Validation of the Subgroups for Targeted Treatment for Back (STarT Back) screening tool at a tertiary care centre.

BACKGROUND: The Subgroups for Targeted Treatment for Back (STarT Back) tool is a screening questionnaire developed to identify modifiable risk factors for back pain disability in primary care. Given the ability of this tool to assist with early identification of patients at high risk, we examined its concurrent convergent and known-group construct validity in tertiary care. METHODS: This was a case-control study of adult (age > 18 yr) patients with and without an active work-related compensation claim recruited from an academic health centre between August 2017 and May 2019. Patients in the study group were assessed by a physiotherapist and an orthopedic surgeon in a spine specialty program designed to assess and treat workplace injuries. The control group included patients referred to an orthopedic spine surgeon in a publicly funded specialty clinic where an advanced practice physiotherapist determined the need for surgical consultation. We used the Roland-Morris Disability Questionnaire (RMDQ) and the Hospital Anxiety and Depression Scale (HADS) to determine the convergent and known-group construct validity of the STarT Back tool. RESULTS: Fifty case and 50 control participants were included. We observed moderate to high association between the STarT Back total score, psychosocial subscore and risk categories and the RMDQ and HADS scores in the expected direction (p < 0.001). A significant association was observed between risk group allocation and depression (area under the curve values > 80), having a compensable injury and work status (p = 0.002-0.001). CONCLUSION: The STarT Back tool was able to differentiate between patients with and without a compensable injury and patients with different levels of work status. The tool has acceptable convergent and known-group construct validity and can assist in clinical decision-making in a tertiary care setting where adjunct psychologic management may be indicated.

Accuracy of infraspinatus isometric testing in predicting tear size and tendon reparability: comparison with imaging and arthroscopy.

BACKGROUND: The purpose of this study was to examine the accuracy of external rotation in neutral (0° external position) and in shortened position (45° external position) in relation to rotator cuff tear size, tendon reparability, and other clinical, surgical, and imaging findings. METHODS: This was a prospective blinded diagnostic study of consecutive surgical candidates for rotator cuff repair using magnetic resonance imaging and arthroscopic surgery as the "gold standards." The area under a receiver operating characteristic (AUROC) curve was calculated for each position. RESULTS: Eighty-five patients (35 female [41%] and 50 male [59%]; age, 65 years [standard deviation = 10]) were included. Sixty patients (71%) had a minor tear (4 small, 56 moderate), and 25 patients (29%) had a major tear (17 large and 8 massive). Seventy patients (82%) had a full repair, and 15 (18%) patients underwent a partial repair. There were 26 (31%) associated full-thickness tears of the infraspinatus. The isometric strength testing in both positions had good to excellent accuracy (range, 0.80-0.90) for detecting reparability, tear retraction, infraspinatus atrophic changes observed by the clinician, and infraspinatus fatty infiltration on magnetic resonance images. The shortened position had an overall higher accuracy than the neutral position and was more clinically useful for detecting an infraspinatus full-thickness tear (AUROC = 0.84 vs 0.78) and rotator cuff tear size (AUROC = 0.80 vs. 0.75). CONCLUSIONS: The isometric external rotation is an accurate test in diagnosing different aspects of rotator cuff disease and specifically of the infraspinatus muscle. The isometric strength at the shortened position was a better predictor of clinical, surgical, and imaging findings.

The effect of expedited rotator cuff surgery in injured workers: a case-control study.

BACKGROUND: Expediting rotator cuff surgery is expected to facilitate recovery and return to work in injured workers. This case-control study examined the effect of expedited rotator cuff surgery on recovery and work status in injured workers. MATERIALS AND METHODS: Injured workers who had undergone an expedited rotator cuff surgery funded by parallel-pay insurance (study group) were compared with workers who had used the public health insurance (control group) while adjusting for sex, age, severity of pathology, and follow-up period. Disability was measured by the American Shoulder and Elbow Surgeons (ASES) Standardized Assessment Form score. The percentage of patients who exceeded the minimal clinically important difference of 17 points in the ASES was calculated. RESULTS: The study group waited less time to have surgery than the control group (P < .0001), reported less disability after surgery, and had a higher number of patients whose improvement exceeded the minimal clinically important difference (119 vs. 65, P < .0001). The study group was more likely to be working at the time of the final follow-up (P < .0001). The final multivariable regressions, which adjusted for unmatched variables, such as dominant side involvement, mechanism of injury, and associated operations that were different between groups, were consistent with univariable analyses indicating superior results in the study group. CONCLUSIONS: Injured workers who underwent expedited rotator cuff surgery reported less disability and had a more successful return to work after surgery than injured workers who waited longer for specialist assessment and surgery within the public health system.

