A cross-sectional observational study comparing individuals with a symptomatic full-thickness rotator cuff tear with age-matched controls.

Background: A full-thickness rotator cuff tear (FTRCT) is defined as a complete tear of one of the four rotator cuff muscle tendons (supraspinatus, infraspinatus, subscapularis or teres minor). This condition can lead to pain and reduced function. However, not all FTRCT are symptomatic. A better understanding of the characteristics that lead some individuals with FTRCT to experience pain is fundamental to improve strategies used to manage this condition. This level II descriptive study aimed to explore potential sociodemographic, anatomical, psychosocial, pain sensitivity, biomechanical and neuromuscular variables that may differ between individuals with symptomatic FTRCT and age-matched individuals with asymptomatic shoulders. Methods: In this cross-sectional observational study, adults aged 50 to 80 years of age, either with symptomatic FTRCT or no shoulder pain, were recruited via convenience sampling. Participants filled out questionnaires on sociodemographic and psychosocial variables. Then, various tests were performed, including pain pressure threshold, shoulder range of motion, shoulder muscle strength, shoulder ultrasound and radiologic examination, and sensorimotor functions testing. Each variable was compared between groups using univariate analyses (independent t-tests, Mann-Whitney U tests, exact probability Fisher tests). Significance was set at 0.05. Results: FTRCT (n = 30) and Control (n = 30) groups were comparable in terms of sex, age, and number of comorbidities. The symptomatic FTRCT group showed a higher proportion of smokers (P = .026) and more participants indicated consuming alcohol or drugs more than they meant to (P = .010). The FTRCT group had a significantly higher prevalence of glenohumeral osteophytes (48% vs. 17%; P = .012). Participants in the FTRCT group were significantly more stressed (P = .04), anxious (P = .003) and depressed (P = .002). The FTRCT group also showed significantly higher levels of pain catastrophisation (P < .001) and sleep disturbance (P < .001). The FTRCT group showed significantly lower range of motion for flexion (P < .001), and external rotation at 0° (P < .001) and 90° (P < .001) of abduction. Isometric strength in both abduction and external rotation were weaker (P = .005) for the FTRCT group. Conclusion: Sociodemographic, anatomical, psychosocial and biomechanical variables showed statistically significant differences between the FTRCT and Control groups.

Measuring upper limb active joint position sense: Introducing a new clinical tool - The Upper Limb Proprioception Reaching Test.

BACKGROUND: Proprioception is our sense of body awareness, including the sub-category of active joint position sense (AJPS). AJPS is fundamental to joint stability and movement coordination. Despite its importance, there remain few confident ways to measure upper limb AJPS in a clinic. OBJECTIVE: To assess a new AJPS clinical tool, the Upper Limb Proprioception Reaching Test (PRO-Reach; seven targets), for discriminant validity, intra-rater and absolute reliability. DESIGN: Cross-sectional measurement study. METHODS: Seventy-five healthy participants took part in a single session with 2 consecutive evaluations (E1 and E2) (within-day reliability). Twenty participants were randomly selected to perform a dominant shoulder fatigue protocol (discriminant validity), whereafter a third evaluation was repeated (E3). The PRO-Reach was analyzed with paired t tests (discriminant validity), intra-class correlation coefficients (ICCs) and minimal detectable change [MDC]) (intra-rater: within-day and between-trial relative and absolute reliability). RESULTS: The PRO-Reach supports moderate (mostly superior targets) to excellent (mostly inferior targets) reliability. Between-trial ICCs (T1/T2/T3) varied between 0.72 and 0.90, and within-day (E1/E2) ICCs between 0.45 and 0.72, with associated MDC95 values (3.9-5.0 cm). The overall scores (seven targets) supported the strongest within-day reliability (ICC = 0.77). The inferior targets demonstrated the highest between-trial and within-day reliability (ICCs = 0.90 and 0.72). A fatigue effect was found with the superior and superior-lateral targets (P < .05). CONCLUSIONS: The inferior targets and overall scores demonstrate the strongest reliability. The use of the PRO-Reach tool may be suitable for clinical use upon further psychometric testing amongst pathological populations. LEVEL OF EVIDENCE: Level III cross-sectional study.

French Version of the Musculoskeletal Pain Intensity and Interference Questionnaire for Professional Orchestra Musicians (MPIIQM-F): Cross-Cultural Adaptation and Preliminary Validation.

