Publications by authors named "Joy C MacDermid"

393 Publications

Diagnostic accuracy of sensory and motor tests for the diagnosis of carpal tunnel syndrome: a systematic review.

BMC Musculoskelet Disord 2021 Apr 7;22(1):337. Epub 2021 Apr 7.

School of Physical Therapy, Faculty of Health Science, Elborn College, Western University, London, ON, Canada.

Background: Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy of the upper extremity. The previous systematic review of the diagnostic tests for CTS was outdated. The objective of this study was to compile and appraise the evidence on the accuracy of sensory and motor tests used for the diagnosis of CTS.

Methods: MEDLINE, CINAHL, and Embase databases were searched on January 20, 2020. Studies assessing at least one diagnostic accuracy property of the sensory or motor tests for CTS diagnosis were selected by two independent reviewers. Diagnostic test accuracy extension of the PRISMA guidelines was followed. Risk of bias and applicability concerns were rated using QUADAS-2 tool. Any reported diagnostic accuracy property was summarized. Study characteristics and any information on the accuracy of the sensory and motor tests for CTS diagnosis were extracted.

Results: We included sixteen clinical studies, assessing thirteen different sensory or motor tests. The most sensitive test for CTS diagnosis was the Semmes-Weinstein monofilament test (with 3.22 in any radial digit as the normal threshold) with sensitivity from 0.49 to 0.96. The tests with the highest specificity (Sp) were palmar grip strength (Sp = 0.94), pinch grip strength (Sp from 0.78 to 0.95), thenar atrophy (Sp from 0.96 to 1.00), and two-point discrimination (Sp from 0.81 to 0.98).

Conclusions: The evidence was inconclusive on which sensory or motor test for CTS diagnosis had the highest diagnostic accuracy. The results suggest that clinicians should not use a single sensory or motor test when deciding on CTS diagnosis.

Trial Registration: PROSPERO CRD42018109031 , on 20 December 2018.
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http://dx.doi.org/10.1186/s12891-021-04202-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028143PMC
April 2021

The yield and usefulness of PAIN and PubMed databases for accessing research evidence on pain management: a randomized crossover trial.

Arch Physiother 2021 Apr 1;11(1). Epub 2021 Apr 1.

Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph's Health Centre, London, Ontario, Canada.

Introduction: PAIN and PubMed are two electronic databases with two different mechanisms of evidence retrieval. PubMed is used to "Pull" evidence where clinicians can enter search terms to find answers while PAIN is a newly developed evidence repository where along with "Pull" service there is a "Push" service that alerts users about new research and the associated quality ratings, based on the individual preferences for content and altering criteria.

Purpose: The primary purpose of the study was to compare yield and usefulness of PubMed and PAIN in retrieving evidence to address clinical research questions on pain management. The secondary purpose of the study was to identify what search terms and methods were used by clinicians to target pain research.

Study Design: Two-phase double blinded randomized crossover trial.

Methods: Clinicians (n = 76) who were exposed to PAIN for at least 1 year took part in this study. Participants were required to search for evidence 2 clinical question scenarios independently. The first clinical question was provided to all participants and thus, was multi-disciplinary. Participants were randomly assigned to search for evidence on their clinical question using either PAIN or PubMed through the electronic interface. Upon completion of the search with one search engine, they were crossed over to the other search engine. A similar process was done for a second scenario that was discipline-specific. The yield was calculated using number of retrieved articles presented to participants and usefulness was evaluated using a series of Likert scale questions embedded in the testing.

Results: Multidisciplinary scenario: Overall, the participants had an overall one-page yield of 715 articles for PAIN and 1135 articles for PubMed. The topmost article retrieved by PAIN was rated as more useful (p = 0.001). While, the topmost article retrieved by PubMed was rated as consistent with current clinical practice (p = 0.02). PubMed (48%) was preferred over PAIN (39%) to perform multidisciplinary search (p = 0.02). Discipline specific scenario: The participants had an overall one-page yield of 1046 articles for PAIN and 1398 articles for PubMed. The topmost article retrieved by PAIN was rated as more useful (p = 0.001) and consistent with current clinical practice (p = 0.02) than the articles retrieved by PubMed. PAIN (52%) was preferred over PubMed (29%) to perform discipline specific search.

Conclusion: Clinicians from different disciplines find both PAIN and PubMed useful for retrieving research studies to address clinical questions about pain management. Greater preferences and perceived usefulness of the top 3 retrieved papers was observed for PAIN, but other dimensions of usefulness did not consistently favor either search engine.

Trial Registration: Registered with ClinicalTrials.gov Identifier: NCT01348802 , Date: May 5, 2011.
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http://dx.doi.org/10.1186/s40945-021-00100-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015066PMC
April 2021

Evaluation of the Structural Validity of the Work Instability Scale Using the Rasch Model.

Arch Rehabil Res Clin Transl 2021 Mar 13;3(1):100103. Epub 2021 Jan 13.

School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.

Objective: To use Rasch analysis to examine the measurement properties of the 23-item version of the Work Instability Scale (WIS-23) in a sample of worker compensation claimants with upper extremity disorders.

Design: Secondary data analysis on the data retrieved from a cross-sectional study.

Setting: Tertiary care hospital.

Participants: Patients (N=392) attending a specialty clinic for workers with upper limb injuries at a tertiary hospital were prospectively enrolled.

Interventions: Not applicable.

Main Outcome Measures: WIS-23.

Results: The study sample contained 392 participants between the ages of 19 and 73 years (mean, 47.0±10.5y). There were 148 (37.8%) women, 182 (46.4%) men, and 62 (15.8%) participants for whom sex identification was unavailable. The initial WIS data analysis showed significant misfit from the Rasch model (item-trait interaction: χ=293.52; <.0001). Item removal and splitting were performed to improve the model fit, resulting in a 20-item scale that met all assumptions (χ=160.42; =.008), including unidimensionality, local independence of items, and the absence of differential item function based on age, sex of respondents, employment type, and affected upper extremity area across all tested factors.

Conclusion: With the application of Rasch analysis, we refined the WIS-23 to produce a 20-item WIS for work-related upper extremity disorders (WIS-WREUD). The 20-item WIS-WREUD demonstrated excellent item and person fit, unidimensionality, acceptable person separation index, and local independency. The WIS-20 may provide better measurement properties, although longitudinal psychometric evaluations are needed.
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http://dx.doi.org/10.1016/j.arrct.2021.100103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984990PMC
March 2021

Appraisal of Clinical Practice Guideline: Physical Activity and Diabetes.

