The Efficacy and Treatment Fidelity of Kinesiology Taping in Conjunction With Conservative Treatment Interventions Among Individuals With Shoulder Pain: A Systematic Review with Meta-Analysis

# Purpose Kinesiology taping is a common intervention used to treat individuals with shoulder pain. While there have been several studies published to date evaluating the effectiveness of this intervention, a systematic review with meta-analysis synthesizing the collective effectiveness of kinesiology taping is not available. Therefore, the purpose of this study was to perform a systematic review with meta-analysis investigating the efficacy and treatment fidelity of kinesiology taping (KT) in combination with conservative interventions for shoulder pain. # Methods Databases (PubMed, EMBASE, SportDiscus, CINAHL) of studies published in English meeting criteria were searched to October 2019. Methodologic quality was assessed utilizing the Modified Downs and Black checklist. Treatment fidelity was evaluated using a modified fidelity tool. Random effects meta-analyses were performed when an outcome (disability, pain, range of motion (ROM)) was reported by two or more studies. Overall effect size (pooled random effects) was estimated for studies with acceptable clinical homogeneity. # Results When KT was used with conservative treatments, meta-analysis revealed large effect sizes for improvements in disability (standard mean difference (SMD) = -1.35; 95% CI, -2.09 to -0.60) and ROM (SMD = 0.96; 95% CI, 0.60-1.33) with no significant effects for pain. The average Modified Downs & Black score for bias was 11.5 ± 3.9. Of 10 retained studies, only two had good treatment fidelity. # Conclusions Adding KT to interventions performed in clinical settings appears to demonstrate efficacy regarding disability and ROM when compared to conservative interventions alone. However, despite reasonably good methodologic quality, fidelity was lacking in a majority of studies. Because of its impact on the implementation of evidence-based practice, lower fidelity should be considered when interpreting results

Training during the COVID-19 lockdown : knowledge, beliefs, and practices of 12,526 athletes from 142 countries and six continents

OBJECTIVE Our objective was to explore the training-related knowledge, beliefs, and practices of athletes and the influence of lockdowns in response to the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS Athletes (n = 12,526, comprising 13% world class, 21% international, 36% national, 24% state, and 6% recreational) completed an online survey that was available from 17 May to 5 July 2020 and explored their training behaviors (training knowledge, beliefs/attitudes, and practices), including specific questions on their training intensity, frequency, and session duration before and during lockdown (March–June 2020). RESULTS Overall, 85% of athletes wanted to “maintain training,” and 79% disagreed with the statement that it is “okay to not train during lockdown,” with a greater prevalence for both in higher-level athletes. In total, 60% of athletes considered “coaching by correspondence (remote coaching)” to be sufficient (highest amongst world-class athletes). During lockdown, < 40% were able to maintain sport-specific training (e.g., long endurance [39%], interval training [35%], weightlifting [33%], most (83%) training for “general fitness and health maintenance” during lockdown. Athletes trained alone (80%) and focused on bodyweight (65%) and cardiovascular (59%) exercise/training during lockdown. Compared with before lockdown, most athletes reported reduced training frequency (from between five and seven sessions per week to four or fewer), shorter training sessions (from ≥ 60 to < 60 min), and lower sport-specific intensity (~ 38% reduction), irrespective of athlete classification. CONCLUSIONS COVID-19-related lockdowns saw marked reductions in athletic training specificity, intensity, frequency, and duration, with notable within-sample differences (by athlete classification). Higher classification athletes had the strongest desire to “maintain” training and the greatest opposition to “not training” during lockdowns. These higher classification athletes retained training specificity to a greater degree than others, probably because of preferential access to limited training resources. More higher classification athletes considered “coaching by correspondence” as sufficient than did lower classification athletes. These lockdown-mediated changes in training were not conducive to maintenance or progression of athletes’ physical capacities and were also likely detrimental to athletes’ mental health. These data can be used by policy makers, athletes, and their multidisciplinary teams to modulate their practice, with a degree of individualization, in the current and continued pandemic-related scenario. Furthermore, the data may drive training-related educational resources for athletes and their multidisciplinary teams. Such upskilling would provide athletes with evidence to inform their training modifications in response to germane situations (e.g., COVID related, injury, and illness).A specific funding was provided by the National Sports Institute of Malaysia for this study.The National Sports Institute of Malaysia.https://www.springer.com/journal/40279am2023Sports Medicin

It is time to put special tests for rotator cuff-related shoulder pain out to pasture