A Phase IV Study of Thromboembolic and Bleeding Events Following Hip and Knee Arthroplasty Using Oral Factor Xa Inhibitor.

BACKGROUND: Multiple randomized controlled trials have documented the effectiveness of rivaroxaban in the prevention of venous thromboembolism up to 1-month following total joint arthroplasty. However, the effectiveness and safety of rivaroxaban in the real-world setting, outside of the strict protocols used by randomized clinical trials, are unknown. METHODS: This was a prospective, observational, noninterventional, phase IV study of 3914 consecutive patients who underwent total joint arthroplasty from June 2010 to December 2012. Patients were treated with rivaroxaban 10 mg by mouth daily starting postoperative day 1 and continued for 15 days. Participants were followed up in clinic at 6 weeks and contacted by telephone at 12 weeks. The primary outcome of interest was symptomatic venous thromboembolism; secondary outcomes included bleeding events, transfusion requirements, and death. RESULTS: The incidence of symptomatic deep venous thrombosis at 3 months was 0.5% (n = 18). Only 1 deep venous thrombosis event occurred within 7 days of surgery. The incidence of symptomatic pulmonary embolism (PE) at 3 months was 0.7% (n = 28). Thirteen PEs (46%) occurred within 7 days of surgery. The rate of major bleeding while on prophylaxis was 0.1%. Only 5% of patients received a blood transfusion. No deaths were attributed to thromboembolic events. CONCLUSION: This prospective, observational, phase IV study demonstrates that rivaroxaban appears to protect patients against symptomatic PE and is not associated with major bleeding events when used in a real-world setting as described.

Effect of arthroscopic rotator cuff surgery in patients with preoperative restricted range of motion.

BACKGROUND: The purpose of this study was to examine the impact of rotator cuff (RC) decompression and/or repair on post-operative ROM in patients with pre-operative restricted passive motion who had undergone arthroscopic subacromial debridement and/or rotator cuff repair. Potential predictors of ROM recovery such as age, sex, mechanism of injury, type of surgery, presence of an endocrine illness and having an active Worker Compensation claim related to the shoulder were explored. METHODS: A retrospective analysis of prospectively collected data was performed. Pre-operative stiffness measured intra-operatively was defined as flexion of < =100° or external rotation of < =30° under anesthesia. Patients who received manipulation under anesthesia or required capsular release were excluded. RESULTS: Two hundred and eighteen patients met the criteria for having stiffness under anesthesia. Twenty six patients had stiffness in both directions, 19 patients had isolated restricted flexion and 173 had isolated restricted external rotation. At six months post-operatively, a statistically significant improvement was observed on average in all disability measures (P < 0.0001). The ROM improved on average in the restricted direction at 6 months (p < 0.0001). Older age had a negative impact on recovery of external rotation (F2,216 = -5.78, p = 0.02). Being a female, having a traumatic event, having a RC repair, or suffering from an endocrine illness such as diabetes, did not have a negative impact on recovery. Patients with an active work-related compensation claim showed an inferior recovery of flexion (F2,216 = -8.76, p = 0.003). CONCLUSION: Patients with RC pathology and concomitant stiffness showed significant improvement in ROM at six months following RC decompression or repair without the need for formal capsular releases or the performance of manipulation under anesthesia. Older patients and those with active Workers Compensation claim showed an inferior recovery in isolated directions.

Sex and gender disparity in pathology, disability, referral pattern, and wait time for surgery in workers with shoulder injury.