J Physiother 2021 Mar 19. Epub 2021 Mar 19.

Western University, London, Canada.

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http://dx.doi.org/10.1016/j.jphys.2021.02.006DOI Listing
March 2021

Measurement Properties of the Brief Pain Inventory-short Form (BPI-SF) and Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) in Pain-related Musculoskeletal Conditions: A Systematic Review.

Clin J Pain 2021 Mar 17. Epub 2021 Mar 17.

Western University, Faculty of Health and Rehabilitation Sciences, Elborn College London, Ontario, Canada Western University, Faculty of Health and Rehabilitation Sciences, Elborn College London, Ontario, Canada; McMaster University, School of Rehabilitation Science, Hamilton, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada McMaster University, School of Rehabilitation Science, Hamilton, Ontario, Canada Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada.

Objective: To systematically locate, critically appraise and summarize clinical measurement research addressing the use of BPI-SF and SF-MPQ-2 in pain-related musculoskeletal (MSK) conditions.

Methods: We systematically searched four databases (Medline, CINAHL, EMBASE & SCOPUS) and screened articles to identify those reporting the psychometric properties (e.g. validity, reliability) and interpretability (e.g. minimal clinically important difference) of BPI-SF and SF-MPQ-2 as evaluated in pain-related musculoskeletal conditions. Independently, two reviewers extracted data and assessed the quality of evidence with a structured quality appraisal tool and the updated COSMIN guidelines.

Results: Twenty-six articles were included (BPI-SF, n=17; SF-MPQ-2, n=9). Both tools lack reporting on their cross-cultural validities and measurement error indices (e.g. standard error of measurement). High quality studies suggest the tools are internally consistent (α=0.83-0.96), and they associate modestly with similar outcomes (r=0.3-0.69). Strong evidence suggest the BPI-SF conforms to its two-dimensional structure in MSK studies; the SF-MPQ-2 four-factor structure was not clearly established. Seven reports of high-to-moderate quality evidence were supportive of the BPI-SF known group validity (n=2) and responsiveness (n=5). One report of high quality established the SF-MPQ-2 responsiveness.

Discussion: Evidence of high to moderate quality supports the internal consistency, criterion-convergent validity, structural validity and responsiveness of the BPI-SF and SF-MPQ-2 and establishes their use as generic multidimensional pain outcomes in musculoskeletal populations. However, more studies of high quality are still needed on their retest reliability, known group validity, cross-cultural validity, interpretability properties and measurement error indices in different MSK populations.
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http://dx.doi.org/10.1097/AJP.0000000000000933DOI Listing
March 2021

Measurement properties of the Michigan hand outcomes questionnaire: Rasch analysis of responses from a traumatic hand injury population.

Disabil Rehabil 2021 Mar 8:1-9. Epub 2021 Mar 8.

School of Physical Therapy, University of Western Ontario, London, Canada.

Purpose: This study aimed to use Rasch analysis to test the content, scoring, and measurement properties of the Michigan Hand Outcomes Questionnaire (MHQ).

Methods: MHQ scores from 196 patients with hand and wrist conditions were collected in an outpatient hand rehabilitation facility. Rasch analysis was conducted to assess the fit statistics of MHQ to confirm the scaling structure of disability subscales, and to identify differential item functioning.

Results: The MHQ did not fit with the Rasch model (χ = 2376.78, df = 74,  < 0.001), and most thresholds of item responses were disordered. The original scoring algorithm derived from 5-point Likert response options was adjusted to 3-point Likert (10 items) and 4-point Likert (11 items) based on the visual inspection of the thresholds map. Differential item functioning was present in the revised scale based on the age, sex, and dominant hand. Only 3 revised subscales of the MHQ including activities daily living (one hand), aesthetics, and satisfaction showed acceptable fit to the Rasch model. Unidimensionality was achieved in all revised subscales.

Conclusions: The overall MHQ had a substantial misfit from the Rasch model. Despite efforts of item reduction and rescoring, we did not reach a satisfactory solution. This calls into question the validity of the statistical evaluations performed on this scale using the traditional scoring.Implications for rehabilitationThe MHQ was designed to measure different dimensions of pain and disability but demonstrates multiple measurement problems that undermine it use in present form.It is not appropriate to sum all 37 items of the MHQ into a single score.Three subscales of activities daily living (one hand), aesthetics, and satisfaction can provide unidimensional subscales scores with interval level scaling if scored with our proposed Rasch-based revised scoring.The 27-item version of the MHQ is shown to have strong psychometric properties for administration with patients with hand injuries; however, it requires further validation.
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http://dx.doi.org/10.1080/09638288.2021.1894246DOI Listing
March 2021

Early post-immobilization pain at rest, movement evoked pain, and their ratio as potential predictors of pain and disability at six- and 12-months after distal radius fracture.

Arch Physiother 2021 Mar 1;11(1). Epub 2021 Mar 1.

Department of Health and Rehabilitation Sciences, School of Physical Therapy, University of Western Ontario, London, Ontario, Canada.

Background: Removal of immobilization is a critical phase of distal radius fracture (DRF) rehabilitation, typically occurring by 2 months post injury. This study examined the extent to which pain at rest (PAR), movement evoked pain (MEP), or the ratio between those (MEPR) assessed at 2-months after DRF predicts the occurrence of chronic pain or disability at 6- and 12-months after the injury.

Methods: This secondary analysis of a prospective cohort study was done at the Hand and Upper Limb Centre (HULC), London, Ontario, Canada. A total of 229 patients with DRF (159 (69.4%) women) were included. Scores for the pain and function subscales of the Patient-Rated Wrist Evaluation (PRWE) were extracted for 2, 6 and 12 months after DRF. Logistic as well as nonlinear quartile regression examined whether PAR and MEP predicted the severity of chronic pain and disability at 6- and 12-months after DRF. Receiver Operating Characteristics Curve were plotted, where area under the curve (AUC) examined the accuracy of the PAR and MEP scores in classifying those who experienced chronic pain and disability.

Results: Scores of ≥3 (AUC of 0.77) for PAR or ≥ 6 (AUC of 0.78) for MEP at 2 months after DRF predicted moderate to severe wrist pain at 6-months, whereas scores of ≥7 (AUC of 0.79) for MEP at 2-months predicted ongoing wrist disability at 6-months after the injury. The MEPR of 2 ≤ or ≥ 8 at 2-months was associated with adverse pain at 6-months and functional outcomes at 6- and 12-months (R-square = 0.7 and 0.04 respectively), but prediction accuracy was very poor (AUC ≤ 0.50).

