Evaluating the content validity of the Single Assessment Numeric Evaluation (SANE) in shoulder pathologies.

BACKGROUND: The Single Assessment Numeric Evaluation (SANE) is a single item patient reported outcome measure (PROM) of function, in where patients rate how normal they feel in relation to a specific joint or problem. Although validated for some orthopedic conditions, it is not yet validated for a population with shoulder pathologies; nor have other studies explored the content validity. This study aims to understand how 1) patients with shoulder conditions interpret and calibrate responses to the SANE and 2) how they define normal. METHODS: This study uses cognitive interviewing, a qualitative methodology that focuses on the interpretation of questionnaire items. Patients with rotator cuff disorders (n = 10), clinicians (n = 6) and measurement researchers (n = 10) were interviewed using a talk aloud structured interview that evaluated the SANE. All interviews were recorded and transcribed verbatim by one researcher (R.F). Analysis was done through an open coding scheme using a previously established framework for classification of interpretation variances. RESULTS: Overall, the single-item SANE was well received by all participants. Through the interviews, the themes of: Comprehension (20% of participants), Reference Point (20% of participants), Relevance (10% of participants), and Perspective Modifiers (50% of participants) emerged as potential sources of interpretation variances. Clinicians indicated this tool facilitates discussion when trying to create realistic recovery expectations for patients post-operatively. The word "normal" was defined by the themes of: 1) levels of current pain compared to pre-injury, 2) personal expectations of recovery and 3) pre-injury activity levels. CONCLUSIONS: Overall, respondents found the SANE to be cognitively simple, but it was clear that the interpretation of the question and what factors calibrated their responses were highly variable between respondents. The SANE is perceived favorable by patients and clinicians, while providing a low response burden. However, the construct being measured may vary between patients.

A Sensibility Assessment of the Job Demands and Accommodation Planning Tool (JDAPT): A Tool to Help Workers with an Episodic Disability Plan Workplace Support.

Purpose Sensibility refers to a tool's comprehensiveness, understandability, relevance, feasibility, and length. It is used in the early development phase to begin assessing a new tool or intervention. This study examined the sensibility of the job demands and accommodation planning tool (JDAPT). The JDAPT identifies job demands related to physical, cognitive, interpersonal, and working conditions to better target strategies for workplace supports and accommodations aimed at assisting individuals with chronic health conditions. Methods Workers with a chronic health condition and workplace representatives were recruited from health charities, workplaces, and newsletters using convenience sampling. Cognitive interviews assessed the JDAPT's sensibility. A 70% endorsement rate was the minimum level of acceptability for sensibility concepts. A short screening tool also was administered, and answers compared to the complete JDAPT. Results Participants were 46 workers and 23 organizational representatives (n = 69). Endorsements highly exceeded the 70% cut-off for understandability, relevance, and length. Congruence between screening questions and the complete JDAPT suggested both workers and organizational representatives overlooked job demands when completing the screener. Participants provided additional examples and three new items to improve comprehensiveness. The JDAPT was rated highly relevant and useful, although not always easy to complete for someone with an episodic condition. Conclusions This study highlights the need for tools that facilitate accommodations for workers with episodic disabilities and provides early evidence for the sensibility of the JDAPT.

Identifying predictors of return to work and the duration of time off work in first responders affected with musculoskeletal injuries or mental health issues.