Abstract Synopsis “Special tests” for rotator cuff–related shoulder pain (RCRSP) have passed their sell-by date. In this Viewpoint, we outline fundamental flaws in the validity of these tests and their proposed ability to accurately identify a pathoanatomical source of pain. The potential harm of these special tests comes in conjunction with imaging findings that are utilized to inform a structural diagnosis or recommend invasive procedures. We offer recommendations for performing a clinical interview and physical examination for people with RCRSP that does not include shoulder orthopaedic tests. J Orthop Sports Phys Ther 2020;50(5):222–225. doi:10.2519/jospt.2020.060

The Reliability, Minimal Detectable Change and Concurrent Validity of A Gravity-Based Bubble Inclinometer and iPhone Application for Measuring Standing Lumbar Lordosis

PURPOSE: To investigate the reliability, minimal detectable change (MDC90) and concurrent validity of a gravity-based bubble inclinometer (inclinometer) and iPhone® application for measuring standing lumbar lordosis. METHODS: Two investigators used both an inclinometer and an iPhone® with an inclinometer application to measure lumbar lordosis of 30 asymptomatic participants. RESULTS: ICC models 3,k and 2,k were used for the intrarater and interrater analysis, respectively. Good interrater and intrarater reliability was present for the inclinometer with Intraclass Correlation Coefficients (ICC) of 0.90 and 0.85, respectively and the iPhone® application with ICC values of 0.96 and 0.81. The minimal detectable change (MDC90) indicates that a change greater than or equal to 7° and 6° is needed to exceed the threshold of error using the iPhone® and inclinometer, respectively. The concurrent validity between the two instruments was good with a Pearson product-moment coefficient of correlation (r) of 0.86 for both raters. Ninety-five percent limits of agreement identified differences ranging from 9° greater in regards to the iPhone® to 8° less regarding the inclinometer. CONCLUSION: Both the inclinometer and iPhone® application possess good interrater reliability, intrarater reliability and concurrent validity for measuring standing lumbar lordosis. This investigation provides preliminary evidence to suggest that smart phone applications may offer clinical utility comparable to inclinometry for quantifying standing lumbar lordosis. Clinicians should recognize potential individual differences when using these devices interchangeably

The Reliability, Minimal Detectable Change and Construct Validity of a Clinical Measurement for Quantifying Posterior Shoulder Tightness in the Post-operative Population

BACKGROUND: Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders. Although reliable and valid measures have been described for the non-operative population one does not exist for the post-operative population. STUDY DESIGN: Blinded repeated measures design. PURPOSE: Investigate the intrarater reliability, minimal detectable change at the 90% confidence interval (MDC(90)) and construct validity of an inclinometric measurement designed to quantify PST in the post-operative population. METHODS: One investigator performed PST measurements on the operative shoulder of 23 participants. Passive internal and external rotation measurements were performed for the validity component of the investigation. RESULTS: Intrarater reliability using an intraclass correlation coefficient (ICC) model 3,k was good (ICC = 0.79). The MDC(90) indicated that a change of greater than or equal to 8 degrees would be required to be 90% certain that a change in the measurement would not be the result of inter-trial variability or measurement error. Construct validity was supported by a statistically significant relationship between PST and internal rotation r = 0.54 and by a relationship between PST and external rotation r = 0.30 which was not statistically significant. CONCLUSION: The sidelying procedure described in this investigation appears to be a reliable and valid means for quantifying PST in the post-operative population. Moreover, the use of inclinometry provides an absolute angle of tightness that may be used for intersubject comparison, documenting change, and to determine reference values. LEVEL OF EVIDENCE: Therapy, level 2b

Meralgia Paresthetica: A Review of The Literature

BACKGROUND AND PURPOSE: Meralgia Paresthetica (MP) is a nerve entrapment which may cause pain, paresthesias, and sensory loss within the distribution of the lateral cutaneous nerve of the thigh. When the differential diagnosis of lateral or anterolateral thigh pain is inconclusive, MP should be considered as a potential source. MP produces similar signs and symptoms as those associated with more common diagnoses such as lumbar spine pathology. This clinical commentary will review the most relevant literature on MP with an emphasis on recognition and management of this condition. DESCRIPTION OF TOPIC WITH RELATED EVIDENCE: The authors reviewed the most relevant published literature on MP from 1970 to 2013 located using the databases PubMed, CINAHL, and Proquest. DISCUSSION/RELATION TO CLINICAL PRACTICE: MP still remains a diagnostic challenge since it can mimic other common diagnoses. Understanding the current literature surrounding the diagnosis and treatment of MP is essential for clinicians practicing in the outpatient environment. The consensus on the most effective non-surgical and surgical interventions is still limited, as is the research on physical therapy interventions for this condition. Perhaps the lack of research and global consensus represents a knowledge deficit that makes MP a challenge to diagnose and successfully treat. Future collaborative studies are needed to improve the clinical diagnostics and understanding of interventions for this pathology. LEVEL OF EVIDENCE: 5