Conclusion: Chronic wrist-related pain at 6-months can be predicted by either elevated PAR ≥ 3/10) or MEP (≥ 6/10) reported at 2-months after the injury, while disability experienced at 6-months after DRF is best predicted by MEP (≥7/10) reported at 2-months. The ratio of these two pain indicators increases assessment complexity and reduces classification accuracy.
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http://dx.doi.org/10.1186/s40945-021-00101-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919326PMC
March 2021

Validation of Persian Version of Patient-Rated Wrist and Hand Evaluation: Confirmatory Factor Analysis and Rasch Analysis.

Arch Rehabil Res Clin Transl 2020 Dec 1;2(4):100076. Epub 2020 Aug 1.

School of Physical Therapy, Western University, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.

Objectives: To determine the factor structure and test the clinometric properties of wrist and hand version of the Patient-Rated Wrist Evaluation.

Design: Cross-sectional study using Rasch analysis and factor analysis. Confirmatory factor analysis was conducted to assess the factor structure. Higher-order factor analysis was used to explore the hierarchical structure of the items. The Rasch model was used to assess the overall fit, reliability, validity, and construct unidimensionality. Rasch analysis and factor analysis were conducted using RUMM2030 and LISREL software, respectively.

Setting: Outpatient hand rehabilitation clinic.

Participants: A convenience sample of patients (N=206) with various hand injuries who completed the Persian version of the Patient-Rated Wrist and Hand Evaluation (PRWHE-P) at 2 months postinjury. The study included 66 men and 139 women, with a mean age of 40 years.

Intervention: Not applicable.

Main Outcome Measures: The PRWHE-P was used as a patient-reported measure of pain and disability in wrist and hand conditions.

Results: Factor analysis confirmed 3-factor models of the PRWHE-P. Items fit well to the Rasch model in 3 subscales. The PRWHE-P had a good item reliability (0.82) and good internal consistency (0.8). No differential item functioning was detected for age, sex, dominant hand, or injured hand.

Conclusions: The results of this study indicated that the PRWHE-P with 3 sub scales is a reliable and valid measurement tool and could be used in patients with different wrist and hand disabilities.
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http://dx.doi.org/10.1016/j.arrct.2020.100076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853362PMC
December 2020

The Efficacy of Fall Hazards Identification on Fall Outcomes: A Systematic Review With Meta-analysis.

Arch Rehabil Res Clin Transl 2020 Sep 20;2(3):100065. Epub 2020 Jun 20.

Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.

Objective: To investigate the efficacy of fall hazards identification programs when compared to no intervention or other fall prevention programs on number of falls, falls incidence, and identifying fall hazards in community-dwelling adults.

Data Sources: CINAHL, PubMed, EMBASE, Scopus, and PsychINFO were used to identify articles.

Study Selection: Studies were selected to compare fall hazards identification programs to a control group. Studies were eligible if they were randomized controlled trials and enrolled adults older than 50 years with the incidence rate of falls as an outcome.

Data Extraction: Study or authors, year, sample characteristics, intervention or comparison groups, number of falls, and number of hazards identified in the intervention and control groups, and follow-up were extracted. The risk of bias assessment was performed using the Cochrane Risk of Bias tool. Quality was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach per outcome.

Data Synthesis: A total of 8 studies (N=8) and 5177 participants were included. There was a high risk of bias across the studies mostly due to improper blinding of personnel of the outcome assessor. Pooled estimate effects from 5 studies assessing the incidence rate of falls from 3019 individuals indicated no difference between fall hazards identification programs and control (incidence rate ratio=0.98; 95% confidence interval, 0.87-1.10).

Conclusions: The current study suggests that there may be a benefit for fall hazards programs in reducing incident falls. However, because of a moderate GRADE rating, more large-scale studies with a higher number of falls events and more consistent control groups are required to determine the true effect.
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http://dx.doi.org/10.1016/j.arrct.2020.100065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853376PMC
September 2020

Individual and organizational factors associated with evidence-based practice among physical and occupational therapy recent graduates: A cross-sectional national study.

J Eval Clin Pract 2020 Dec 13. Epub 2020 Dec 13.

Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada.

Background: Occupational therapy (OT) and physical therapy (PT) programs in Canada have moved to graduate-level entry education to address graduates' readiness for evidence-based practice (EBP). Whether rehabilitation professionals with advanced training in EBP are meeting their responsibilities as evidence-based professionals upon entry into practice and the factors that influence the use of evidence is unclear. The aim of this study was to examine the individual and organizational factors associated with the use of EBP and supporting evidence-based activities among graduates of professional OT and PT master's programs.

Methods: A cross-sectional design using a survey of recent graduates of the 29 OT and PT programs in Canada. The survey measured six constructs supportive of EBP (ie, knowledge, attitudes, confidence, organizational resources, actual use of EBP, and evidence-based activities). Analyses consisted of descriptive statistics to characterize the sample and the different variables and ordinal multivariate regression analysis.

Results: 257 graduates (15%) completed the survey. Attitudes towards EBP was positively associated both with evidence-based activities (odds ratio = 1.36 with a 95% CI: 1.22 to 1.52) and use of EBP (odds ratio = 1.23 with a 95% CI: 1.12 to 1.36); greater confidence was related to greater use of EBP (OR = 1.12, 95% CI: 1.01 to 1.24); and working in a private practice setting was found to be related to performing more evidence-based activities (odds ratio = 3.15, 95% CI: 1.40 to 7.12).

Conclusions: Despite a greater focus on EBP knowledge in these curricula across Canada, knowledge was not related to EBP use nor evidence-based activities upon entry into practice. On the other hand, attitudes, confidence and working in private practice were. University programs should consider curricular strategies that increase the use of EBP, provide opportunities to engage in evidence-based activities with an emphasis on promoting the development of positive attitudes towards EBP and increasing learners' confidence in their ability to be evidence-based professionals.
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http://dx.doi.org/10.1111/jep.13518DOI Listing
December 2020

An Evaluation of the Structural Validity of the Work Limitation Questionnaire Using the Rasch Model.

Arch Phys Med Rehabil 2021 Apr 10;102(4):633-644. Epub 2020 Dec 10.

Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada.

Objective: To investigate the targeting, scaling, and structural validity of the Work Limitation Questionnaire (WLQ) using Rasch analysis.

Design: Secondary data analysis.

Setting: Tertiary care hospital.

Participants: The data were sourced from an upper limb specialty clinic of injured workers using the convenience sampling method and from a national randomized controlled trial investigating 2 surgical options for rotator cuff repair by formal, randomized selection (N=315).