BACKGROUND: The Musculoskeletal Pain Intensity and Interference Questionnaire for Professional Orchestra Musicians (MPIIQM) is a prominent patient-reported outcome measure (PROM) in the musicians' health literature. It has been published in at least four languages, but not in French. AIMS: To cross-culturally adapt the MPIIQM into French and establish the preliminary psychometric properties (validity, reliability, and responsiveness) of the MPIIQM-F. METHODS: Standardized cross-cultural adaptation methods included forward translations, an expert committee, and verbal field tests in the target population. Psychometric properties were assessed in a population of French-speaking professional orchestra musicians who participated in three evaluation sessions. Evaluated properties include content, face, structural and construct validity, reliability (internal consistency, test-retest reliability, minimal detectable change [MDC], measurement error), and responsiveness (effect size and standardized response means [SRM]). RESULTS: Sixty-one French-speaking orchestra musicians participated in the psychometric validation. Exploratory factor analysis revealed a two-factor solution equivalent to previous versions, confirming the Pain Intensity and Interference subscales. Spearman correlations for construct validity were as hypothesized for four of six hypotheses (minor deviances for the other two hypotheses) using the Brief Pain Inventory, Disability of the Arm, Shoulder and Hand Performing Arts Module, and PROMIS Global Health Scale as comparators. Reliability results demonstrated high internal consistency (Cronbach's a=0.84-0.89), excellent test-retest reliability (intraclass correlation coefficient = 0.91-0.97), and small measurement error with MDC for the overall scale <10%. Responsiveness resulted in moderate to large effect sizes and SRM (0.54-0.87). CONCLUSIONS: Preliminary validation of the MPIIQM-F suggests good validity, reliability, and responsiveness, indicating its suitability for use in French-speaking orchestra musicians.

UTAUT2-based questionnaire: cross-cultural adaptation to Canadian French.

PURPOSE: The extended version of the Unified Theory of Acceptance and Use of Technology (UTAUT2) aims to better understand acceptance of technology. The objective of this study was to translate the English UTAUT2-based questionnaire to Canadian French. METHODS: The translation included five steps: (1) Forward translation, (2) Synthesis of the translated versions, (3) Backward translation, (4) Synthesis by a multidisciplinary committee and proposal of the Pre-final Canadian French version, and (5) Cognitive debriefing. Cognitive debriefing included the assessment of the questionnaire items' clarity by (1) a sample of workers, and (2) rehabilitation professionals. Any item not reaching an 80% inter-rater agreement for clarity or relevance was re-evaluated. RESULTS: The multidisciplinary committee included six researchers and clinicians from four different backgrounds. Twelve workers and 12 experts participated in the cognitive debriefing. Each item (n = 40) was judged as "clear" by at least 92% of the worker sample. Six and four items were reviewed following clarity and relevance assessments. The final version was approved unanimously. CONCLUSION: A Canadian French version of the UTAUT2-based questionnaire has been developed. Studies are necessary to examine cultural and semantic equivalence of the original and translated versions, and the cultural appropriateness of the questionnaire.IMPLICATIONS FOR REHABILITATIONThere is an exponential growth in technology, including in the rehabilitation field.Implementing rehabilitation technology into clinical practice remains a challenge.The UTAUT model, and its extension, help to better understand the acceptance of technology before its implementation.The UTAUT2-based questionnaire evaluates the acceptability of rehabilitation technology prior to implementation.

Reliability, validity, and responsiveness of a Canadian French adaptation of the pain self-efficacy questionnaire (PSEQ).

