Towards a better understanding of our patients. A qualitative study about how patients and their physiotherapists perceive the recovery of shoulder problems.

OBJECTIVE: To investigate how people with shoulder problems and their physiotherapists perceive the recovery of shoulder problems. METHOD: We performed a qualitative study using semi-structured interviews with patients and their physiotherapists. Nine pairs of patients and physiotherapists (n = 18) were recruited. The transcribed interviews were analyzed in a consecutive multistep iterative process using a conventional content analysis. RESULTS: Analysis of the interviews resulted in three major themes: 'What do I expect from my recovery?', 'Am I recovering?' and 'When do I consider myself recovered?' The patients and physiotherapists talked similarly about the importance of and interdependency between these themes. Central to these three themes are the analysis of the cause of shoulder problems and the experience of uncertainty. Our analyses suggest that there are conceptual differences in how patients and physiotherapists formulate their expectations about recovery, observe the recovering process, and conceptualize when someone may be considered recovered. Different interpretations by the patients of the information provided by the physical therapists appeared to fuel these differences. CONCLUSION: Our results show that the concept of recovery is defined by patients and physiotherapists in three distinct themes. Within these themes the patients and physiotherapists differ substantially in their conceptualization of the recovery. IMPACT STATEMENT: This insight in the concept of recovery can help patients and physiotherapists better understand each other, enhance the alignment of ideas about the care process, and support making decisions together. Physiotherapists should be aware that patients might interpret their words, explanations, and expectations substantially different.

Reliability of Performance-Based Clinical Measurements to Assess Shoulder Girdle Kinematics and Positioning: Systematic Review.

Background: Deviant shoulder girdle movement is suggested as an eminent factor in the etiology of shoulder pain. Reliable measurements of shoulder girdle kinematics are a prerequisite for optimizing clinical management strategies. Purpose: The purpose of this study was to evaluate the reliability, measurement error, and internal consistency of measurements with performance-based clinical tests for shoulder girdle kinematics and positioning in patients with shoulder pain. Data Sources: The MEDLINE, Embase, CINAHL, and SPORTDiscus databases were systematically searched from inception to August 2015. Study Selection: Articles published in Dutch, English, or German were included if they involved the evaluation of at least one of the measurement properties of interest. Data Extraction: Two reviewers independently evaluated the methodological quality per studied measurement property with the 4-point-rating scale of the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist, extracted data, and assessed the adequacy of the measurement properties. Data Synthesis: Forty studies comprising more than 30 clinical tests were included. Actual reported measurements of the tests were categorized into: (1) positional measurement methods, (2) measurement methods to determine dynamic characteristics, and (3) tests to diagnose impairments of shoulder girdle function. Best evidence synthesis of the tests was performed per measurement for each measurement property. Limitations: All studies had significant limitations, including incongruence between test description and actual reported measurements and a lack of reporting on minimal important change. In general, the methodological quality of the selected studies was fair to poor. Conclusions: High-quality evidence indicates that measurements obtained with the Modified Scapular Assistance Test are not reliable for clinical use. Sound recommendations for the use of other tests could not be made due to inadequate evidence. Across studies, diversity in description, performance, and interpretation of similar tests was present, and different criteria were used to establish similar diagnoses, mostly without taking into account a clinically meaningful context. Consequently, these tests lack face validity, which hampers their clinical use. Further research on validity and how to integrate a clinically meaningful context of movement into clinical tests is warranted.

Arthroscopic side-to-side repair of massive and contracted rotator cuff tears using a single uninterrupted suture: the shoestring bridge technique.

PURPOSE: This study was performed to evaluate the clinical effectiveness of a new side-to-side repair technique for massive rotator cuff tears using a single uninterrupted suture in the configuration of a shoestring in a medial-to-lateral progression. METHODS: Thirty-one consecutive patients with a mean age of 59 years (SD, 4.7 years) had primary arthroscopic repair of their massive, U-shaped, contracted supraspinatus and infraspinatus tear by the shoestring bridge technique. Preoperatively and postoperatively, we measured active forward flexion and determined the visual analog scale score for pain, Simple Shoulder Test score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. Repair integrity was evaluated by ultrasonography. RESULTS: At a mean follow-up of 26.5 months, all scores had significantly improved: active forward flexion, mean of 70° (SD, 29°) preoperatively to 139° (SD, 39°) postoperatively (P < .001); visual analog scale score for pain, 8.0 ± 1.4 points to 2.5 ± 1.8 points (P < .001); Simple Shoulder Test score, 15% ± 19% to 72% ± 23% (P < .001); and Disabilities of the Arm, Shoulder and Hand score, 62 ± 17 points to 21 ± 14 points (P < .001). Ultrasound evaluation showed that 25 of 31 patients (81%) had heeled tendons. Of 31 patients, 6 (19%) had a complete retear. Only 3 of these 6 patients were not satisfied with the result. CONCLUSIONS: Arthroscopic side-to-side repair by the shoestring bridge technique is effective in the treatment of massive, U-shaped, contracted supraspinatus and infraspinatus tears. It provides the shoulder surgeon a treatment modality with significant improvement in pain and function, high patient satisfaction, and a low retear rate. LEVEL OF EVIDENCE: Level IV, therapeutic case series.