PURPOSE: To identify predictors of return to work, duration of time off work, and claim closure for first responders experiencing injuries or illnesses, and summarize the claim data. METHODS: First responder claims collected between January 2012 and July 2017 were obtained from a disability management company. Known predictors of return to work were extracted from the data including age, sex, diagnosis, years of service, claim lag, medical report lag, and the return-to-work duties. Survival analyses were performed to identify predictors of return to work and claim closure using the Cox proportional regression analysis. Log-rank tests were performed to identify predictors that affected the rate of return to work and claim closure. Summary statistics were performed for the injury and return-to-work data. RESULTS: 60 of the 67 (89.6%) identified first responders returned to work within the data collection period. Musculoskeletal injuries predicted an increased likelihood of returning to work (hazard ratio = 2.0, 95%CI = 1.14-3.60) and a shorter duration of time off work (37 days on average) compared to mental health issues. Everyday of claim lag and medical report lag predicted a 2% decrease in likelihood of return to work. Returning to work was the only predictor of claim closure. 45 (67.2%) first responders returned to their pre-absence duties. 22 (32.8%) mental health claims and 45 (67.2%) injury claims were identified. CONCLUSIONS: 89.6% of first responders returned to work, although only 67.2% returned to their pre-absence duties. Predictors of return to work included injury type, as first responders with musculoskeletal injuries returned to work sooner, and claim and medical lag delayed the return to work.

A Scoping Review of the Evidence regarding Assessment and Management of Psychological Features of Shoulder Pain.

METHODS: A scoping review of research studies identified through PubMed, EMBASE, and CINAHL and graduate theses identified using Google Scholar was conducted to determine studies and systematic reviews that addressed the management of psychological aspects of shoulder pain with or without neck pain. The search terms included psychological factors, anxiety, depression, catastrophic thinking, fear of movement, and psychological treatments. Two investigators screened study titles and abstracts. Data extraction, content analysis, and thematic coding focused on the dimensions of pain addressed (emotional, behavioural, and cognitive) and treatment approaches used (dimensions targeted, specific treatment parameters) and the linkage between treatment targets/rationale with interventions/outcomes measured. RESULTS: Ten studies (seven randomized trials and three cohorts) were identified that addressed the psychological aspects of shoulder pain. Out of seven RCTs, four compared psychological interventions with usual care. Eight studies used cognitive approaches, including emotional freedom techniques (EFT), pain coping strategies (PCS), physical-cognitive-mindfulness training (PCMT), psychological flexibility, face-to-face cognitive-behavioural treatment (CBT), and cognitive therapy using virtual reality (V.R.). Three studies used the behavioural approaches as their intervention, including behavioural therapy and Graded Exercise Therapy (GET). Pain intensity was addressed as the primary outcome in two studies and as a secondary outcome in five studies. Cognitive factors were evaluated in 50% of the articles using nine different measures. Emotional factors were evaluated in 80% of articles using ten different measures. Reduction of pain intensity and catastrophic thinking concerning pain was achieved in most studies using a biopsychosocial approach (70%). Applying a behavioural approach was associated with reductions in kinesiophobia and pain catastrophizing. Cognitive approaches had a positive association with reductions in the emotional aspect of pain. Only one study specifically linked rationale or specific physical and psychosocial treatment targets with the treatments provided and outcomes measured. CONCLUSIONS: Small pools of studies indicate that the rationale and treatment targeting are poorly defined in biopsychosocial interventions for shoulder pain. However, these benefits have been demonstrated when cognitive or behavioural components are added to the standard physical treatment of shoulder pain. A better definition of treatment targets, description of intervention components, and linkage of outcomes to targets are needed to advance our understanding of optimizing bio-psychosocial approaches.

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.

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.

Assessment of age-related differences in decomposition-based quantitative EMG in the intrinsic hand muscles: A multivariate approach.