Interventions: Not applicable.

Main Outcome Measures: Work Limitation Questionnaire 25-item version (WLQ-25). The WLQ contains 25 items measuring a client's ability to perform specific job demands on a 5-point ordinal response scale ranging from 0 (difficulty none of the time) to 4 (difficulty all the time). The average of all 25 items is used as the total score, ranging from 0 to 4, where higher index scores indicate greater difficulty performing daily work. Subscales were used to assess time management, physical demands (PD), mental-interpersonal demands, and output demands.

Results: The Rasch analyses performed on the dataset included the test of fit of residuals, ordering of item thresholds, Person separation index, differential item functioning (DIF), dependency, and unidimensionality. The partial credit model was selected for the current Rasch analysis because the likelihood ratio test was significant at both the overall questionnaire and the subscale level (P<.001). The WLQ-25 did not fit with the Rasch model (χ=1715.58; df=125; P<.001) and most of the thresholds were disordered. A series of steps were undertaken to improve the fit statistic, including item reduction (6 items) and response merging (9 items). DIF was absent in the revised scale based on sex, age, full- or part-time employment, and type of employment. Only 3 revised subscales, namely the PD, mental demands, and interpersonal demands subscales, demonstrated acceptable fit to the Rasch model.

Conclusions: The WLQ-25 demonstrated substantial misfit from the Rasch model, which could not be fully mediated. The revised PD, mental demands, and interpersonal demands subscales could be used to assess these constructs.
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http://dx.doi.org/10.1016/j.apmr.2020.11.009DOI Listing
April 2021

Psychometric properties of Patient-Specific Functional Scale in patients with upper extremity disorders. A systematic review.

Disabil Rehabil 2020 Dec 8:1-10. Epub 2020 Dec 8.

Faculty of Health Science, School of Physical Therapy, Western University, London, Canada.

Purpose: To identify, critically appraise, and synthesise the measurement properties of Patient-Specific Functional Scale (PSFS) in patients with upper extremity musculoskeletal disorders.

Methods: Medline, Embase, PubMed, and Google Scholar databases from January 1999 to November 2020 were searched. Prospective measurement studies that included patients with upper extremity musculoskeletal disorders, that reported on the psychometric properties of PSFS were included. We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) 2018 guideline for systematic reviews to appraise the studies.

Results: Fourteen eligible studies were included. Three studies with adequate-very good quality and sufficient properties indicated excellent intra-class correlation coefficients (ICC) (≥0.75) in patients with shoulder pain (mean age 48 ± 11 years), multiple shoulder disorders (mean age 55 ± 16 years), and hand osteoarthritis (mean age 64 ± 9 years). The construct validity estimates of PSFS were moderate, when compared with Upper Extremity Functional Index (UEFI) ( = 0.50) and Numeric Pain Rating Scale (NPRS) ( = 0.51) in patients with combined upper extremity musculoskeletal disorders (shoulder/upper arm, wrist/hand and elbow/forearm).

Conclusions: The patient-specific functional scale can be considered as a reliable, valid, and responsive tool in assessing functional change in patients with shoulder disorders/pain. Implications for rehabilitation The Patient-Specific Functional Scale (PSFS) can be considered as: • a reliable outcome measure in assessing functional change in patients with shoulder pain and hand osteoarthritis; • a valid measure in assessing functional limitation in patients with upper extremity disorders; • a measure that is sensitive to change (displays longitudinal validity) in assessing functional change in patients with upper extremity disorders and in patients with shoulder pain; and • a responsive outcome measure in assessing functional change in patients with upper extremity disorders.
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http://dx.doi.org/10.1080/09638288.2020.1851784DOI Listing
December 2020

Rasch analysis of The Shoulder Pain and Disability Index (SPADI) in a postrepair rotator cuff sample.

J Hand Ther 2020 Sep 12. Epub 2020 Sep 12.

Professor, School of Physical Therapy, Western University, London, ON, Canada; Co-Director of Clinical Research, Roth, McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.

Study Design: Clinical measurement study: Level of evidence (N/A) INTRODUCTION: The Shoulder Pain and Disability Index (SPADI) is a self-reported outcome measure of pain and disability related to shoulder pathology. In comparison to Classical Test Theory (CTT), Rasch analysis offers a more rigorous examination of the measurement properties of a scale.

Purpose Of The Study: This study utilizes Rasch analysis to evaluate the psychometric properties of the SPADI to propose potential modifications and avenues for future investigation.

Methods: SPADI scores (n = 212) from participants one-year post rotator cuff repair were collected from an outpatient specialty clinic. Fit to the Rasch model, unidimensionality of the subscales, and areas of bias were evaluated.

Results: Both the pain and disability subscales satisfied the requirements of the Rasch model with very minimal modifications and demonstrated unidimensionality. The person separation index was found to be high (P > .80), indicating reliability and internal consistency. Sex and the affected dominant side influenced how people scored on the SPADI (Differential item functioning (DIF)).

Conclusions: The findings suggest some patients in our sample have difficulty discriminating between item responses, particularly within the middle of the scale. Rasch analysis supports the clinical measurement properties of consistency and reliability, previously determined by CTT methods.
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http://dx.doi.org/10.1016/j.jht.2020.09.001DOI Listing
September 2020

Psychological Characteristics, Female Sex, and Opioid Use Predict Acute Postoperative Pain in Patients Surgically Treated for Thumb Base Osteoarthritis: A Cohort Study.

Plast Reconstr Surg 2020 12;146(6):1307-1316

From the Center for Hand Therapy, Handtherapie Nederland; the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School; the Hand and Wrist Center, Xpert Clinic; the School of Physical Therapy, Western University; the School of Rehabilitation Science, McMaster University; and the Hand and Upper Limb Centre, St Joseph's Health Centre.

Background: It is unclear which factors predict acute postoperative pain in patients surgically treated for thumb base osteoarthritis. The authors investigated the influence of type of surgery, preoperative sociodemographics, preoperative patient-reported outcome measures, psychological characteristics, and postoperative opioid use on acute postoperative pain 24 hours postoperatively following surgery for thumb carpometacarpal osteoarthritis. In addition, preoperative and acute postoperative pain were compared.

Methods: In this prospective cohort study, 215 patients surgically treated for thumb carpometacarpal osteoarthritis were included. Data were collected in 16 clinics for hand surgery and therapy in The Netherlands. Hierarchical regression was used to identify whether type of surgery, preoperative sociodemographics, preoperative patient-reported outcome measures, psychological characteristics (including treatment credibility and expectations, illness perception, pain catastrophizing, anxiety, and depression), and postoperative opioid use predicted acute postoperative pain 24 hours postoperatively, measured using the Numeric Pain Rating Scale (range, 0 to 10).