BACKGROUND: The role of sex as an important biological determinant of vulnerability to sustaining injury and gender as a social determinate of access to resources, referral for medical care and perceived disability remains conflicted in injured workers. The purpose of this study was to examine sex and gender disparity following a compensable work-related shoulder injury. METHODS: This study involved cross-sectional analyses of data of two independent samples of workers with shoulder injury. Measures of disability and pain were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Numerical Pain Rating Scale (NPRS) for patients seen at an Early Shoulder Physician Assessment (ESPA) program and the American Shoulder and Elbow Surgeons (ASES) assessment form and Visual Analogue Scale (VAS) for the sample who underwent surgery. RESULTS: The files of 1000 (443 females, 557 men) consecutive patients seen at an ESPA program and 150 (44 females, and 106 men) consecutive patients who underwent rotator cuff surgery (repair or decompression) were reviewed. Significant gender disparity was observed in the referral pattern of injured workers seen at the ESPA program who were referred for surgical consultation (22 vs. 78 % for females and males respectively, p < 0.0001). The independent rotator cuff surgical group had a similar gender discrepancy (29 % vs. 71 %, p < 0.0001). The timeframe from injury to surgery was longer in women in the surgical group (p = 0.01). As well, women waited longer from the date of consent to date of surgery (p = 0.04). Women had higher incidence of repetitive injuries (p = 0.01) with men reporting higher incidence of falls (p = 0.01). Women seen at the ESPA program were more disabled than men (p = 0.02). Women in both samples had a higher rate of medication consumption than men (p = 0.01 to <0.0001). Men seen at the ESPA program had a higher prevalence of full thickness rotator cuff tears (p < 0.0001) and labral pathology (p = 0.01). However, these pathologies did not explain gender disparity in the subsample of ESPA who were referred for surgical consultation or those who had surgery. CONCLUSIONS: Sex and gender disparity exists in workers with shoulder injuries and is evident in the mechanism of injury, perceived disability, medication consumption, referral pattern, and wait time for surgery.

Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy.

BACKGROUND: There is limited information on the validity of magnetic resonance imaging (MRI) in detection of biceps disease. The purpose of this study was to examine the measurement properties of noncontrasted MRI in diagnosis of biceps disease using arthroscopic surgery as the "gold standard." MATERIALS AND METHODS: Prospectively collected surgical data of patients with impingement syndrome or rotator cuff tear, with biceps disease (study group) or without biceps disease (control group), were reviewed. MRI reports of radiologists with fellowship training in musculoskeletal imaging were retrospectively reviewed and compared with surgical findings. RESULTS: Data of 183 (130 study and 53 control) patients (73 women [40%], 110 men [60%]; mean age, 62 years [standard deviation, 9]) who had undergone arthroscopic rotator cuff-related surgery during a period of 11 years were used for analysis. Sensitivity and specificity of MRI for detection of full tears of the biceps tendon were 0.54 and 0.98, respectively. Sensitivity and specificity were 0.27 and 0.86 for partial tears of the biceps tendon, respectively. For biceps subluxation or dislocation, sensitivity was 1.00 and specificity was 0.83. The areas under the receiver operating characteristic curves, which quantify the overall accuracy of the tests, were 0.57, 0.75, and 0.92 for partial tear, full tear, and instability of the biceps tendon, respectively. CONCLUSIONS: Noncontrasted MRI has a low sensitivity and high specificity for detection of full-thickness tears of the biceps tendon. It is highly sensitive for diagnosis of instability of the long head of the biceps. However, its usefulness for diagnosis of partial tears of the biceps tendon remains limited.

Relationship between probability of future shoulder arthroplasty and outcomes of arthroscopic debridement in patients with advanced osteoarthritis of glenohumeral joint.

BACKGROUND: Arthroscopic glenohumeral debridement for symptom control has shown promising short term results in the young active population, when arthroplasty may not be a practical option due to the recommended activity restrictions, potential for complications and/or early wear, and a need for revision. The purpose of this study was twofold: 1) to examine the impact of arthroscopic debridement with or without subacromial decompression on clinical outcomes in patients with severe glenohumeral osteoarthritis (OA), and 2) to explore the differences in post-debridement outcomes between patients who eventually progressed to arthroplasty vs. those who did not. The role of an active worker's compensation claim was examined. METHODS: Prospectively collected data of patients who were not good candidates for shoulder arthroplasty and had subsequently undergone arthroscopic shoulder debridement were used for analysis. Disability was measured using the relative Constant-Murley score (CMS), the American Shoulder and Elbow Surgeon's (ASES) assessment form, pain free range of motion (ROM), and strength. RESULTS: Fifty-six patients were included in the final analysis. Eighteen (32 %) patients underwent arthroplasty surgery (arthroplasty group) over a period of 11 years. The arthroplasty group was comparable with the non-arthroplasty group prior to debridement but was more disabled at post-debridement surgery follow-up, functioning at less than 50 % of normal based on ASES, relative CMS, and active painfree ROM. In the multivariable analysis, the post-debridement relative CMS was affected by having a compensation claim and having a future arthroplasty. CONCLUSION: Arthroscopic debridement improved clinical outcome in 68 % of patients suffering from advanced OA of glenohumeral joint. Having less than 50 % of normal score in ASES, relative CMS and painfree ROM post- debridement within a period of two years may be an indication for future arthroplasty. Role of worker's compensation claims should not be underestimated.