OBJECTIVE: Decomposition-based quantitative electromyography (DQEMG) is one method of measuring neuromuscular physiology in human muscles. The objective of the current study is to compare the neuromuscular physiology of a typical aging population in the intrinsic hand muscles. METHODS: Measurements of DQEMG were detected with a standard concentric needle and surface EMG from the intrinsic hand muscles. DQEMG was obtained from the first dorsal interosseous (FDI), the abductor digiti minimi (ADM) and fourth dorsal interosseous (4DI). Multivariate analysis of variance (MANOVA) were performed for the surface and intramuscular EMG measures to identify age differences in motor unit properties. RESULTS: Large differences were observed between the age groups for the canonical intramuscular and surface EMG variables. Older adults demonstrated a large decrease in motor unit number estimation in the ADM and FDI. Likewise, medium to large decreases in motor unit stability were observed in the FDI, ADM and 4DI. CONCLUSIONS: With aging, there are decreases in motor unit number estimation and stability in the intrinsic hand muscles. Using a multivariate approach allows for age-related differences and the relationship between the variables to be further elucidated. SIGNIFICANCE: Multivariate analysis of DQEMG may be useful for identifying patterns of change in neuromuscular physiology with age-related changes to hand musculature. This may potentially lead to future prognostic biomarkers of age-related changes to hand muscles.

Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effectiveness of chronic pain self-management support with pain science education and exercise (COMMENCE) on improving function, pain interference, work status, pain intensity, fatigue, psychological factors associated with pain, health care visits, satisfaction, and perceived change compared with usual care. DESIGN: Parallel group randomized controlled trial with 1- and 12-week follow-ups. SETTING: Community health center. PARTICIPANTS: Adults (N=102) with chronic noncancer pain referred for self-management support. Eighty of 102 participants completed 12-week follow-up assessments. No participants withdrew with adverse events. INTERVENTIONS: Participants were randomized to COMMENCE or usual care. MAIN OUTCOME MEASURES: Primary: Function measured using the Short Musculoskeletal Function Assessment-Dysfunction Index. Secondary: Short Musculoskeletal Function Assessment-Bother Index, Patient Reported Outcomes Measurement Information System pain interference, work status, numeric pain, and fatigue rating scales, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Pain Self-Efficacy Scale, Neurophysiology of Pain Questionnaire, number of health care visits, satisfaction, and global rating of change. RESULTS: COMMENCE resulted in greater improvements in function (mean difference [MD] at 12-wk follow-up=-8.0; 95% CI, -14.7 to -1.3), bother with functional difficulties (MD, -12.0; 95% CI, -20.8 to -3.2), pain intensity (MD, -1.0; 95% CI, -2.1 to -0.1), catastrophizing (MD , -8.2; 95% CI, -14.5 to -2.0), self-efficacy (MD, 7.0; 95% CI, 0.8-13.2), knowledge (MD, 2.8; 95% CI, 1.6-3.9), satisfaction (MD, 1.2; 95% CI, 0.7-1.8), and perceived change (MD, 1.4; 95% CI, 0.8-2.1). There were no significant between-group differences in pain interference, work, fatigue, depressive symptoms, or health care visits. CONCLUSION: COMMENCE is more effective than usual care at improving function, pain, catastrophic thinking, self-efficacy, pain knowledge, satisfaction, and perceived change but not pain interference, work status, fatigue, depressive symptoms, or health care visits.

Facilitators and Barriers to Access to Pediatric Medical Services in a Community Hospital.

Background: Missed medical appointments decrease continuity of medical care, waste resources, and may affect health outcomes. We examined the factors associated with missed children's supervision visits in Eastern Brooklyn, NY, USA. Methods: We surveyed guardians whose children received routine medical care at four pediatric clinics. Participants filled out a questionnaire that queried: demographics, food security, recent relocation, parental support of healthy behaviors, and length of knowing provider. Preexisting disease(s) and missed visits were retrieved from medical records. Regression analyses were used to determine factors that were associated with missing medical appointments. Results: Among 213 families, 33% faced food insecurity and 16.4% reported moving within the past 12 months. Forty percent of children missed at least 1 visit. Food insecurity (adjusted odds ratio [aOR] 2.3, 95% confidence interval [CI 1.0% to 5.2%) and recent relocation (aOR 1.8, 95% CI 1.1-3.4 were associated with missed health supervision visits, whereas greater parental healthy behaviors (aOR 0.5, 95% CI 0.3-0.9) and longer length of knowing provider (aOR 0.8, 95% CI 0.7-1.0) were associated with fewer missed appointments. Conclusion: This study indicates that social inequity may contribute to poor adherence to medical appointments through multiple mechanisms, including food insecurity, lack of social stability, and parental health behaviors. Multidimensional proactive prevention, and reactive tolerance should be considered as opportunities to mitigate the impact of social inequity on health outcomes.

