BIOPSYCHOLOGICAL PREDICTORS OF PAIN AND FUNCTION IN PATIENTS WITH ROTATOR CUFF CONDITIONS

Predicting worse patient-reported outcomes in those with Rotator Cuff (RC) conditions is dependent on examining both biological and psychological impairments. In order to help determine which biopsychological factors are associated with pain and function in patients with RC related conditions and to determine who may be at an increased risk for worse outcomes after Reverse Shoulder Arthroplasty (RSA), biopsychological associations between patient demographics, scapular motion, humeral motion, RC tear size, pain associated psychological distress, and function were clinically evaluated to investigate prediction models for pain and function. The central hypothesis is that in a group of patients with symptomatic Cuff Tear Arthropathy (CTA), increased scapular motion and increased psychological distress will predict worse American Shoulder and Elbow Surgeon (ASES) pain and function scores one-year after RSA. In 50 patients with RC tears, we used the pain, function, and the total outcome components of the ASES to examine which biopsychological factors are associated with each component of the ASES score. Additionally, 16 patients with CTA were examined to determine which biopsychological factors predicted each final score of the ASES one year after RSA. The principle finding of this study is that a multivariate approach examining clinical biopsychological factors in patients with RC tears is necessary to better understand clinical components leading to ASES pain, function, and total scores

Reliability and Validity of a Clinical Assessment Tool for Measuring Scapular Motion in All 3 Anatomical Planes

CONTEXT: A single clinical assessment device that objectively measures scapular motion in each anatomical plane is not currently available. The development of a novel electric goniometer affords the ability to quantify scapular motion in all three anatomical planes. OBJECTIVE: Investigate the reliability and validity of an electric goniometer to measure scapular motion in each anatomical plane during arm elevation. DESIGN: Cross-sectional. SETTING: Laboratory setting. PATIENTS OR OTHER PARTICIPANTS: Sixty participants (29 females, 31 males) were recruited from the general population. INTERVENTION(S): An electric goniometer was used to record clinical measurements of scapular position at rest and total arc of motion (excursion) during active arm elevation in two testing sessions separated by several days. Measurements were recorded independently by two examiners. In one session, scapular motion was recorded simultaneously with a 14-camera three-dimensional optical motion capture system. MAIN OUTCOME MEASURES: Reliability analysis included examination of clinical measurements for scapular position at rest and excursion during each condition. Both the intra-rater reliability between testing sessions and the inter-rater reliability recorded within the same session were assessed using Intraclass Correlation Coefficients (ICC2,3). The criterion-validity was examined by comparing the mean excursion values of each condition recorded by the electric goniometer to the 3D optical motion capture system. Validity was assessed by evaluating the average difference and root mean square error (RMSE). RESULTS: The between session intra-rater reliability was moderate to good (ICC2,3: 0.628-0.874). The within session inter-rater reliability was moderate to excellent (ICC2,3: 0.545-0.912). The average difference between the electric goniometer and 3D optical motion capture system ranged from -7° to 4° and the RMSE was between 7-10°. CONCLUSIONS: The reliability of scapular measurements is best when a standard operating procedure is used. The electric goniometer provides an accurate measurement of scapular excursions in all three anatomical planes during arm elevation