Examining outcome of early physician specialist assessment in injured workers with shoulder complaints.

BACKGROUND: There is minimal research on demographics, type of injury and diagnosis of injured workers with shoulder problems. The purposes of this study were: 1) to document the demographics of patients with shoulder complaints referred to an Early Shoulder Physician Assessment (ESPA) Program and to describe the recommended management, and 2) to examine the relationship between patient characteristics and their subjective complaints of pain and functional difficulty. METHODS: This study involved a retrospective review of electronic files of injured workers mostly seen within the first 16 weeks of injury or recurrence. Measures of functional difficulty and pain were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Numeric Pain Scale (NPS). RESULTS: Files of 550 consecutive patients, 260 females (47%), 290 men (53%) were examined. The average age was 49 (SD = 11, range 22-77), with 28 (5%) patients being 65 years of age or older. Patients who were not working were the most disabled group based on Quick DASH (F = 49.93, p < 0.0001) and NPS (F = 10.24, p = 0.002). Patients who were working full time performing regular duties were the least disabled according to both measures, the QuickDASH (F = 10.24, p = 0.002) and NPS (F = 7.57, p = 0.006). Patients waiting more than 16 weeks were slightly older (53 years of age vs. 49, p = 0.045) than those who met the criteria for early assessment with similar levels of pain and functional difficulty. Biceps pathology had the highest prevalence (37%). Full thickness tear had a prevalence of 14%. Instability, labral lesions and osteoarthritis of glenohumeral joint were uncommon conditions (3, 2 and 1% respectively). Fifty-five patients (10%) were surgical candidates and had higher scores on QuickDASH (F = 7.16, p = 0.008) and NPS (F = 4.24, p = 0.04) compared to those who did not require surgery. CONCLUSIONS: This study provides information on characteristics and prevalence of important variables in injured workers with shoulder problems and highlights the impact of these characteristics on pain and disability.

Full-thickness rotator cuff tears in patients younger than 55 years: clinical outcome of arthroscopic repair in comparison with older patients.

PURPOSE: The purpose of this study was to examine whether younger patients had a similar response to repair of a full-thickness rotator cuff tear (RCT) as older patients. METHODS: A secondary analysis was conducted of prospectively collected data of patients with full-thickness RCTs. Patients were categorized into patients <55 years of age and patients 55 and older. Patient-related outcome measures of disability at 2 years following surgery were the Short Western Ontario Rotator Cuff (Short WORC), American Shoulder and Elbow Surgeon's (ASES) assessment form, and absolute Constant-Murley score (ACMS). RESULTS: Review of the database between 2001 and 2011 identified 344 patients (median age 62, range 24-90). Of these, 83 (24 %) patients were younger than 55 years of age (median age 48, range 24-54) and 261 (76 %) were in the older age group (median age 66, range 55-90). The median follow-up was 24 months (range 23-25). Patients in the younger age group had a higher prevalence of traumatic events (p = 0.02), had sustained more work-related injuries (p < 0.0001), and had a higher ratio of smaller tears (p = 0.0001). No difference was seen between groups with respect to post-operative scores of Short WORC, ASES, or ACMS. Pre-operative scores, having a work-related claim, increased tear size, and concomitant procedures affected the 2-year outcome scores. CONCLUSION: This study shows that younger patients with full-thickness RCTs who undergo an arthroscopic repair do as well as older individuals regardless of the measure used to document their recovery. LEVEL OF EVIDENCE: Retrospective outcome study, Level II.

Association between pre-operative magnetic resonance imaging and reparability of large and massive rotator cuff tears.