Item reduction of the patient-rated wrist evaluation using decision tree modelling.

Background: The aim of this study is to assess the viability of a decision tree version of an often used questionnaire to measure wrist pain and disability, the Patient Rated Wrist Evaluation.Methods: Patient Rated Wrist Evaluation scores were collected from a cohort of 10394 patients who are part of a routine outcome measurement system. A decision tree version of the Patient Rated Wrist Evaluation (PRWE) was created. The intraclass correlation was used to evaluate the inter-version reliability between the original PRWE and the decision tree version.Results: The decision tree reduced the number of questions from 5 to 3 for the pain subscale, and from 10 to 3 for the disability subscale. The intraclass correlation between the original PRWE and the decision tree version was 0.97. The mean difference between the Patient Rated Wrist Evaluation and the decision tree Patient Rated Wrist Evaluation total sumscore was 0.35 (95% CI -9.92-10.62).Conclusions: We found that the decision tree was successful at reducing the items of the Patient Rated Wrist Evaluation from fifteen to only six questions with very high similarity to the scores of the full questionnaire.Implications for rehabilitationThe Patient Rated Wrist Evaluation can reliably be used with 6 instead of 15 questions.Decision trees are useful statistical tools to shorten lengthy questionnaires, especially when large amounts of data are available.Having a shortened Patient Rated Wrist Evaluation saves patients and clinicians time in answering this specific questionnaire.

Measurement Properties of the Hand Grip Strength Assessment: A Systematic Review With Meta-analysis.

OBJECTIVE: The aim of this study was to critically appraise, compare, and summarize the quality of the measurement properties of grip strength (GS) in patients with musculoskeletal, neurologic, or systemic conditions and healthy participants without these conditions. DATA SOURCES: We followed the Consensus-based Standards for the Selection of Health Measurement Instruments guideline. To identify studies on measurement properties of GS, we searched the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health, Physiotherapy Evidence, and Cochrane Library databases from inception until June 2019. Meta-analyses were carried out using a random effects model and 95% CIs were calculated. STUDY SELECTION: Studies were included if they reported at least 1 measurement property of hand GS in a population with musculoskeletal, neurologic, and systemic conditions or a healthy population without these conditions. DATA EXTRACTION: The extracted data included the study population, setting, sample size, measurement evaluated, and the test interval. DATA SYNTHESIS: Twenty-five studies were included with 1879 participants. The pooled results indicated excellent intraclass correlation coefficient (ICC) of 0.92 (95% CI, -0.88-0.94 for healthy participants without any conditions, ICC of 0.95 (95% CI, -0.93-0.97) for upper extremity conditions, and an ICC of 0.96 (95% CI, -0.94-0.97) for patients with neurologic conditions. Minimum clinically important difference (MCID) scores for hand GS were 5.0 kg (dominant side) and 6.2 kg (nondominant side) for patients post stroke, 6.5 kg for the affected side after distal radius fracture, 10.5 lb and 10 kPa for immune-mediated neuropathies, 17 kg for patients with lateral epicondylitis, and 0.84 kg (affected side) and 1.12 kg (unaffected side) in the carpometacarpal osteoarthritis group; MCID GS estimates were 2.69-2.44 kg in the healthy group without conditions. CONCLUSION: Our synthesized evidence indicated that GS assessment is a reliable and valid procedure among healthy participants as well as across various clinical populations. Furthermore, our MCID summary scores provided useful information for evaluating (clinical importance) new interventions regarding hand GS.

Low Income and Nonadherence to Health Supervision Visits Predispose Children to More Emergency Room Utilization.