PURPOSE: The objectives of this study were to translate the Pain Self-Efficacy Questionnaire (PSEQ) into Canadian French (PSEQ-F) and to evaluate its validity, reliability and responsiveness in a French-Canadian sample of patients with persistent rotator cuff related shoulder pain (RCRSP). METHODS: Translation and cross-cultural adaptation of the original English version of the PSEQ into Canadian French were performed according to standard procedures. Thereafter, 78 adults with RCRSP completed the PSEQ-F on three occasions: baseline, 2 days later to evaluate the reliability and 6 weeks later to evaluate responsiveness. RESULTS: Cross-cultural adaptation was performed without problems with content or language. The PSEQ-F was found to be reliable (Intraclass Correlation Coefficient = 0.96; Minimal Detectable Change = 3 points [5%]), valid (moderate correlations with an abbreviated version of Disability of the Arm, Shoulder and Hand [QuickDASH] and Brief Pain Inventory [BPI] Questionnaires) and responsive (Standardized Response Mean = 0.96; Effect Size = 0.81; Minimal Clinically Important Difference = 6 points [10%]). CONCLUSION: The PSEQ-F is a reliable, valid and responsive questionnaire that can be used to assess pain self-efficacy in French-speaking individuals with RCRSP. Further studies should use a self-efficacy-specific Global Rating of Change scale to estimate its responsiveness more thoroughly.Implications for rehabilitationHigher levels of pain self-efficacy have been associated with increased odds of symptom resolution in those with persistent rotator cuff related shoulder pain (RCRSP).The Pain Self-Efficacy Questionnaire (PSEQ) has been identified as the most frequently used tool by clinicians to assess pain self-efficacy in patients at risk of developing persistent musculoskeletal pain.The Canadian French version of the PSEQ (PSEQ-F) is a reliable, valid and responsive questionnaire that can be used to assess pain self-efficacy in French-speaking individuals with RCRSP.

Patient-reported outcome measures of musculoskeletal symptoms and psychosocial factors in musicians: a systematic review of psychometric properties.

PURPOSE: To systematically review patient-reported outcome measures (PROMs) of musicians' musculoskeletal symptoms (MSS) and psychosocial factors and their psychometric properties. METHODS: Six databases were searched. Studies evaluating at least one psychometric property of a PROM developed for or adapted to adult musicians and measuring MSS or occupational psychosocial factors were included. Study quality was evaluated using mainly the COSMIN checklist. RESULTS: Twenty-eight studies were included, yielding 27 PROMs. Most COSMIN scores are Doubtful or Inadequate. Validity and internal consistency are the most evaluated psychometric properties. Test-retest reliability was evaluated in five studies (all inadequate sample sizes), measurement error in one, and responsiveness in none. The English, German and Polish Musculoskeletal Pain Intensity and Interference Questionnaire for professional orchestra Musicians (MPIIQM), the 40-item English and Peruvian Spanish Kenny Music Performance Anxiety Inventory (KMPAI) and the Psychosocial Risks Questionnaire for Musicians (PRQM, Polish) are the most robust scales for their constructs. Their internal consistency is sufficient (Cronbach's α ≥ 0.70). Test-retest reliability and construct validity are only sufficient for the German MPIIQM (intraclass correlation coefficients ≥ 0.70). However, results are based on one study per PROM; all require further validation before validity, reliability and responsiveness can be confirmed. CONCLUSION: Due to generally poor methodological quality and one study per PROM on average, none can be confirmed valid, reliable and responsive. Yet, preliminary validation recommends prudent use of some PROMs pending further validation. Robust PROM studies are needed to fill the important literature gap regarding musician-specific, validated PROMs.

A qualitative study exploring the implementation determinants of rehabilitation and global wellness programs for orchestral musicians.

OBJECTIVE: To explore the facilitators and barriers to implementation of a pilot workplace rehabilitation and global wellness program for orchestral musicians. DESIGN: Qualitative study comprising focus groups and interviews.Setting: Workplace of conservatory and orchestral musicians and administrators. PARTICIPANTS: Musicians, administrators and a conductor from two professional orchestras; tertiary-level orchestral students and an administrator from a conservatory of music. INTERVENTIONS: We held four focus groups and two interviews to document the perspectives of the participants concerning the implementation determinants of a pilot workplace rehabilitation and wellness program (exercises and health-related education). Meetings consisted of questions based on the Consolidated Framework for Implementation Research. Thematic content analysis was conducted using this same framework, with subcoding according to the Theoretical Domains Framework. RESULTS: Fourteen musicians and five administrators participated. Results suggest that the implementation determinants for the pilot and future programs rely mainly on the Inner Setting, that is, what musicians refer to as 'the music world', specifically cultural elements such as pain beliefs (e.g. no pain no gain) and lack of resources and time (barriers). Characteristics of Individuals such as social influences amongst colleagues and beliefs about the consequences of self-care or lack thereof, and Intervention Characteristics such as complexity can be facilitators or barriers. All emerging themes have an undercurrent that lies in the Inner Setting. CONCLUSION: Musicians' culture, currently a barrier, is a crucial determinant of rehabilitation and wellness program implementation in the orchestral musicians' workplace. A focus on musicians' workplace environment is necessary to optimise implementation and intervention impacts.

