Особливості розташування лопатки у пацієнтів із болями в ділянці плеча: достовірність досліджень та важливість клінічних тестів

Therefore, this study aimed at examining the interob-server reliability, examining the internal consistency, and examining the clinical importance of 3 clinical tests for the assessment of scapular positioning in patients with shoulder pain. To examine the clinical importance of the tests, we searched for associations between the outcome of the tests and self-reported pain severity and disability in patients with shoulder pain. Indeed, some impairments (ie, impairments in scapular positioning) may not be related to disability and therefore need not become a focus of treatment. This is a difficult yet critical step in the clinical reasoning process. The «Clinical Research Agenda for Physical Therapy has identified the relation between impairments and disability as an extremely important question for the conduct of clinical practice. Furthermore, it was hypothesized that if the outcome on the clinical tests generates clinically relevant data, then the outcome would differ between the symptomatic and asymptomatic side.

 

 

Subject Recruitment and Research Design а convenience sample of 29 patients with a variety of shoulder disorders, diagnosed by a physician, was recruited from 10 private practices for physical therapy (PT) and 4 hospital outpatient PT divisions. To be included in the trial, subjects had to be diagnosed as having a shoulder disorder by a physician, be referred by a physician for PT, and have shoulder pain at the time of the study. In addition, patients receiving PT for shoulder pain related to a recent surgical intervention were excluded. Blinding of assessors was deemed crucial for the examination of the research questions; scars due to a recent surgical intervention would prohibit blinding of the assessors (symptomatic side). Likewise, all subjects having a visible injury related to the shoulder pain (eg, a hematoma) were excluded from the study sample.

Before study participation, all subjects received oral information about study. Next, an information leaflet was handed out to all participants, and they were instructed to read it carefully and, if applicable, to ask for additional clarification. Subjects able to provide written informed consent were then asked to fill in the Shoulder Disability Questionnaire (SDQ) 1516 and a visual analog scale (VAS) for pain severity. Afterward, the first examiner assessed the patient. The following tests were performed in order of appearance: measurement of the distance between the posterior border of the acromion and the table (both with the shoulder girdle at rest and with active shoulder retraction), measurement of the distance from the medial scapular border to the fourth thoracic spinous processes (again, both at rest and with active shoulder retraction), and the LSST. After the standardized assessment by the first examiner, the second examiner entered the room and performed the same tests. Both shoulders were assessed, and the investigators were blinded to both the symptomatic side and the outcome of the tests performed by the other assessor. When the study took place, the investigators held a bachelor's degree in PT and had completed their final year of the master's degree program in PT. In a 2-hour training session before data collection, the investigators were trained in performing the tests under supervision of 2 manual therapists.

Self-Reported Measures

The SDQ aims at assessing disability in patients with shoulder pain. In this study, we used the Dutch version of the SDQ. The SDQ is a self-administered questionnaire consisting of 16 items. For each item, the patient has 3 possible responses: shoulder pain during the activity included in the item, no pain during the activity of interest, or not applicable (if the patient did not perform the activity of interest during the past 24 hours). The overall score is the ratio of the painful activities versus the number of applicable items, multiplied by 100. Consequently, the overall scores vary from 0% to 100% disability. The time to administer the SDQ ranges from 5 to 10 minutes. The responsiveness ratio (calibrated responsiveness ratio) of the SDQ after 1 month was 2. 22 and after 6 months was 1. 89. 15 Data supporting the content validity of the SDQ have been reported as well. 16 From a systematic literature review on clinimetric evaluation of shoulder disability questionnaires, it was concluded that the construct validity of the SDQ is good, but data addressing the test-retest reliability are currently lacking. 17

The VAS (range, 0-100mm) was used to assess shoulder pain severity. The pain scores obtained with the VAS are believed to be reliable, 181'' valid, 20 and sensitive to change. 19

Clinical Tests

The measurement of the distance between the posterior border of the acromion and the table was performed as described by Host. 3 The patient was positioned supine and instructed to relax. In this position, the assessor measured the distance between the posterior