Effect Of Scapular Stabilization During Horizontal Adduction Stretching On Passive Internal Rotation And Posterior Shoulder Tightness In Young Women Volleyball Athletes: A Randomized Controlled Trial

Objective To evaluate the effect of scapular stabilization during horizontal adduction stretching (cross-body) on posterior shoulder tightness (PST) and passive internal rotation (IR). Design Randomized controlled trial with single blinding. Setting Athletic club. Participants Asymptomatic volleyball players who are women with glenohumeral internal rotation deficit (N=60). Interventions Subjects were randomly assigned to either horizontal adduction stretching with manual scapular stabilization (n=30) or horizontal adduction stretching without stabilization (n=30). Passive stretching was performed for 3- to 30-second holds in both groups. Main Outcome Measures Range of motion measurements of PST and IR were performed on the athlete\u27s dominant shoulder prior to and immediately after the intervention. Results Baseline mean angular measurements of PST and IR for all athletes involved in the study were 62°±14° and 40°±10°, respectively, with no significant difference between groups (P=.598 and P=.734, respectively). Mean PST measurements were significantly different between groups after the horizontal adduction stretch, with a mean angle of 83°±17° among the scapular stabilization group and 65°±13° among the nonstabilization group (P\u3c.001). Measurements of IR were also significantly different between groups, with a mean angle of 51°±14° among the scapular stabilization group and 43°±9° among the nonstabilization group (P=.006). Conclusions Horizontal adduction stretches performed with scapular stabilization produced significantly greater improvements in IR and PST than horizontal adduction stretching without scapular stabilization

Effect of Scapular Stabilization During Horizontal Adduction Stretching on Passive Internal Rotation and Posterior Shoulder Tightness in Young Women Volleyball Athletes: A Randomized Controlled Trial

OBJECTIVE: To evaluate the effect of scapular stabilization during horizontal adduction stretching (cross-body) on posterior shoulder tightness (PST) and passive internal rotation (IR). DESIGN: Randomized controlled trial with single blinding. SETTING: Athletic club. PARTICIPANTS: Asymptomatic volleyball players who are women with glenohumeral internal rotation deficit (N=60). INTERVENTIONS: Subjects were randomly assigned to either horizontal adduction stretching with manual scapular stabilization (n=30) or horizontal adduction stretching without stabilization (n=30). Passive stretching was performed for 3- to 30-second holds in both groups. MAIN OUTCOME MEASURES: Range of motion measurements of PST and IR were performed on the athlete\u27s dominant shoulder prior to and immediately after the intervention. RESULTS: Baseline mean angular measurements of PST and IR for all athletes involved in the study were 62°±14° and 40°±10°, respectively, with no significant difference between groups (P=.598 and P=.734, respectively). Mean PST measurements were significantly different between groups after the horizontal adduction stretch, with a mean angle of 83°±17° among the scapular stabilization group and 65°±13° among the nonstabilization group (P CONCLUSIONS: Horizontal adduction stretches performed with scapular stabilization produced significantly greater improvements in IR and PST than horizontal adduction stretching without scapular stabilization

Clinimetric evaluation of the disabilities of the arm, shoulder, and hand (DASH) and QuickDASH questionnaires for patients with shoulder disorders

Background: The disability of the shoulder, arm, and hand (DASH) and shortened version QuickDASH instruments are self-report questionnaires designed to measure physical function and symptoms in patients with upper-extremity disorders. An understanding of the clinimetric properties of these instruments may guide clinicians and researchers in their use. Objective: To systematically review the clinimetric properties of the DASH and QuickDASH for use among individuals with shoulder disorders. Methods: A search was conducted using Medline, CINAHL, SPORTDiscus, AMED, and PEDro from 1996 to July 2013 using the following keywords independently and in combination: disabilities of the shoulder, arm, and hand; DASH, QuickDASH, and shoulder. Articles retained were inclusive of at least one clinimetric property of the DASH or QuickDASH as the main focus of the study. Articles retained for review after meeting inclusion criteria were then cross referenced. Results: Eighteen articles were ultimately retained for the review. The clinimetric properties of the DASH and QuickDASH were comparable across various shoulder pathologies including both non-operative and post-surgical cohorts. Both instruments possess good reliability and internal consistency. Construct validity is present in both instruments when correlated to other physical and non-physical outcome measures. Moreover, each instrument is responsive and sensitive to change when compared to global and specific measures of improvement. The administrative and respondent burden is somewhat higher for the DASH when compared to the QuickDASH. Conclusions: Both instruments possess desirable clinimetric properties including reliability, validity, and responsiveness. The QuickDASH offers a more efficient means of identifying baseline function and monitoring outcomes