiple serious injuries". Age, gender and years of service accounted for only 37.4% of the variance in the number of critical incidents among firefighters. In addition, our pooled estimate results of previous similar studies indicated an overall prevalence estimate of critical incident exposures was 93.40% (4 studies, 1725 of 1877 firefighters, 95% CI: 82.26 -99.30). CONCLUSIONS: Nearly all (96.4%) firefighters were exposed to some form of critical event over the span of their entire firefighting careers. Age, gender and years of service accounted for one-third of the variance in the number of critical incident exposures among firefighters.

Psychometric properties of the Single Assessment Numeric Evaluation (SANE) in patients with shoulder conditions. A systematic review.

BACKGROUND: Musculoskeletal injuries (i.e. shoulder pain) is the third most commonly reported symptom. The development of the Single Assessment Numeric Evaluation (SANE) scale has presented clinicians and researchers with a more efficient approach in measuring function. Therefore, it is important to establish the reliability, validity and responsiveness properties of this scale, prior to its application in research and clinic. OBJECTIVES: To identify, critically appraise and synthesize the reported psychometric properties of the SANE scale in patients with shoulder related pathologies. DATA SOURCES: Medline, Embase, Scopus and CINAHL databases from inception till February 2019 were searched. Two independent reviewers carried out the systematic electronic searches in each database and screened the retrieved studies and assessed their eligibility. STUDY SELECTION OR ELIGIBILITY CRITERIA: Randomized/prospective studies, that included patients with shoulder joint related pathologies, that reported on the psychometric properties (reliability, validity, responsiveness) of SANE scale. STUDY APPRAISAL AND SYNTHESIS METHODS: The "Quality Appraisal for Clinical Measurement Research Reports Evaluation Form" - a 12-item structured clinical measurement specific appraisal tool was used to assess studies. A qualitative synthesis was performed, and main results summarized based on the shoulder conditions, reported properties and study quality. RESULTS: Nine studies were included. The quality ranged from 82% to 95% - very good to excellent quality. SANE scale reliability measures indicated excellent reliability properties. The Intra-class Correlation Coefficient (ICC) was ≥0.80 and Standard Error of Measurement (SEM) ranged from 4.23 to 7.82 points. Validity measures displayed correlations of 0.50-0.88 (moderate to very strong correlations) between the SANE scale and other patient reported outcomes (American Shoulder and Elbow Surgeons, Rowe score, Simple Shoulder Test, Physical Function Computerized Adaptive Test). Four studies assessed SANE scale responsiveness measures. Effect sizes of 1.5 and 0.83; and minimal clinically important differences that ranged from 27.25 to 37.05 (anchor-based approach) and 11.80 to 18.1 (distribution-based approach) were reported. LIMITATIONS: Caution must be used when interpreting our ICCs values. CONCLUSION IMPLICATIONS OF KEY FINDINGS: Very good to excellent quality evidence indicated that the SANE scale demonstrates evidence of a reliable, valid and responsive tool in patients with shoulder related pathologies. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42018117874.

Agreement between original and Rasch-approved neck disability index.

BACKGROUND: Given the high prevalence of neck pain, the neck disability index (NDI) has been used to evaluate patient status and treatment outcomes. Modified versions were proposed as solutions to measurement deficits in the NDI. However, the original 10-item NDI was scored out of 50 and is still the most frequently administered version. Examining the extent of agreement between traditional and Rasch-based versions using Bland-Altman (B&A) plots will inform our understanding of score differences that might rise from using different versions. Therefore, the objective of current study was to describe the extent of agreement between different versions of NDI. METHODS: The current study was a secondary data analysis. The study data was compiled from two prospectively collected data sources. We performed a comprehensive literature search to identify Rasch approved NDI within four databases including Embase, Medline, PubMed, and Google Scholar. Alternate forms and scorings were compared to each other and to the standard NDI. We graphed B&A plots and calculated the mean difference and the 95% limits of agreement (LoA; ±1.96 times the standard deviation). RESULTS: Two Rasch approved alternative versions (8 vs 5 items) were identified from 303 screened publications. We analyzed data from 201 (43 males and 158 females) patients attending community clinics for neck pain. We found that the mean difference was approximately 10% of the total score between the 10-item and 5-item (- 4.6 points), whereas the 10-item versus 8-item and 8-item versus 5-item had smaller mean differences (- 2.3 points). The B&A plots displayed wider 95% LoA for the agreement between 10-item and 8-item (LoA: - 12.0, 7.4) and 5-item (LoA: - 14.9, 5.8) compared with the LoA for the 8-item and 5-item (LoA: - 7.8, 3.3). CONCLUSION: Two Rasch-based NDI solutions (8 vs 5 items) which differ in number of items and conceptual construction are available to provide interval level scoring. They both provide scores that are substantially different from the ordinal NDI, which does not provide interval level scoring. Smaller differences between the two Rasch solutions exist and may relate to the items included. Due to the size and unpredictable nature of the bias between measures, they should not be used interchangeably.

Measurement Properties of a 2-Dimensional Movement Analysis System: A Systematic Review and Meta-analysis.

