Prognostic factors of nonsurgical intervention outcomes for patients with frozen shoulder: a retrospective study.

PURPOSE: This study aimed to investigate the correlation between mental and physical health-related quality of life and the outcomes of conservative treatment in patients with frozen shoulder (FS). METHODS: This was a two-center retrospective study. It included 84 consecutive patients who underwent a 3-month treatment comprising education, physical therapy, and corticosteroid-anesthetic injections. Changes in range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) scores, measured at baseline and after 3 months, were selected as dependent variables. Data on age, sex, Body Mass Index, duration of symptoms, dominant affected limb, and Short Form-36 (SF-36) subscales were gathered at baseline and investigated as prognostic factors. Backward stepwise regression models were used to identify significant associations. RESULTS: At 3-month follow-up, all the patients showed significant improvement. Higher SF-36 General Health, Mental Health and Social Functioning scores at baseline were associated with a greater beneficial change in ROM and SPADI. In contrast, lower SF-36 Bodily Pain and Role Emotional scores were found to be associated with greater improvement. CONCLUSION: The study findings indicate that the self-perceived mental and physical health of patients have a significant impact on both subjective and objective clinical outcomes and healthcare professionals should take these aspects into account. LEVEL OF EVIDENCE: Prognostic Level II.

Self-perceived mental and physical health could impact the prognosis of subjects affected by frozen shoulder.Healthcare providers should adopt a multi-professional approach to frozen shoulder rehabilitation, integrating the psychological perspective into the management of this condition.For people affected by frozen shoulder, a comprehensive assessment that goes beyond just physical function is recommended.

Psychometric properties of the Disability of Arm Shoulder and Hand (DASH) in subjects with frozen shoulder: a reliability and validity study.

BACKGROUND: Frozen Shoulder (FS) is a painful condition characterized by severe pain and progressive restriction of shoulder movement, leading to functional impairment and reduced quality of life. While different Patient Reported Outcome Measurements (PROMs) tools exist for assessing shoulder diseases, few specific PROMs are validated for FS patients. PURPOSE: This study aims to assess the psychometric properties of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire in FS patients. METHODS: One hundred and twenty-four subjects (mean ± SD age = 55.4 ± 7.9 years; 55.6% female) diagnosed with FS were included and completed the DASH questionnaire, the Numerical Pain Rating Scale (NPRS), the Shoulder Pain and Disability Index (SPADI), and the Short-Form Health Survey 36 (SF-36). Floor or ceiling effects were investigated. Structural validity was analysed through a unidimensional Confirmatory Factor Analysis (CFA), internal consistency through Cronbach's alpha, test-retest reliability through the Intraclass Correlation coefficient (ICC), measurement error through the Standard Error of Measurement (SEM), and the Minimum Detectable Change (MDC), and construct validity through the hypothesis testing with the correlation with the other outcome measures used. RESULTS: No floor or ceiling effects were observed. CFA confirmed a one-factor structure after addressing local item dependency (Root Mean Square Error of Approximation = 0.055; Standardized Root Mean Square Residual = 0.077; Comparative Fit Index = 0.970; Tucker-Lewis Index = 0.968). Cronbach's alpha was high (= 0.951), and test-retest reliability was excellent (ICC = 0.999; 95% CI: 0.998-1.000). SEM was equal to 0.5 points, and MDC to 1.5 points. Construct validity was considered satisfactory as 80% of the a-priori hypotheses were met. CONCLUSION: The DASH questionnaire demonstrated good psychometric properties in FS patients, supporting its use as a valuable tool for assessing the impact of FS in clinical and research settings.

The multidisciplinary team in the management of chronic pain and pain-related fear: an evidence-based approach in a clinical case.