Long-Term Effects of a Multimodal Physiotherapy Program on the Severity of Somatosensory Tinnitus and Identification of Clinical Indicators Predicting Favorable Outcomes of the Program.

BACKGROUND: Tinnitus, the perception of sound in the absence of external auditory stimuli, is commonly associated with problems of the auditory system. Head and neck disorders can also be involved in tinnitus emergence. In such cases, the term somatosensory tinnitus is used. Physiotherapy treatments have been identified as a promising avenue in the treatment of somatosensory tinnitus. PURPOSE: The aim of the study was to explore the effect of a physiotherapy program on the intensity and severity of somatosensory tinnitus and to identify the clinical characteristics of the patients who respond well to this treatment. RESEARCH DESIGN: Quasi-experimental pre-post single-group design. STUDY SAMPLE: Thirty-one adults with presumed somatosensory tinnitus. INTERVENTION: All participants received on average ten physiotherapy treatments over six weeks. Treatments included cervical and thoracic mobilizations, as well as muscular strengthening, stretching, postural instruction, and cervical stabilization. DATA COLLECTION AND ANALYSIS: Outcomes were measured at baseline, at the end of the physiotherapy program, and three months later. The primary outcomes were the Tinnitus Handicap Inventory and visual analog scales for loudness and annoyance caused by tinnitus. After the last evaluation, participants were divided into two groups: improved and unimproved participants. Participants were considered improved if they (1) showed significant improvement in at least two of the three primary outcome measures and (2) indicated subjective improvement. Thereafter, the baseline characteristics that correctly identify participants susceptible to improve significantly following treatment were determined (Cohen's effect size d > 0.8). RESULTS: A significant improvement in tinnitus intensity was observed at the end of the program. Of the 31 participants, 14 experienced persistent improvement in the intensity of their tinnitus and were classified as improved. Baseline characteristics strongly associated with tinnitus improvement were no increase in tinnitus when exposed to noise (d = -1.57), no family history of tinnitus (d = -1.16), somatosensory modulation in response to the contraction used to resist pressure applied to the forehead (d = 1.20), and recent onset of tinnitus (d = 1.03). CONCLUSIONS: This exploratory study showed that a multimodal physiotherapy program is effective in decreasing the severity of tinnitus, principally in individuals presenting with somatosensory tinnitus in combination with specific clinical characteristics.

Effect of a rehabilitation program on performance-related musculoskeletal disorders in student and professional orchestral musicians: a randomized controlled trial.

OBJECTIVE:: To explore the feasibility of a rehabilitation program and its effect on the performance-related musculoskeletal symptoms and functional limitations of orchestral musicians. DESIGN:: Single-blind pilot randomized controlled trial with exercise group and control group. SETTING:: Workplace of professional symphony orchestra and tertiary-level conservatory orchestral musicians. PARTICIPANTS:: Professional and student orchestral musicians with or without performance-related musculoskeletal disorders. INTERVENTIONS:: A rehabilitation program including an educational presentation, an 11-week home exercise program and three supervised exercise sessions, versus no intervention. MEASURES:: Feasibility measures included adherence and drop-out rate. The Musculoskeletal Pain Intensity and Interference Questionnaire for professional orchestra Musicians (MPIIQM) measured symptom intensity and functional limitations, while the Nordic Musculoskeletal Questionnaire (NMQ) measured symptom prevalence and frequency. RESULTS:: A total of 30 participants were recruited ( n = 15 per group). Exercise group adherence was 97.7% for the supervised sessions and 89% for the home exercise program. There were no drop-outs. Significant group-time interactions were obtained for both the pain intensity (partial η2 = 0.166; P = 0.025) and pain interference (partial η2 = 0.186; P = 0.017) sections of the MPIIQM. Mean (standard deviation) pain intensity score changes from baseline to 11 weeks were control group: 0.40 (5.04); P = 0.763; partial η2 = 0.007; and exercise group: -4.07 (5.31); P = 0.010; partial η2 = 0.386. For pain interference, mean score changes were control group: 0.20 (9.10); P = 0.933; partial η2 = 0.001; and exercise group: -9.00 (10.73); P = 0.006; partial η2 = 0.430. NMQ analyses revealed no significant interaction ( P > 0.05). CONCLUSION:: Results suggest that the studied program is feasible and effective in decreasing the intensity and functional impact of musicians' symptoms. However, no significant medium-term effect on the prevalence and frequency of symptoms was shown.

Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain.

BACKGROUND: Low back pain (LBP) encompasses heterogeneous patients unlikely to respond to a unique treatment. Identifying sub-groups of LBP may help to improve treatment outcomes. This is a hypothesis-setting study designed to create a clinical prediction rule (CPR) that will predict favorable outcomes in soldiers with sub-acute and chronic LBP participating in a multi-station exercise program. METHODS: Military members with LBP participated in a supervised program comprising 7 stations each consisting of exercises of increasing difficulty. Demographic, impairment and disability data were collected at baseline. The modified Oswestry Disability Index (ODI) was administered at baseline and following the 6-week program. An improvement of 50% in the initial ODI score was considered the reference standard to determine a favorable outcome. Univariate associations with favorable outcome were tested using chi-square or paired t-tests. Variables that showed between-group (favorable/unfavorable) differences were entered into a logistic regression after determining the sampling adequacy. Finally, continuous variables were dichotomized and the sensitivity, specificity and positive and negative likelihood ratios were determined for the model and for each variable. RESULTS: A sample of 85 participants was included in analyses. Five variables contributed to prediction of a favorable outcome: no pain in lying down (p = 0.017), no use of antidepressants (p = 0.061), FABQ work score < 22.5 (p = 0.061), fewer than 5 physiotherapy sessions before entering the program (p = 0.144) and less than 6 months' work restriction (p = 0.161). This model yielded a sensitivity of 0.78, specificity of 0.80, LR+ of 3.88, and LR- of 0.28. A 77.5% probability of favorable outcome can be predicted by the presence of more than three of the five variables, while an 80% probability of unfavorable outcome can be expected if only three or fewer variables are present. CONCLUSION: The use of prognostic factors may guide clinicians in identifying soldiers with LBP most likely to have a favorable outcome. Further validation studies are needed to determine if the variables identified in our study are treatment effect modifiers that can predict success following participation in the multi-station exercise program. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03464877 registered retrospectively on 14 March 2018.

Shoulder proprioception: How is it measured and is it reliable? A systematic review.

STUDY DESIGN: Systematic review. INTRODUCTION: Constituents of proprioception include our awareness of the position (joint position sense [JPS]) and motion (kinesthesia) of our limbs in space. Proprioceptive deficits are associated with musculoskeletal disorders but remain a challenge to quantify, particularly at the shoulder. PURPOSE OF THE STUDY: To report the psychometric values of validity, reliability, and responsiveness for shoulder JPS and/or kinesthesia protocols. METHODS: A review of 5 databases was conducted from inception to July 2016 for studies reporting a psychometric property of a shoulder proprioception protocol. The included studies were evaluated using the QualSyst checklist and COSMIN 4-point scale. RESULTS: Twenty-one studies were included, yielding 407 participants and 553 evaluated shoulders (n). The included studies support excellent methodological scores using the QualSyst checklist (88.1 ± 9.9%) and good psychometric scores with the COSMIN for reliability (71.1%) and moderate-to-low quality score (50%) for criterion validity. Weighted average intraclass correlation coefficients (ICCs) for intrarater reliability were highest for passive JPS and kinesthesia, ICC = 0.92 ± 0.07 (n = 214) and ICC = 0.92 ± 0.04 (n = 74), respectively. The most reliable movement and tool are internal rotation at 90° of abduction, ICC = 0.88 ± 0.01 (n = 53), and the dynamometer, ICC = 0.92 ± 0.88 (n = 225). Only 2 studies quantify an aspect of validity and no responsiveness indices were reported among the included studies. CONCLUSION: Based on the results of the included studies, the evaluation of shoulder proprioception is most reliable when using a passive protocol with an isokinetic dynamometer for internal rotation at 90° of shoulder abduction. Standardized protocols addressing the psychometric properties of shoulder proprioception measures are needed. LEVEL OF EVIDENCE: Level 1a: systematic review.