PURPOSE: It is recognized that a percentage of large and massive rotator cuff tears (RCTs) cannot be anatomically repaired. We hypothesized that factors identified on pre-operative MRI would be associated with rotator cuff reparability. METHODS: A single-surgeon retrospective study was performed on patients who had undergone either an anatomical or partial repair of a large or massive RCT. Pre-operative MRI images were evaluated by a fellowship-trained shoulder surgeon, blinded to the surgical outcome. Stump location, tear dimension in the coronal and sagittal plane, fatty infiltration, muscle atrophy (occupation ratio, tangent sign), and superior migration of the humeral head (acromion-humeral distance, inferior glenohumeral distance, and best-fit humeral circle technique) were assessed as the predictors of repair. Logistic regression and chi-square analyses were used. RESULTS: A total of sixty patients with median age 63 (range 40-83) were included. On MRI, reparability was associated with increased medial-lateral (ML) tear size (p = 0.003), but not increased AP tear size (n.s.). An association was seen between partial repair and tendon retraction to or beyond the glenoid (p = 0.0005), positive tangent sign (p = 0.04), advanced supraspinatus fatty infiltration in isolation (p = 0.046), combined advanced supraspinatus and infraspinatus fatty infiltration (p = 0.04), and superior migration of the humeral head as measured by the inferior glenohumeral distance only (p = 0.004). Multivariable analysis identified increased ML tear size as the most significant factor associated with partial repair. CONCLUSION: This study demonstrates that MRI findings of tendon retraction to or beyond the glenoid, increased inferior glenohumeral distance, and a positive tangent sign are associated with irreparability of large and massive RCTs.

Outcome of distal clavicle resection in patients with acromioclavicular joint osteoarthritis and full-thickness rotator cuff tear.

PURPOSE: The purpose of this study was to examine the impact of distal clavicle resection (DCR) on subjective and objective outcome measures in patients with acromioclavicular (AC) joint osteoarthritis (OA) and rotator cuff tear. METHODS: Prospectively collected data of consecutive patients with arthroscopic evidence of OA of the ACJ with complete data at 2 years were used for the data analysis. Patients with moderate-to-severe OA of the AC joint underwent a DCR in conjunction with rotator cuff repair, while patients with mild OA of the ACJ underwent surgery related to concomitant rotator cuff tear without a DCR. RESULTS: Data of 184 (72 females, 112 males, mean age: 62) patients with rotator cuff tear and varying degrees of OA of the AC joint were used for the analysis. Of 184 patients, 144 (78 %) had a resection of distal clavicle (resection group) and 40 (22 %) did not have a resection (no-resection group). Both groups showed a statistically significant (p < 0.0001) improvement in the American Shoulder and Elbow Surgeons (ASES) scores, Constant Murley score, and strength. Multivariable analysis showed that lower pre-operative ASES scores (higher disability), having a larger tear, an active compensation claim, and not having a DCR, had a negative impact on post-operative ASES scores. CONCLUSION: When untreated surgically, even mild arthroscopic findings of AC joint OA may lead to a poorer outcome after rotator cuff repair. Further characterisation of patients in whom mild arthroscopic findings of OA of AC joint are clinically significant and warrant resection is needed. LEVEL OF EVIDENCE: Retrospective outcome study, Level II.

Relationship between clinical and surgical findings and reparability of large and massive rotator cuff tears: a longitudinal study.

BACKGROUND: The literature has shown good results with partial repairs of large and massive tears of rotator cuff but the role of factors that affect reparability is less clear. The purpose of this study was twofold, 1) to examine clinical outcomes following complete or partial repair of large or massive full-thickness rotator cuff tear, and 2) to explore the value of clinical and surgical factors in predicting reparability. METHODS: This was a secondary data analysis of consecutive patients with large or massive rotator cuff tear who required surgical treatment (arthroscopic complete or partial repair) and were followed up for two years. Disability measures included the American Shoulder and Elbow Surgeons (ASES), the relative Constant-Murley score (CMS) and the shortened version of the Western Ontario Rotator Cuff Index (ShortWORC). The relationship between predictors and reparability was examined through logistic regressions and chi-square statistics as appropriate. Within group change over time and between group differences in disability outcomes, range of motion and strength were examined by student's T-tests and non-parametric statistics. RESULTS: One hundred and twenty two patients (41 women, 81 men, mean age 64, SD=9) were included in the analysis. There were 86 large (39 fully reparable, 47 partially reparable) and 36 (10 fully reparable, 26 partially reparable) massive tears. Reparability was not associated with age, sex, or pre-operative active flexion or abduction (p0>0.05) but the fully reparable tear group showed a better pre-operative ASES score (p=0.01) and better active external rotation in neutral (p=0.01). Reparability was associated with tear shape (p<0.0001), size (p=0.002), and tendon quality (p<0.0001). CONCLUSIONS: Reparability of large or massive tears is affected by a number of clinical and surgical factors. Patients whose tears could not be fully repaired showed a statistically significant improvement in range of motion, strength and disability at 2 years, although they had slightly inferior results compared to those with complete repairs.