PURPOSE: Pain is a complex, intimate, and subjective experience influenced by biological, psychological, and social factors. This case report investigates the effectiveness of a multidisciplinary team approach in addressing chronic pain and pain-related fear. CASE DESCRIPTION: The case report describes a 22-year-old female who experienced anterior knee pain for seven years, despite undergoing two knee surgeries and physiotherapy without improvement. Following a comprehensive assessment, which included a detailed medical history, clinical examination, and thoughtful clinical analysis, a multidisciplinary approach was recommended. Employing an evidence-based methodology that integrated neurocognitive rehabilitation techniques, including Pain Neuroscience Education, Graded Motor Imagery, and Tactile Discrimination Training, alongside psychological rehabilitation strategies such as Mindfulness, Acceptance and Commitment Therapy, and Problem-Solving Therapy, the report presents a comprehensive in-depth rehabilitation plan exemplifying the application of this multimodal approach within a clinical setting in a patient with chronic pain. This approach is designed not to address the biomechanical aspects but to delve into the cognitive facets associated with pain perception and avoidance, as well as potential psychological factors that may be influencing the onset and persistence of symptoms. OUTCOMES: The scores from the rating scales provided valuable insights into patient progress in pain management, functional improvement, fear of movement, and overall physical, psychological, and emotional well-being, at six months. CONCLUSION: This case report offers valuable insights into the usefulness of this multidisciplinary and multimodal approach, highlighting its potential as an avenue in the management of chronic pain and pain-related fear.

Reliability and validity of the Shoulder Pain and Disability Index in a sample of patients with frozen shoulder.

BACKGROUND: The Shoulder and Pain Disability Index (SPADI) is a widely used outcome measure. The aim of this study is to explore the reliability and validity of SPADI in a sample of patients with idiopathic frozen shoulder. METHODS: The SPADI was administered to 124 patients with idiopathic frozen shoulder. A sub-group of 29 patients were retested after 7 days. SPADI scores were correlated with other outcome measures (i.e., Disabilities of the Arm, Shoulder and Hand Questionnaire - DASH; Numerical Pain Rating Scale-NPRS; and 36-item Short Form Health Survey-SF-36) to examine construct validity. Structural validity was assessed by a Two-Factors Confirmatory Factor Analysis (CFA). Internal consistency, test-retest reliability, and measurement error were also analyzed. RESULTS: The construct validity was satisfactory as seven out of eight of the expected correlations formulated (≥ 75%) for the subscales were satisfied. The CFA showed good values of all indicators for both Pain and Disability subscales (Comparative Fit Index = 0.999; Tucker-Lewis Index = 0.997; Root Mean Square Error of Approximation = 0.030). Internal consistency was good for pain (α = 0.859) and disability (α = 0.895) subscales. High test-retest reliability (Intraclass correlation coefficient [ICC]) was found for pain (ICC = 0.989 [95% Confidence Interval (CI = 0.975-0.995]) and disability (ICC = 0.990 [95% CI = 0.988-0.998]). Standard Error of Measurement values of 2.27 and 2.32 and Minimal Detectable Change values of 6.27 and 6.25 were calculated for pain and disability subscales, respectively. CONCLUSION: The SPADI demonstrated satisfactory reliability and validity properties in a sample of patients with idiopathic frozen shoulder.

Psychometric properties of three different scales for subjective evaluation of shoulder pain and dysfunction in Italian patients after shoulder surgery for anterior instability.

BACKGROUND: The Italian versions of Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST), and University of California-Los Angeles (UCLA) Shoulder Rating Scale have been validated to assess shoulder dysfunction in patients treated for neck cancer. The present study investigated the psychometric properties of the Italian versions of the SPADI, SST, and UCLA in patients after shoulder surgery for anterior instability. MATERIALS AND METHODS: The study population included 98 patients. Patients completed the Italian SPADI, SST, and UCLA, and Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, Oxford Shoulder Score (OSS), and 36-Item Short Form Health Survey (SF-36). Reproducibility was assessed by asking patients to complete another UCLA, SPADI, and SST 48 hours after the first. Validity was assessed by calculating the correlation between the SPADI, SST, and UCLA and the WOSI, ASES, OSS, and the SF-36 Physical Health subscales. RESULTS: The internal consistencies of the SPADI (α = 0.97) and the SST (α = 0.87) were very high. The test-retest reliability was excellent with intraclass correlation coefficient of 0.97 for the SPADI, 0.93 for UCLA pain, 0.95 for UCLA function, and 0.97 for the SST. A significant correlation was found between the Italian SPADI, SST, and UCLA and the WOSI, the ASES and the OSS. DISCUSSION: Psychometric properties of the Italian SPADI, SST, and UCLA compared well with those reported for the original versions, supporting their use as reliable clinimetric instruments in the setting of shoulder disorders after surgery for recurrent anterior instability.

