The minimal important change for the seven-item disability of the arm, shoulder, and hand (DASH 7) questionnaire - Assessing shoulder function in patients with subacromial pain.

BACKGROUND: The DASH 7 is a recently published activity-related 7-item short form of the disability of the arm, shoulder, and hand (DASH) questionnaire developed to assess shoulder function in patients with subacromial pain. Before implementation in both intervention studies and in clinical practice, it is essential to evaluate its responsiveness. The objective of this study was to determine the minimal important change (MIC) in the DASH 7 questionnaire for patients with subacromial pain after a 3 months exercise intervention in a primary care context. METHODS: In this psychometric study the anchor-based MIC-distribution method was used to establish the MIC. The Patient Global Impression of Change (PGIC) was used as external criterion. Data from a clinical implementation study, aimed to implement a specific exercise strategy for patients with subacromial pain among physiotherapists in primary care, were used. Data from 70 patients were included in the analyses. RESULTS: The correlation coefficient between Patient Global Impression of Change and the DASH 7 score change was 0.67 and the area under the curve was 0.94 (95% confidence interval: 0.88-1.0). The MICROC for improvement was detected at a mean change in 6.5 points with the sensitivity at 0.98 (98%) and the specificity at 0.78 (78%), and the MIC95% limit for improvement was detected at a mean change of 25.7 points. There were 77% of the patients who reached at least this MICROC and 51% who reached at least the MIC95% limit after 3 months of exercise intervention. CONCLUSION: The DASH 7 is responsive to change over time and can discriminate between patients considered to be improved and patients considered not improved. These MIC values for patients with subacromial pain in the primary care setting can be used in clinical practice and in intervention studies as an indication on the patients clinically important level of score change for improvement.

Heterogeneity among patients with subacromial pain - variabilities within clinical presentation and its impact on daily life.

OBJECTIVE: The primary aim was to describe the variability within clinical presentation of patients with subacromial pain in primary care, secondly to investigate associations between clinical presentation and self-reported pain intensity, shoulder function, level of anxiety and depression, and health-related quality of life. DESIGN AND SETTING: A cross-sectional study based on data from two clinical studies in primary care, one randomized controlled trial and one implementation study. Three components: active range of motion (AROM), rotator cuff function and scapular kinematics were analyzed to describe variability within clinical presentation and patient-reported measurements were used to investigate the impact on daily life. PARTICIPANTS: Patients aged 30-67 years, describing pain for more than two weeks, with positive signs for a minimum of three out of the following five clinical tests: impingement sign according to Neer, impingement test according to Hawkins-Kennedy, Pattes maneuver, Jobe's test, and painful arc. RESULTS: Among the 164 patients included, 24% displayed dysfunction in one, 50% two and 24% in all three components. Limited AROM was seen in 46%, rotator cuff dysfunction in 91% and scapular dyskinesia in 57% of the patients. CONCLUSIONS: These results reveal a heterogeneity among primary care patients with subacromial pain confirming a large variability regarding the components AROM, rotator cuff function and scapular kinematics. All three components appear unique (not significantly correlated) where a rotator cuff dysfunction is very frequent while limited AROM and scapular dyskinesia are more inconsistent. There are significant, but rather weak, associations between clinical presentation and impact on daily life.

A short activity-related scale for measuring shoulder function in patients with subacromial pain: the DASH 7.

BACKGROUND: Subacromial pain is a common cause of shoulder dysfunction that negatively affects quality of life. Currently, most outcome measures for shoulder pain are applied to a heterogeneous group of patients. Of these measures, the Disabilities of the Arm, Shoulder, and Hand (DASH) is the most widely recognized test with which to assess patients with subacromial pain. The primary aim of this study was to assess the content validity of DASH for patients with subacromial pain, with a secondary aim to test responsiveness to a modified set of DASH items tailored to these patients. METHODS: There were 129 patients who reported activities in the Patient-Specific Functional Scale (PSFS). To assess validity, 5 independent physiotherapists matched PSFS activities to the most appropriate DASH item. DASH items identified as being of greatest importance to patients were those corresponding to the highest number of PSFS-matched activities. Calculations were made for responsiveness and internal consistency. RESULTS: Physiotherapists matched DASH items to 271 PSFS activities, reaching agreement for almost 80%. Seven DASH items (DASH 7) were identified as being particularly important. Effect size data (Cohen's d) were 0.93 for DASH 7, 0.92 for DASH 30, and 0.85 for QuickDASH; the corresponding Cronbach's α values (for DASH 7, DASH 30, and QuickDASH) were 0.84, 0.94, and 0.86, respectively. CONCLUSIONS: DASH 7 is a short, patient-centered, and activity-related scale that can measure shoulder function in patients with subacromial pain using a quarter of the original DASH items. DASH 7 demonstrated responsiveness, with a satisfactory level of internal consistency.

Effects of acupuncture versus ultrasound in patients with impingement syndrome: randomized clinical trial.

BACKGROUND AND PURPOSE: There is no definitive evidence for the efficacy of the physical therapy interventions used for patients with impingement syndrome. The purpose of this study was to compare manual acupuncture and continuous ultrasound, both applied in addition to home exercises, for patients diagnosed with impingement syndrome. SUBJECTS AND METHODS: Eighty-five patients with clinical signs of impingement syndrome were randomly assigned to either a group that received acupuncture (n=44) or a group that received ultrasound (n=41). Both interventions were given by physical therapists twice a week for 5 weeks in addition to a home exercise program. Scores from 3 shoulder disability measures, combined in the analysis, measured change during a period of 12 months. RESULTS: Both groups improved, but the acupuncture group had a larger improvement in the combined score. DISCUSSION AND CONCLUSION: The results suggest that acupuncture is more efficacious than ultrasound when applied in addition to home exercises.

Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment.

This study evaluates the standardized strength test in the Constant-Murley shoulder assessment of adults with healthy shoulders in a randomized, single-blind design. The following questions were to be answered: (1) Can the spring balance and a digital dynamometer both yield the same result? (2) What is the intraobserver and interobserver reliability of the strength test? (3) Is the strength test sensitive to change in technique or affected by calculation with mean or maximum values? Ten subjects were included in a comparison of the Handyscale (digital dynamometer) and the mechanical spring balance for concurrent validity, resulting in intraclass correlation coefficient values ranging from 0.96 to 0.99. For intraobserver and interobserver reliability, 2 observers tested 20 subjects with the Handyscale and retested them after 2 weeks. Regardless of technique during testing, this resulted in almost perfect agreement (intraclass correlation coefficient range, 0.89-0.98). The digital dynamometer can replace the conventional spring balance. The standardized strength test in the Constant-Murley shoulder assessment is reliable in young subjects with healthy shoulders, independent of technique or whether calculated with mean or maximum values.