Pattern of recovery following total shoulder arthroplasty and humeral head replacement.

BACKGROUND: Understanding the pattern of recovery and expected rate of change after shoulder arthroplasty is helpful to clinicians and patients for setting realistic expectations and goals. The purpose of this study was to describe the pattern of recovery over a 2-year period for patients receiving either a Total Shoulder Arthroplasty (TSA) or Humeral Head Replacement (HHR). METHODS: This was a secondary analysis of prospectively collected data of patients who had undergone TSA or HHR and were followed for up to 2 years. Patients were seen prior to surgery and at 6 months, one year and two years after surgery and completed the American Shoulder and Elbow Surgeon's (ASES) questionnaire, Relative Constant Murley score (RCMS) and underwent range of motion and strength assessment. RESULTS: Data of 134 patients who had surgery from April 2001 to July 2011 were used for analysis. One hundred and eight patients underwent TSA (81%) and 26 (19%) had HHR. Both surgeries were associated with a statistically significant improvement in physical symptoms, ASES, RCMS, range of motion and strength (p <0.0001). The greatest change for all outcomes occurred within the first 6-months of surgery. Improvement in ASES, RCMS continued up to 12-months and then plateaued. Improvement in physical symptoms leveled off at 6-months in the HHR group but continued up to 12-months in the TSR group. Strength showed improvement in both groups up to 24-months post-surgery. CONCLUSION: Both TSA and HHR groups showed a statistically significant improvement in perceived disability, range of motion and strength over two years with the greatest improvement made by 6 months. The recovery profiles for the surgeries showed different patterns.

Patient-reported compliance with thromboprophylaxis using an oral factor Xa inhibitor (rivaroxaban) following total hip and total knee arthroplasty.

This prospective study examines patient non-compliance (NC) for an oral factor Xa inhibitor (Rivaroxaban) when used as venous thromboembolic (VTE) prophylaxis following lower limb arthroplasty. A total of 3145 patients underwent surgery from May 2010 to December 2011. At 6 weeks patients completed an anonymous self-administered questionnaire. Postoperatively 2947 (94%, 2947/3145) received Rivaroxaban. 2824 (96%, 2824/2947) completed all in-hospital doses. Seven percent (203/2824) of patients did not attend the 6-week follow-up. Two thousand one hundred sixty-three (83%, 2163/2621) completed all prescribed doses, 98 (4%, 98/2621) were NC and 360 (14%, 360/2621) had incomplete data. Gender, age, body mass index and preoperative hemoglobin all correlated with NC (p < 0.05). Type and side of surgery did not correlate with compliance (p > 0.05). Patient-reported NC for Rivaroxaban is 4% which compares favorably to other VTE prophylaxis modalities.

Discordance between self-report and performance-based outcomes: Contribution of psychosocial factors.

The purpose of this study was to examine the role of psychosocial factors in the discordance between perceived and observed physical disability in patients with osteoarthritis of the hip or knee joint. This was a cross-sectional study of patients seen for consideration of joint arthroplasty surgery. Patients completed a psychosocial outcome measure, a patient self-reported functional scale, and two performance-based tests. Data of 121 patients, mean age, 67 (8), 81 (67%) females were used for analysis. The fear avoidance and positive affect domains had the strongest association with the discordance between the self-report and both performance outcome measures. Age, gender, and severity of osteoarthritis were associated with discordance in relation to walking. Fear avoidance beliefs and positive affect play important roles in perception of pain and function. Age, gender, and severity of arthritis should be taken into consideration for a more holistic approach to arthritis care.