SHOULDER PAIN IN COMPETITIVE TEENAGE SWIMMERS AND IT'S PREVENTION: A RETROSPECTIVE EPIDEMIOLOGICAL CROSS SECTIONAL STUDY OF PREVALENCE.

BACKGROUND: The term "swimmer's shoulder" was first introduced in 1974 by Kennedy and Hawkins to describe a common condition among competitive swimmers characterized by pain and dysfunction of the shoulder complex. Currently, the term does not define a specific clinical diagnosis and its etiology is considered to be multifactorial. In the literature shoulder pain prevalence varies according to the adopted definitions (from 3% to 91%); however, in the Italian environment there is no prevalence study regarding swimmer shoulder. Prevention by means of dry land activities may assist in delimiting shoulder pain in swimmers. PURPOSES: The purpose of this study was to investigate the prevalence of swimmer's shoulder over the prior 12 months among teenage athletes and the preventive activities carried out across different sport's teams. A second purpose was to determine whether the extent of the condition is affected by dry land preventive activity. And finally, to compare different preventive activities related to the prevalence of swimmer's shoulder. STUDY DESIGN: Retrospective epidemiological cross-sectional study of prevalence. METHODS: Athletes from four levels of training: Esordienti A, Ragazzi, Juniores and Cadetti (according to Italian Swimming Federation F.I.N.'s partition age) belonging to eight Italian swimming teams and their respective coaches were involved in this study. Two types of questionnaires were created and completed by both the athletes and their coaches during May 2015. The collected data were analyzed by means of descriptive and inferential statistics. RESULTS: Shoulder pain prevalence over the previous 12 months from the completion of the survey was 51%. In six out of eight of the societies a specific shoulder dry land warm-up was carried out before water training, whereas among seven out of eight societies also utilized weekly sessions of performance (physical) training. Statistically significant differences were noticed between shoulder pain and gender, weekly frequency and duration of dry land warm-up and duration of physical training. CONCLUSION: The results of the current study indicate that shoulder pain is prevalent in youth swimmers (51%) and appears to be affected by dry land preventive activities. A weekly frequency of dry land warm-up more than five times appeared to protect swimmers from pain (p=0.044); whereas, a dry land warm-up duration greater than 10 minutes seems to cause shoulder pain (p=0.043). A single physical training duration lower than 45 minutes seems to be associated with pain (p=0.035). LEVELS OF EVIDENCE: 3a.

ACUTE EFFECTS OF DRY NEEDLING ON POSTERIOR SHOULDER TIGHTNESS. A CASE REPORT.

BACKGROUND AND PURPOSE: Posterior shoulder tightness has been associated with numerous shoulder disorders. Methods to increase posterior shoulder mobility may be beneficial. The purpose of this case report is to report the outcomes of a subject with posterior shoulder tightness treated with dry needling as a primary intervention strategy. CASE DESCRIPTION: The subject was a 46-year-old man who was referred to physical therapy with primary symptoms of shoulder pain and loss of motion consistent with subacromial impingement syndrome. Clinical findings upon examination revealed glenohumeral internal rotation and horizontal adduction losses of motion and reproduction of pain symptoms upon palpation of the infraspinatus, teres minor, and posterior deltoid. A single treatment of trigger point dry needling was used to decrease pain and improve range of motion. OUTCOMES: Following the intervention, clinically meaningful improvements were seen in pain and shoulder range of motion. DISCUSSION: This case report describes the use of trigger point dry needling in the treatment of a subject with posterior shoulder tightness. The immediate improvement seen in this subject following the dry needling to the infraspinatus, teres minor, and posterior deltoid muscles suggests that muscles may be a significant source of pain and range of motion limitation in this condition. LEVEL OF EVIDENCE: Level 4.