Social inequity can have broad health impacts. The purpose of this study was to examine the effects of low income and nonadherence to health supervision visits on emergency room (ER) utilization in Eastern Brooklyn, New York. This study surveyed parents/guardians of children who received routine medical care at Brookdale ambulatory clinics from June 2017 to February 2018. Participants were asked to fill out a questionnaire on social demographics, food insecurity, and relocation. Electronic medical records (EMRs) were reviewed to retrieve numbers of missing health supervision and ER visit in past 12 months. Comorbidity was identified through EMR by International Classification of Diseases. Logistic regression analyses were used to examine the effects of nonadherence to health supervision visits on ER utilization when controlling for demographics, food insecurity, recent moving, and comorbidity. Among 268 participants, 56.0% reported their household income was less than $20,000 annually, 39.6% missed at least 1 health supervision visit, and 31.7% had at least 1 ER visit within the past 12 months. Younger age (adjusted odds ratio [aOR] = 0.92, 95% confidence interval [CI] = 0.86-0.97, P < .01), household income less than $20,000 (aOR = 1.86, 95% CI = 1.02-3.39), preexisting comorbidity (aOR = 2.36, 95% CI = 1.26-4.42), and nonadherence to health supervision visits (aOR = 5.83, 95% CI = 3.21-10.56) were associated with increased ER utilization. Nonadherence to health supervision visits is an independent risk factor and potentially modifiable. Evaluation and remediation should be pursued as a means of improving health outcomes of children in vulnerable circumstances.

Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: systematic review of psychometric properties.

BACKGROUND: Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair. METHODS: This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence. RESULTS: Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity. CONCLUSIONS: Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective.

Content validation of the Patient-Reported Hamilton Inventory for Complex Regional Pain Syndrome: Validité de contenu du Hamilton Inventory for Complex Regional Pain Syndrome, une mesure des résultats déclarés par le patient.

BACKGROUND: Complex regional pain syndrome (CRPS) is a perplexing neurological condition, and persons with CRPS experience substantial loss of daily roles and activities. A condition-specific measure is being developed to evaluate CRPS. PURPOSE: We describe the use of cognitive interviews to examine content validity of this patient-reported outcome measure for CRPS. METHOD: Interviews with 44 persons with CRPS were analyzed to identify problems with wording and support content validation. Item-total correlations were calculated for proposed subscales, and scores were plotted to consider floor/ceiling effects. FINDINGS: Interviews identified questions where respondents considered factors unrelated to the construct of interest or were underaddressed by the questionnaire, including depression and skin temperature. The symptoms, daily function, and coping/social impact scales demonstrated satisfactory correlations (Cronbach's alpha 0.76-0.86). Despite a sampling bias of severity, no frank floor/ceiling effects were noted. IMPLICATIONS: This study builds a foundation for continuing development and evaluation of the measurement properties of the Patient-Reported Hamilton Inventory for CRPS. It makes explicit the iterative decisions involved in rigorous instrument development.

Psychometric properties of the Zephyr bioharness device: a systematic review.

BACKGROUND: Technological development and improvements in Wearable Physiological Monitoring devices, have facilitated the wireless and continuous field-based monitoring/capturing of physiologic measures in healthy, clinical or athletic populations. These devices have many applications for prevention and rehabilitation of musculoskeletal disorders, assuming reliable and valid data is collected. The purpose of this study was to appraise the quality and synthesize findings from published studies on psychometric properties of heart rate measurements taken with the Zephyr Bioharness device. METHODS: We searched the Embase, Medline, PsycInfo, PuMed and Google Scholar databases to identify articles. Articles were appraised for quality using a structured clinical measurement specific appraisal tool. Two raters evaluated the quality and conducted data extraction. We extracted data on the reliability (intra-class correlation coefficients and standard error of measurement) and validity measures (Pearson/Spearman's correlation coefficients) along with mean differences. Agreement parameters were summarised by the average biases and 95% limits of agreement. RESULTS: A total of ten studies were included: quality ratings ranged from 54 to 92%. The intra-class correlation coefficients reported ranged from 0.85-0.98. The construct validity coefficients compared against gold standard calibrations or other commercially used devices, ranged from 0.74-0.99 and 0.67-0.98 respectively. Zephyr Bioharness agreement error ranged from - 4.81 (under-estimation) to 3.00 (over-estimation) beats per minute, with varying 95% limits of agreement, when compared with gold standard measures. CONCLUSION: Good to excellent quality evidence from ten studies suggested that the Zephyr Bioharness device can provide reliable and valid measurements of heart rate across multiple contexts, and that it displayed good agreements vs. gold standard comparators - supporting criterion validity.