OBJECTIVES: To critically appraise, compare, and summarize the quality of the measurement properties of the Dartfish software across various populations and motion tasks. DATA SOURCES: Systematic electronic searches were performed in the PsychInfo, Embase, Medline@Ovid, CINAHL, and Google Scholar databases from January 1999 to January 2020. STUDY SELECTION: Prospective measurement studies published in English peer-reviewed journals that reported on at least 1 psychometric property (reliability, validity, measurement error) using Dartfish were included. An independent reviewer performed searches and identified studies. DATA EXTRACTION: We followed the COnsensus-based Standards for the selection of health Measurement INstruments 2018 guideline for abstracting and assessing data quality. Independent extraction was performed by 2 individual authors. The extracted data involved the author, year, study population, setting, sample size, and measurement properties, as well as information on camera positions, analyzed movement variables, and the corresponding strategy for addressing perspective error. DATA SYNTHESIS: In total, 23 studies were included in this review. Studies were pooled to examine inter-rater reliability estimates for different tasks: single-leg squat angle (2 studies, 115 participants; intra-class correlation coefficient [ICC], 0.94; 95% confidence interval [CI], 0.62-0.99), single-leg vertical drop jump angle (2 studies, 94 participants; ICC, 0.92; 95% CI, 0.20-0.99), and vertical drop jump angle (2 studies, 100 participants; ICC, 0.88; 95% CI, 0.83-0.92). Concurrent validity (2-dimensional Dartfish vs 3-dimensional Vicon) was established using the push and release task, single leg stance, and single leg stance with acutely induced dizziness in 45 healthy Parkinson patients. A correlation of 0.59 to 0.98 was reported. For tracking angles across various movements, a measurement error of approximately 10° retest variation was reported in 3 studies. CONCLUSION: Dartfish is a reliable software for assessing a variety of tasks across multiple contexts of assessments. Evidence suggests that the estimates of motion obtained with Dartfish are valid for single plane movements.

Cross-cultural adaptions and measurement properties of the WORC (Western Ontario rotator cuff index): a systematic review.

BACKGROUND: To evaluate the translations, cross-cultural adaptation procedures and measurement properties of the Western Ontario Rotator Cuff Index (WORC), when it is adapted for different cultures. METHODS: A systematic review was performed, considering different cultural adaptions of the WORC accessible through MEDLINE, CINAHL, EMBASE and/or Google Scholar. Included were prospective cohort studies that used an adapted version of the WORC to measure QoL in patients with rotator cuff disorders. All studies were evaluated according to the current guidelines for cross-cultural adaptations and measurement properties. RESULTS: The search retrieved 14 studies that met the inclusion criteria. According to the recommended guidelines for cross-cultural adaptations, 8 studies performed 100% of the steps, 2 studies performed 80% of the steps and 4 studies used previously translated measures. When evaluating the studies' psychometric properties based on the quality criteria, none of the studies reported all recommended measurement properties. All of the studies reported the measurement property of reliability, but none of the studies reported agreement. Internal consistency was fully reported by 15% of studies. Construct validity was reported by 43% of studies. Only one study reported 100% of the cross-cultural adaption guidelines and 83% of the quality criteria. CONCLUSIONS: Although the majority of studies demonstrated proper adaptation procedures, testing of the measurement properties were inadequate. It is recommended that the current adapted versions of the WORC undergo further testing before use in clinical practise, and researchers continue to adapt the WORC for different cultures as it proves to be an appropriate instrument for assessing rotator cuff pathology.

Psychometric Properties of Performance-Based Functional Tests in Patients With Shoulder Pathologies: A Systematic Review and Meta-analysis.

OBJECTIVES: To identify, critically appraise, and synthesize the reported psychometric properties of shoulder performance-based functional tests in patients with shoulder diseases. DATA SOURCES: MEDLINE, Embase, Scopus, and Cumulative Index to Nursing and Allied Health databases from inception until March 2019 were searched. STUDY SELECTION: Randomized/prospective studies of patients with shoulder diseases that reported on the psychometric properties (reliability, validity, responsiveness) of performance-based functional tests (Standardized Index of Shoulder Function [FI2S], Functional Impairment Test-Hand and Neck/Shoulder/Arm, Closed Kinetic Chain Upper Extremity Stability Test, Timed Functional Arm and Shoulder Test, Shoulder Function Index [SFInX], and hand to neck, scapula, and opposite scapula). DATA EXTRACTION: We used the Consensus-Based Standards for the Selection of Health Measurement Instruments 2018 guideline for systematic reviews. We performed a qualitative synthesis in which the results were summarized based on reported measurement properties and study quality. DATA SYNTHESIS: Eight eligible studies were included with 28 measures (16 reliability; 10 validity; 2 responsiveness). Performance-based functional tests reliability (test-retest, intra- and interrater) measures indicated excellent reliability properties. Intraclass correlation coefficient (ICC) was ≥0.83 and standard error of the mean (SEM) ranged from 0.03-13.3 points. Validity (construct/convergent/concurrent) measures displayed correlations of -0.76 to 0.91 between performance-based functional tests and other patient-reported outcomes (Disabilities of the Arm, Shoulder, and Hand, Constant, Shoulder Pain and Disability Index). Two studies assessed the responsiveness measures performance-based functional tests. Effect sizes of 0.44 and 1.50 and minimal clinically important differences of 10.3 using the anchor-based approach were reported. CONCLUSIONS: The FI2S and the SFInX are reliable, valid, and responsive in patients with shoulder-related diseases.