Results: Female sex, opioid use, higher preoperative satisfaction with hand, and higher self-reported consequences and coherence predicted greater postoperative pain, with 31 percent explained variance in the final model including psychological factors. Mean postoperative Numeric Pain Rating Scale score was lower (5.1 ± 2.4) than preoperative pain, measured using visual analogue scales (during the past week, 6.7 ± 1.7; physical load, 7.5 ± 1.7) and the Michigan Hand Outcomes Questionnaire (6.4 ± 1.4; p < 0.001).

Conclusions: Psychological factors, female sex, and opioid use enhance the prediction of acute postoperative pain beyond surgery type, preoperative sociodemographics, and patient-reported outcome measures. Female sex and opioid use were the strongest predictors, even after controlling for psychological factors. Future studies may investigate sex-based approaches and patient education for reducing acute postoperative pain.

Clinical Question/level Of Evidence: Risk, II.
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http://dx.doi.org/10.1097/PRS.0000000000007337DOI Listing
December 2020

Distribution of Number, Location of Pain and Comorbidities, and Determinants of Work Limitations among Firefighters.

Rehabil Res Pract 2020 8;2020:1942513. Epub 2020 Nov 8.

School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada.

Introduction: The unique demands of firefighting results in acute, recurrent, or chronic pain complications. We aimed to describe the percentage distribution of number and location of painful sites among FFs and determine whether work limitations differed based on the number or location of painful sites, age, and/or sex.

Methods: About 325 firefighters completed a work limitation questionnaire (WLQ-26) and a checklist to indicate painful regions of the body using either a paper format or an online survey. A one-way ANOVA was employed to analyze the transformed work limitation scores; this was a two-sided test with a significance level of <0.05, to determine if work limitations differed among firefighters based on the number or location of painful sites, age, and/or sex.

Results: The data analyzed consisted of 325 (men = 216, women = 109) FFs in total. The percentage distribution of the number of painful sites in our study cohort was 43% no pain, 17% one painful site, 19% two painful sites, and 21% three or more painful sites. The percentage distribution of the locations of painful sites was 43% no pain, 41% spine, 9% lower extremity, and 7% upper extremity. An estimated 31% of FFs ( = 102) reported non-MSK comorbidities with 23% ( = 76) reporting at least one non-MSK comorbidity and 8% ( = 26) reported having two or more comorbidities. FFs > 45 years of age experienced more physical work limitations than FFs ≤ 45years (mean difference: 0.74/10; 95% CI .19-1.29; = 0.008).

Conclusions: The majority of firefighters reported having at least one painful site and indicated the spine as the most common painful location. Age, the number of painful sites, and location of pain were identified as a potential contributor to physical/mental and work output limitations.
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http://dx.doi.org/10.1155/2020/1942513DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669334PMC
November 2020

Physical activity, targeted therapeutic exercise, and purposeful activity: The need for clarity and patient centeredness.

Authors:
Joy C MacDermid

J Hand Ther 2020 Oct - Dec;33(4):443-444

School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jht.2020.10.001DOI Listing
November 2020

A structured classification of the types of pain research studies accessed by different health professionals involved in pain management.

Br J Pain 2020 Nov 9;14(4):227-237. Epub 2019 Jul 9.

School of Physical Therapy, McGill University, Montreal, QC, Canada.

Objectives: The aim of this study was to describe the information access behaviours of clinicians involved in pain management with respect to their use of a pain evidence resource and to determine the areas of professional differences.

Methods: Users (n = 258) of a free pain evidence alerting service (PAIN) were enrolled in this study. The users regularly received email alerts about newly published clinical articles about pain that were pre-appraised for scientific merit and clinical relevance. A sample of up to 10 abstracts retrieved by each user were retrieved and classified using a descriptive classification system to describe the types of research, pain subtypes, interventions and outcomes that were reported in the accessed studies. Frequencies and chi-square tests were performed to compare access behaviours across professions.

Results: A total of 258 participants viewed 2311 abstracts. More than 52% of abstracts viewed were primary clinical studies; the majority (87%) addressed treatment effectiveness and were quantitative research (99.8%). The most commonly accessed clinical topic (58%) related to musculoskeletal pain and the most accessed pain type was chronic pain (76%). Drugs, injections and rehabilitation therapy were most commonly addressed in accessed intervention studies. Differences in professional focus were reflected in access: physicians/nurses accessed studies on injections (23%) and drugs (26%) and nurses accessed surgical studies, whereas other professions rarely did. Physiotherapists (PTs) and occupational therapists (OTs) preferentially accessed studies on rehabilitation. OTs and psychologists preferentially accessed the available studies on cognitive interventions; OTs accessed more ergonomic studies. Psychologists most accessed educational and psychosocial intervention studies. There were no differences in access across professions to multidisciplinary interventions.

Conclusion: While access partially reflects the content of the pain repository, professional differences in access were evident that related to the nature of the intervention, type of pain and the research design. Multidisciplinary evidence repositories may need to consider how to include and meet varied information needs.
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http://dx.doi.org/10.1177/2049463719857100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605063PMC
November 2020

Clinimetric testing of the Persian version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires in patients with lateral elbow tendinopathy.

Disabil Rehabil 2020 Nov 12:1-6. Epub 2020 Nov 12.

Reconstructive and Microsurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the longitudinal validity and responsiveness of the Persian version of Patient-Rated Tennis Elbow Evaluation (PRTEE) and the Disabilities of the Arm, Shoulder, and Hand (DASH) in patients with lateral elbow tendinopathy (LET).

Methods: Sixty-four patients with LET completed the PRTEE, DASH, and Global Rating of Change Scale (GRC) at baseline and six weeks. The external and internal responsiveness, floor and ceiling effects, minimal detectable change (MDC) and minimal clinically important difference (MCID) were calculated.

Results: No ceiling and floor effects were detected for either the PRTEE or DASH. External responsiveness as an indicator to detect the relationship between change in the measured and external indicator of change was acceptable for both, but higher for the PRTEE (AUC = 0.90; CI: 0.83-0.97) vs. DASH (AUC = 0.80; CI: 69-90). Internal responsiveness to detect intervention related changes indicated slightly superiority in responsiveness for PRTEE. The relative efficiency (1.21), standard effect size (1.14 PRTEE vs. 1.03 DASH), and standard response mean (1.34 PRTEE vs. 1.10 DASH). The MDC were 11 and 12, and MCID were 20 and 18 for the PRTEE and DASH, respectively.