The assessment of psychological factors on upper extremity disability: A scoping review.

INTRODUCTION: The primary purpose of this scoping review was to describe the nature and extent of the published research that assesses the relationship between psychological features and patient-reported outcome following surgery or rehabilitation of upper extremity disease or injury. METHODS: Twenty-two included studies were examined for quantitative study design, outcome measure, inclusion/exclusion criteria, follow-up and recruitment strategy. Patient population and psychological assessment tools were examined for validity. RESULTS: Twenty-two studies met the inclusion criteria for this study. Only 7 of the 22 studies were longitudinal and the rest were cross sectional studies. Depression was the most common psychological status of interest and was included in 17 studies. Pain catastrophizing was the psychological status of interest in 5 of the studies. Four studies considered anxiety, 3 considered pain anxiety, 3 considered distress, 2 considered coping, 2 considered catastrophic thinking, and 2 considered fear avoidance beliefs. DISCUSSION: The majority of studies in this review were cross-sectional studies. Cross-sectional studies may not provide conclusive information about cause-and-effect relationships. This review encourages clinicians to be mindful of the psychological implications found in rehabilitation of individuals with upper extremity disease or injury along with being cognizant of choosing appropriate measurement tools that best represent each patient's characteristics and diagnoses. CONCLUSIONS: The nature of the research addressing psychological factors affecting outcomes after hand injury focus on negative traits and have limited strength to suggest causation as most have used cross-sectional designs. Stronger longitudinal designs and consideration of positive traits are needed in future studies.

Predictors of outcomes after rotator cuff repair-A meta-analysis.

STUDY DESIGN: Systematic review. INTRODUCTION: Clinical outcomes associated with rotator cuff repair (RCR) are generally favorable, but no study has attempted to establish a set of predictors that affect outcomes. PURPOSE OF STUDY: This study aims to statistically analyze articles and establish a set of predictors that affect outcomes after RCR. METHODS: An electronic literature search of multiple databases was conducted to identify studies that addressed prognosis after RCR. Quality ratings were conducted with a prognostic study evaluation tool. Summary data for predictors and outcomes were extracted, entered in comprehensive meta-analysis software, transformed where necessary, and pooled to allow for estimation of odds ratio for each predictor. RESULTS: From 18 studies, 3 were high quality, 7 were moderate and 8 were low-quality studies. Fatty infiltration had a significant negative effect (OR = 9.3), whereas larger tear size, lower preoperative muscle strength (OR = 4.0), multiple tendon involvement (OR = 6.0), diabetes, and worker's compensation status (OR = 8.7) had a moderate negative effect on outcomes after RCR. Older age had a modest negative effect on cuff integrity at follow-up (OR = 2.8), but no significant effect on function. In addition, a history of trauma, smoking, and duration of symptoms before surgery had no significant effect on outcomes. DISCUSSION: Injury to the cuff (body structure), physical impairment, personal factors and social factors affects outcomes; although the importance of predictors varies between anatomic and functional outcomes. CONCLUSIONS: A multifactorial biopsychosocial prognosis should be considered in management. LEVEL OF EVIDENCE: Level 2.

Is Casting for Non-Displaced Simple Scaphoid Waist Fracture Effective? A CT Based Assessment of Union.