Impact of prosthetic design on clinical and radiologic outcomes of total shoulder arthroplasty: a prospective study.

BACKGROUND: This prospective longitudinal study compared clinical and radiologic outcomes of total shoulder arthroplasty (TSA) using 3 different prosthetic designs, the Neer II system, the Bigliani-Flatow (BF), and a stemless prosthesis, the Total Evolutive Shoulder System (TESS). MATERIALS AND METHODS: Patients with advanced osteoarthritis of the glenohumeral joint who underwent TSA were followed up for 2 years. Four patient-oriented disability outcomes were used. The clinical data collected before surgery and at follow-up assessments during a 2-year period included active range of motion (ROM) in 6 directions and strength. Radiographic signs of glenoid and humeral component loosening were recorded. The incidence of humeral head subluxation was documented. RESULTS: Seventy-four patients completed the study. There was a significant improvement in the 4 disability measures, ROM, and strength at 2 years in all 3 groups (P < .0001). Active external rotation at 90° abduction was statistically significantly lower in the Neer II group (P = .001). The incidence of lucent lines around the glenoid component was higher in the Neer II group (P = .0002). No statistically significant relationship was seen between type of prosthesis and patient satisfaction (P > 0.05). CONCLUSIONS: The 3 types of TSA prostheses used in this study all provided significant improvement in pain and function and were associated with high patient satisfaction. The Neer II was associated with less active external rotation and more lucent lines.

Risk Stratification in a Tertiary Care Spine Centre: Comparison Between STarTBack and OSPRO-YF Screening Tools.

Purpose: STarT Back Screening Tool and OSPRO-YF scales have been reported to be accurate tools for estimating risk for the development of persistent pain or prolonged disability in primary care settings. We performed a comparison of construct convergent and known-group validity and ceiling floor effect (CFE) of these tools using a common sample of patients seen at a tertiary care spine centre. Methods: This was a cross-sectional study of patients with and without a work-related back injury. The Hospital Anxiety and Depression Scale (HADS) was used as the reference outcome measure for convergent validity. For known-group validity, we examined the ability of the scales to differentiate between different levels of compensation, presence of non-organic signs, and work status. The CFE values were calculated. Results: Fifty consecutive injured workers were included along with 50 patients without an active compensation claim related to their low back pain. STarTBack and OSPRO-YF had moderate to high associations with the depression component of the HADS (0.69 to 0.77 respectively) with a statistically significant difference in favour of the OSPRO-YF. STarTBack's risk stratification categories were able to differentiate patients with a compensable injury, non-organic signs, and inability to work (p values ranging from 0.002 to < 0.001). The physical activity and work fear-avoidance beliefs constructs of the OSPRO-YF consistently outperformed other yellow flag constructs (p values ranging from 0.008 to < 0.001). The psychological sub-score of STarTBack showed a ceiling effect. There was a floor effect for the negative affect domain of OSPRO-YF. Neither total score had a floor or ceiling effect. Conclusions: STarTBack and OSPRO-YF are short screening tools with acceptable convergent and known-group construct validity and no floor or ceiling effect of their total score. Both tools could assist with the identification, evaluation, and management of psychological distress in patients presenting to tertiary care spine centres.