Conclusions: Both the DASH and PRTEE were responsive in detecting improvement in patients with LET. The PRTEE was shorter, more efficient, and slightly more responsive which supports its use as a core outcome measure in evaluating patients with LET. Implications for Rehabilitation The Patient-Rated Tennis Elbow Evaluation (PRTEE) compared with the Disability of the Arm, Shoulder, and Hand (DASH) is a shorter questionnaire with higher psychometric and clinimetric properties for evaluating the patients with lateral elbow tendinopathy. This supports the use of the PRTEE in evaluating patients with elbow tendinopathy.
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http://dx.doi.org/10.1080/09638288.2020.1844318DOI Listing
November 2020

Reproducibility: reliability and agreement parameters of the Revised Short McGill Pain Questionnaire Version-2 for use in patients with musculoskeletal shoulder pain.

Health Qual Life Outcomes 2020 Nov 11;18(1):365. Epub 2020 Nov 11.

Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, N6A 4L6, Canada.

Background: The Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) is a multidimensional outcome measure designed to capture, evaluate and discriminate pain from neuropathic and non-neuropathic sources. A recent systematic review found insufficient psychometric data with respect to musculoskeletal (MSK) health conditions. This study aimed to describe the reproducibility (test-retest reliability and agreement) and internal consistency of the SF-MPQ-2 for use among patients with musculoskeletal shoulder pain.

Methods: Eligible patients with shoulder pain from MSK sources completed the SF-MPQ-2: at baseline (n = 195), and a subset did so again after 3-7 days (n = 48), if their response to the Global Rating of Change (GROC) scale remained unchanged. Cronbach alpha (α) and intraclass correlation coefficient (ICC), and their related 95% CI were calculated. Standard error of measurement (SEM), group and individual minimal detectable change (MDC90), and Bland-Altman (BA) plots were used to assess agreement.

Results: Cronbach α ranged from 0.83 to 0.95 suggesting very satisfactory internal consistency across the SF-MPQ-2 domains. Excellent ICC scores were found in support of the total scale (0.95) and continuous subscale (0.92) scores; the remaining subscales displayed good ICC scores (0.78-0.88). Bland-Altman analysis revealed no systematic bias between the test and retest scores (mean difference = 0.13-0.19). While the best agreement coefficients were seen on the total scale (SEM = 0.5; MDC = 1.2 and MDC = 0.3), they were acceptable for the SF-MPQ-2 subscales (SEM: range 0.7-1; MDC: range 1.7-2.3; MDC: range 0.4-0.5).

Conclusion: Good reproducibility supports the SF-MPQ-2 domains for augmented or independent use in MSK-related shoulder pain assessment, with the total scale displaying the best reproducibility coefficients. Additional research on the validity and responsiveness of the SF-MPQ-2 is still required in this population.
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http://dx.doi.org/10.1186/s12955-020-01617-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661222PMC
November 2020

Content validation of the Kamath and Stothard questionnaire for carpal tunnel syndrome diagnosis: a cognitive interviewing study.

Health Qual Life Outcomes 2020 Nov 7;18(1):359. Epub 2020 Nov 7.

McMaster University, Hamilton, ON, Canada.

Background: Accurate diagnosis of carpal tunnel syndrome (CTS) is essential for directing appropriate treatment; and for making decisions about work injury claims. The Kamath and Stothard Questionnaire (KSQ) is a self-reported tool used for the diagnosis of CTS. Comprehensibility and comprehensiveness of this questionnaire are critical to diagnostic performance and need to be established. The purpose of the study was to describe how potential respondents, clinicians, and measurement researchers interpret KSQ questions in order to identify and resolve potential sources of misclassification.

Methods: Hand therapists, measurement researchers, participants with CTS, and a control group were interviewed using cognitive interviewing techniques (talk aloud, semi-structured interview probes) in Hamilton, Canada. All interviews were recorded and transcribed verbatim. A directed content analysis was done to analyze the interviews using a previously established framework.

Findings: Eighteen participants were interviewed. Areas, where questions were unclear to some participants, were recorded and categorized into five themes: Clarity and Comprehension (52%), Relativeness (38%), Inadequate Response Definition (4%), Perspective Modifiers (4%), and Reference Point (2%). Respondents also identified several symptoms of CTS that are not covered by the KSQ that might be of diagnostic value, e.g., weakness and dropping items.

Conclusion: The content validity of the current iteration of the KSQ was not established. The problematic questions identified in the study have been reported to have low specificity and negative predictive values in a previous quantitative study. The content validity issues identified may explain the poor performance. Recommendations were made to modify the wording of the KSQ and the potential addition of three new questions. Future studies should determine whether the modified questionnaire can provide better diagnostic accuracy and psychometric properties. The results of this study may assist in ruling in or out CTS diagnosis to a wide variety of target audience, such as hand specialists, physical and occupational therapists, as well as family doctors.
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http://dx.doi.org/10.1186/s12955-020-01614-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648957PMC
November 2020

The Quality, Readability, Completeness, and Accuracy of PTSD Websites for Firefighters.

Int J Environ Res Public Health 2020 10 19;17(20). Epub 2020 Oct 19.

Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada.

Firefighters appear at an increased risk for post-traumatic stress disorder (PTSD). Because of PTSD-related stigma, firefighters may search for information online. The current study evaluated the quality, readability, and completeness of PTSD online resources, and to determine how the online treatment recommendations align with current evidence. Google.ca (Canada) searches were performed using four phrases: 'firefighter PTSD', 'firefighter operational stress', 'PTSD symptoms', and 'PTSD treatment'. The 75 websites identified were assessed using quality criteria for consumer health information (DISCERN), readability and health literacy statistics, content analysis, and a comparison of treatments mentioned to the current best evidence. The average DISCERN score was 43.8 out of 75 (indicating 'fair' quality), with 9 'poor' websites (16-30), 31 'fair' websites (31-45), 26 "good" websites (46-60), and nine excellent websites (61-75). The average grade level required to understand the health-related content was 10.6. The most mentioned content was PTSD symptoms (48/75 websites) and PTSD treatments (60/75 websites). The most frequently mentioned treatments were medications (41/75 websites) and cognitive behavioural therapy (40/75 websites). Cognitive behavioural therapy is supported by strong evidence, but evidence for medications appears inconsistent in current systematic reviews. Online PTSD resources exist for firefighters, but the information is challenging to read and lacks evidence-based treatment recommendations.
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http://dx.doi.org/10.3390/ijerph17207629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593916PMC
October 2020

Correspondence: Reply to Hadidi et al.