OBJECTIVE: The purpose of this study is to report the union rate and time to union for acute non-displaced scaphoid waist fractures treated with a short arm thumb spica cast. METHODS: A database was searched (2006-2013) to identify acute undisplaced scaphoid waist fractures. Cases that were not given a trial of casting were excluded (n=33). X-rays, CT scans and health records for each patient were reviewed to extract data. RESULTS: 172 patients met inclusion criteria. There were 138 males, 34 females, the mean age was 30 ± 16 years. The union rate was 99.4% (1 nonunion/172 subjects). The mean time to union was approximately 7.5 weeks (53 ± 37 days). Energy of injury, age or gender did not affect union rates or time to union. Cysts did not affect the union rate (p=0.73) but patients with cystic resorption along the fracture line required approximately 10 weeks for union (69 ± 60 days) compared to 7 weeks (51 ± 34 days) for those without cysts (p=0.05). Diabetes did not affect the union rate (p=0.81) but was found to increase the risk of delayed union (p=0.05). There was a weak, but statistically significant correlation between the number of days before the fracture was casted and the length of time needed to achieve union (r=0.27, p=0.001). CONCLUSION: Non-displaced scaphoid waist fractures have a high healing rate with appropriate identification and immobilization. Follow-up CT scans to assess healing can identify union within a shorter time frame (~7 weeks) than previously reported in the literature.

A Unified Approach to Outcomes Assessment for Distal Radius Fractures.

Distal radius fractures are one of the most common upper extremity injuries. Currently, outcome assessment after treatment of these injuries varies widely with respect to the measures that are used, timing of assessment, and the end points that are considered. A more consistent approach to outcomes assessment would provide a standard by which to assess treatment options and best practices. In this summary, we review the consensus regarding outcomes assessment after distal radius fractures and propose a systematic approach that integrates performance, patient-reported outcomes, pain, complications, and radiographs.

Quality assessment of osteoporosis clinical practice guidelines for physical activity and safe movement: an AGREE II appraisal.

UNLABELLED: Many osteoporosis clinical practice guidelines are published, and the extent to which physical activity and safe movement is addressed varies. To better inform clinical decision-making, a quality assessment and structured analysis of recommendations was undertaken. Guideline quality varied substantially, and improvement is necessary in physical activity and safe movement recommendations. PURPOSE: The purpose of the present study is to survey available osteoporosis clinical practice guidelines (CPGs) containing physical activity and safe movement recommendations in order to assess the methodological quality with which they were developed. An analysis of the various physical activity and safe movement recommendations was conducted to determine variability between CPGs. METHODS: An online literature search revealed 19 CPGs meeting our inclusion criteria. Three independent scorers evaluated CPG quality using the Appraisal of Guidelines for Research and Evaluation version II (AGREE II) instrument. Two separate individuals used a standard table to extract relevant recommendations. RESULTS: Intra-reviewer AGREE II score agreement ranged from fair to good (intra-class correlation coefficient (ICC) = 0.34 to 0.65). The quality of the 19 included CPGs was variable (AGREE sub-scores: 14 to 100%). CPGs scored higher in the "scope and purpose" and "clarity of presentation" domains. They scored the lowest in "applicability" and "editorial independence." Four CPGs were classified as high quality, ten average quality, and five low quality. Most CPGs recommended weight-bearing, muscle-strengthening, and resistance exercises. Information on exercise dosage, progression, and contraindications was often absent. Immobility and movements involving spinal flexion and/or torsion were discouraged. CONCLUSIONS: There were several high-quality CPGs; however, variability in quality and lack of specific parameters for implementation necessitates caution and critical examination by readers. CPG development groups should pay special attention to the clinical applicability of their CPGs as well as fully disclosing conflicts of interest. CPGs were in general an agreement regarding safe physical activity and safe movement recommendations. However, recommendations were often vague and the more specific recommendations were inconsistent between CPGs.