Objectif : l'outil de dépistage STarT Back et les échelles OSPRO-YF sont considérés comme des mécanismes précis pour estimer le risque d'apparition d'une douleur persistante ou d'une invalidité prolongée en soins primaires. Les chercheurs ont comparé la validité convergente de construit, la validité des groupes connus et l'effet plafond-plancher (EPP) de ces outils auprès d'un échantillon commun de patients suivis dans un centre tertiaire du rachis. Méthodologie : étude transversale de patients atteints ou non d'une blessure dorsale liée au travail. Les chercheurs ont utilisé l'échelle HADS (anxiété et dépression à l'hôpital) comme mesure de référence des résultats pour déterminer la validité convergente. Pour ce qui est de la validité des groupes connus, ils ont examiné la capacité des échelles à distinguer les divers taux d'indemnisation, la présence de signes non organiques et la situation d'emploi et ont calculé les valeurs de l'EPP. Résultats : cinquante (50) travailleurs blessés consécutifs ont participé à l'étude, de même que 50 patients n'ayant pas de réclamation d'indemnisation active liée à leur douleur lombaire. Les outils STarTBack et OSPRO-YF étaient dotés d'associations modérées à élevées avec l'élément « depression ¼ de l'échelle HADS (0,69 à 0,77. respectivement), et la différence en faveur de l'échelle OSPRO-YF était statistiquement significative. Les catégories de stratification du risque de l'outil STarTBack pouvaient distinguer les patients atteints d'une blessure justifiant une indemnisation, les signes non organiques et l'incapacité de travailler (valeurs p de 0,002 à < 0,001). Les construits de l'activité physique et des comportements d'appréhension ou d'évitement de l'échelle OSPRO-YF étaient constamment supérieurs aux autres construits de drapeau jaune (valeurs p de 0,008 à < 0,001). Le sous-score psychologique de l'outil STarTBack avait un effet plafond, tandis que le domaine d'affect négatif de l'échelle OSPRO-YF avait un effet plancher. Aucun des scores totaux n'avait d'effet plancher ou plafond. Conclusions : STarTBack et OSPRO-YF sont de courts outils de dépistage à la validité de construit convergente et de groupes connus et dont le score total n'a ni effet plancher ni effet plafond. Les deux outils pourraient contribuer à déterminer, à évaluer et à prendre en charge la détresse psychologique chez les parents qui consultent dans un centre tertiaire du rachis.

Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process.

Purpose: The primary purpose of this study was to validate an appropriateness decision-aid tool as a part of engaging patients with glenohumeral arthritis in their surgical management. The associations between the final decision to have surgery and patient characteristics were examined. Materials and Methods: This was an observational study. The demographics, overall health, patient-specific risk profile, expectations, and health-related quality of life were documented. Visual analog scale and the American Shoulder & Elbow Surgeon (ASES) measured pain and functional disability, respectively. Clinical and imaging examination documented clinical findings and extent of degenerative arthritis and cuff tear arthropathy. Appropriateness for arthroplasty surgery was documented by a 5-item Likert response survey and the final decision was documented as ready, not-ready, and would like to further discuss. Results: Eighty patients, 38 women (47.5%), mean age: 72(8) participated in the study. The appropriateness decision aid showed excellent discriminate validity (area under the receiver operating characteristic curve value of 0.93) in differentiating between patients who were "ready" and those who were "not-ready" to have surgery. Gender (P = 0.037), overall health (P = .024), strength in external rotation (P = .002), pain severity (P = .001), ASES score (P < .0001), and expectations (P = .024) were contributing factors to the decision to have surgery. Imaging findings did not play a significant role in the final decision to have surgery. Conclusions: A 5-item tool showed excellent validity in differentiating patients who were ready to have surgery versus those who were not. Patient's gender, expectations, strength, and self-reported outcomes were important factors in reaching the final decision.

Virtual performance measure in osteoarthritis: An innovative transformation of patient care.

Objectives: The purpose of this study was to develop and establish reliability and validity of a virtual performance measure (VPM) score that encompassed 10 videos in patients with osteoarthritis of the knee joint. Patients' experience and satisfaction were documented. Design: Forty videos were chosen for 10 functional tasks, with four videos showing increasing difficulty for each task. Patients were requested to choose the video that best reflected their own situation. Clinical and radiological findings and self-report and performance measures were completed. Results: Data of 100 patients, 70 (70%) females, mean age: 65 â€‹± â€‹9 were examined. The Cronbach's alpha coefficient that examined internal consistency of the VPM score was 0.92. The intraclass correlation value of 0.82 was obtained for test-retest reliability. Factor analysis showed three distinct domains. There was moderate correlations between the VPM score and the self-report and actual performance measures ranging from r â€‹= â€‹0.46 to 0.66. The VPM summated score of 10 activities was able to differentiate between candidates and non-candidates for knee arthroplasty, with the area under the curve value of 0.90 indicating excellent predictive validity. The overall patient experience and satisfaction was positive with 67% of participants feeling that virtual care could have an impact on minimizing physical presence in the clinic or hospital. Conclusions: The VPM is a reliable and valid outcome measure in patients with osteoarthritis of the knee joint. This digital tool has the potential to transform osteoarthritis care by providing a valid remote measurement of real-life functional limitations and reduce the burden of time consuming in-person tests.