J Physiother 2020 10 25;66(4):278. Epub 2020 Sep 25.

Clinical Research Outcomes Laboratory, Roth-MacFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, Western University, London, Canada.

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http://dx.doi.org/10.1016/j.jphys.2020.09.003DOI Listing
October 2020

Prevalence of musculoskeletal symptoms among Canadian firefighters.

Work 2020 ;67(1):185-191

Secretary, Hamilton Professional Fire Fighters Association, Canada.

Background: Musculoskeletal symptoms (MSSs) remain the most frequently reported type of injuries sustained during fire-ground operations in firefighters. However, there is a paucity of reports concerning the prevalence estimates of MSSs among female firefighters and different fire services across Canada.

Objectives: To assess the point prevalence of self-reported MSSs, stratified by age and sex in a cohort of active duty firefighters from across Canada, and to determine whether age, sex or length of service can be used to predict the likelihood of the number of MSSs sustained.

Methods: We recruited 390 firefighters (272 males, 118 females). To identify the prevalence of self-reported rates of MSSs, firefighters were asked to complete a standardized 11-item questionnaire that asked, "Please indicate whether you have experienced pain in any body region within the last week", with response options that included "Yes", "No", and "Head", "Neck", "Shoulder", "Arm/Elbow/Hand", "Back", "Stomach/Abdomen", "Upper Thigh", "Knee", "Lower Leg", "Foot", "Other, please specify".

Results: Among the 390 full-time firefighters, 212 (54%) indicated to have experienced some type of MSSs within the last week. The most prevalent region-specific MSSs included, 123 (32%) in the back region, 92 (24%) in the shoulder region, 74 (19%) in the neck region and 70 (18%) in the knee region. In addition, women indicated a 1.6 times greater likelihood of sustaining ≥2 MSSs when controlling for individual differences in age and years of service.

Conclusions: The point prevalence of MSSs in a cohort of full-time firefighters was 54% (55% males; 53% females). Women experienced a 1.4-1.6 times greater likelihood of sustaining MSSs when controlling for individual differences in age and years of service.
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http://dx.doi.org/10.3233/WOR-203264DOI Listing
January 2020

Knowledge, Attitude and Implementation of Evidence-Based Practice among Physiotherapists Working in the Kingdom of Saudi Arabia: A Cross-Sectional Survey.

Healthcare (Basel) 2020 Sep 22;8(3). Epub 2020 Sep 22.

Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia.

The current study aimed to investigate knowledge, attitudes, and implementation of evidence-based practice among physiotherapists working in Saudi Arabia. A sample of physiotherapists working in various outpatient settings in Saudi Arabia participated in this survey. Sixty-four therapists (30 females, 34 males) completed a 28-item survey questionnaire. Approximately half of the participants indicated that evidence-based practice was useful and important for clinical practice. About 60% of the participants reported that they have adopted the evidence-based practice on a regular basis. Participants who had a membership in a physiotherapy organization and had advanced degrees showed more positive attitudes (t = -2.31, = 0.02 and t = -2.15, = 0.04, respectively) and greater levels of knowledge (t = -2.32, = 0.02 and t = -3.86, = 0.001, respectively) regarding evidence-based practice terminology. Furthermore, place of training (trained overseas) was associated with a positive attitude towards literature findings (t = 2.26, = 0.03). The results of this study demonstrated that participants reported that evidence-based practice had not been extensively implemented, despite positive attitudes regarding its implementation among physiotherapists practicing in Saudi Arabia.
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http://dx.doi.org/10.3390/healthcare8030354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551816PMC
September 2020

Virtual Self-Management Has Potential Benefits and Challenges: A Response to a Letter to the Editor.

Arch Phys Med Rehabil 2021 01 18;102(1):161-162. Epub 2020 Sep 18.

School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.

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http://dx.doi.org/10.1016/j.apmr.2020.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500339PMC
January 2021

Prevalence of exposure to critical incidents in firefighters across Canada.

Work 2020 ;67(1):215-222

School of Rehabilitation Therapy & Canadian Institute for Military & Veteran Health Research (CIMVHR), Queen's University, Kingston, ON, Canada.

Background: Firefighters partake in and are exposed to a range of potentially traumatic events throughout their careers and the impact of such critical events could last a life time. Therefore, capturing such lifetime exposures is necessary for supporting firefighter health.

Objective: To estimate the prevalence of critical incidents in firefighters across Canada and determine whether the number of critical events varied based on age, gender, years of service; and to integrate our prevalence estimates using meta-analysis with previous studies to provide a pooled estimate.

Methods: We recruited 464 firefighters. Firefighters were asked to complete a self-report Critical Incident Inventory (CII) survey that included questions on exposure to critical events throughout their firefighting careers. Individual CII items were summarized as percentages, number of exposures, the total number and percentages of exposures to each of the six CII sub-scales. We also performed a multivariate enter regression analysis with the CII total score as dependant variable, and age, gender, years of service as independent variables, to estimate if the number of critical incidents among firefighters varied based on age, gender and years of service.

Results: Among the 390 full-time firefighters, 376 (96.4%) indicated exposure to some type of critical incident. More specifically, 351 (90%) reported a "respond to incident involving one or two deaths", and 314 (81%) reported a "respond to incident involving multiple serious injuries". Age, gender and years of service accounted for only 37.4% of the variance in the number of critical incidents among firefighters. In addition, our pooled estimate results of previous similar studies indicated an overall prevalence estimate of critical incident exposures was 93.40% (4 studies, 1725 of 1877 firefighters, 95% CI: 82.26 -99.30).

Conclusions: Nearly all (96.4%) firefighters were exposed to some form of critical event over the span of their entire firefighting careers. Age, gender and years of service accounted for one-third of the variance in the number of critical incident exposures among firefighters.
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http://dx.doi.org/10.3233/WOR-203267DOI Listing
January 2020

Defining pain and interference recovery trajectories after acute non-catastrophic musculoskeletal trauma through growth mixture modeling.

BMC Musculoskelet Disord 2020 Sep 17;21(1):615. Epub 2020 Sep 17.

Faculty of Health Sciences, Western University, London, ON, Canada.

Background: Recovery trajectories support early identification of delayed recovery and can inform personalized management or phenotyping of risk profiles in patients. The objective of this study was to investigate the trajectories in pain severity and functional interference following non-catastrophic musculoskeletal (MSK) trauma in an international, mixed injury sample.

Methods: A prospective longitudinal cohort (n = 241) was formed from patients identified within four weeks of trauma, from attendance at emergency or urgent care centres located in London, ON, Canada, or Chicago, IL, USA. Pain interference was measured via the Brief Pain Inventory (London cohort) or the Neck Disability Index (Chicago cohort). Pain severity was captured in both cohorts using the numeric pain rating scale. Growth mixture modeling and RM repeated measures ANOVA approaches identified distinct trajectories of recovery within pain interference and pain severity data.

Results: For pain interference, the three trajectories were labeled accordingly: Class 1 = Rapid recovery (lowest intercept, full or near full recovery by 3 months, 32.0% of the sample); Class 2 = Delayed recovery (higher intercept, recovery by 12 months, 26.7% of the sample); Class 3 = Minimal or no recovery (higher intercept, persistently high interference scores at 12 months, 41.3% of the sample). For pain severity, the two trajectories were labeled: Class 1 = Rapid recovery (lower intercept, recovery by 3 months, 81.3% of the sample); and Class 2 = Minimal or no recovery (higher intercept, flat curve, 18.7% of the sample). The "Minimal or No Recovery" trajectory could be predicted by female sex and axial (vs. peripheral) region of trauma with 74.3% accuracy across the 3 classes for the % Interference outcome. For the Pain Severity outcome, only region (axial trauma, 81.3% accuracy) predicted the "Minimal or No Recovery" trajectory.

Conclusions: These results suggest that three meaningful recovery trajectories can be identified in an international, mixed-injury sample when pain interference is the outcome, and two recovery trajectories emerge when pain severity is the outcome. Females in the sample or people who suffered axial injuries (head, neck, or low back) were more likely to be classed in poor outcome trajectories.

Trial Registration: National Institutes of Health - clinicaltrials.gov ( NCT02711085 ; Retrospectively registered Mar 17, 2016).
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http://dx.doi.org/10.1186/s12891-020-03621-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495896PMC
September 2020

Diagnosing Carpal Tunnel Syndrome: Diagnostic Test Accuracy of Scales, Questionnaires, and Hand Symptom Diagrams-A Systematic Review.

J Orthop Sports Phys Ther 2020 11 16;50(11):622-631. Epub 2020 Sep 16.

Objective: To summarize and evaluate research on the accuracy of clinical diagnostic scales, questionnaires, and hand symptom diagrams/maps used for diagnosis of carpal tunnel syndrome (CTS).

Design: Systematic review of diagnostic test accuracy.

Literature Search: A comprehensive literature search of the MEDLINE, CINAHL, and Embase databases was conducted on January 20, 2020.

Study Selection Criteria: Studies that assessed at least 1 diagnostic accuracy property of the scales, questionnaires, and hand symptom diagrams used for the diagnosis of CTS.

Data Synthesis: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Risk of bias and applicability concerns were assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Diagnostic accuracy properties were summarized.

Results: Out of 4052 citations after removing duplicates, 21 articles met the inclusion criteria. Twelve articles reported on the diagnostic accuracy of scales and questionnaires, including the Bland questionnaire, Kamath and Stothard questionnaire, 6-item carpal tunnel syndrome symptoms scale (CTS-6), Boston Carpal Tunnel Questionnaire, Wainner clinical prediction rule, and Lo clinical prediction rule. Positive likelihood ratios ranged from 0.94 for the Boston Carpal Tunnel Questionnaire to 10.5 for the CTS-6, and negative likelihood ratios ranged from 1.04 to 0.05 for the same diagnostic tools, respectively. Nine studies reported the diagnostic accuracy of the Katz and Stirrat hand symptom diagram. Positive and negative likelihood ratios ranged from 1.42 to 8 and from 0.78 to 0.05, respectively. Only 4 studies had high methodologic quality.

Conclusion: Limited evidence supports high accuracy of the CTS-6, Kamath and Stothard questionnaire, and Katz and Stirrat hand symptom diagram. Other scales have lesser and more conflicting evidence. Further high-quality studies are necessary to examine the diagnostic accuracy of these tests to assist ruling in or ruling out CTS. .
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http://dx.doi.org/10.2519/jospt.2020.9599DOI Listing
November 2020

Effectiveness of surgical and non-surgical interventions for managing diabetic shoulder pain: a systematic review.

Disabil Rehabil 2020 Sep 15:1-14. Epub 2020 Sep 15.

Roth|McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, Canada.

Purpose: This systematic review evaluated and compared the effectiveness of non-surgical and surgical interventions for managing shoulder pain in patients with diabetes.

Methods: PubMed, Scopus, CINAHL, EMBASE, Sport Discus, and Cochrane library were searched for studies published in the last 20 years. Randomized clinical trials (RCTs) and cohort studies that assessed shoulder pain in patients with diabetes and implemented one or a combination of non-surgical and surgical interventions were eligible for inclusion. The quality of the included studies was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES) tool. Data extracted from the eligible studies included study design, patient characteristics, duration of symptoms, type of interventions, outcome measures used to assess pain, follow-up intervals, and research findings.

Results: A narrative synthesis with effect sizes (ES) or between-group differences was conducted. A total of 25 (14 non-surgical and 11 surgical) studies met the inclusion criteria. Six studies addressed physiotherapeutic interventions (three RCTs and three cohorts - ES = 0.07-1.3), three studies assessed the effect of steroid injections (two RCTs and one cohort - ES = 0.2-0.4), two cohorts addressed arthrographic capsular distension (between-group difference of 1.1 on Visual Analogue Scale), two cohorts addressed MUA, and one RCT addressed suprascapular nerve block (ES = 1-6). For the surgical studies, six cohorts addressed arthroscopic capsular release (ES = 0.2), three cohorts addressed arthroscopic rotator cuff repair (ES = 0.05-0.5), and one cohort addressed arthroplasty (ES = 0.3).

Conclusion: Moderate- to very-low-quality evidence suggests large effects of physiotherapy modalities plus exercise and suprascapular nerve block, and trivial to small effects for surgical interventions for improving shoulder pain in patients with diabetes. Future well-designed studies are needed to provide accurate estimates of the true effects of these interventions on improving shoulder pain in patients with diabetes. Implications For Rehabilitation Shoulder pain may lead to disability in patients with diabetes. We recommend the use of physiotherapy interventions to reduce shoulder pain. Corticosteroid injections are recommended for short-term shoulder pain relief.
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http://dx.doi.org/10.1080/09638288.2020.1811783DOI Listing
September 2020