Patient reported shoulder function in patients with subacromial impingement: the role of maximum isometric force, range of motion and pain

WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426

(1) physical therapists are well positioned to engage in health promotion and wellness; (2) the model facilitates interdisciplinary collaboration and consultation; (3) a more explicit depiction of the client as the focus of the model is needed; (4) issues related to reimbursement for health promotion and wellness should be addressed; and (5) physical therapist credibility in addressing health behaviors may need to be established. In the phase 2 Delphi process, the majority achieved consensus on all constructs of the model. Minor changes were made in wording and formatting. Conclusion(s): Feedback obtained through the Summit and Delphi process indicates that the HFPT model is viable as a practice model. Next steps include dissemination of the model to a global audience and further research to explore the feasibility of all constructs across practice settings. Implications: Opportunities exist for physical therapists to define and expand their roles in health promotion and wellness. This model may provide an avenue for pursuing this initiative. Keywords: Health promotion; Model; Validation Funding acknowledgements: None. Ethics approval: This project was approved by the Institutional Review Board at The University of Alabama at Birmingham. http://dx.doi.org/10.1016/j.physio.2015.03.439 Research Report Poster Presentation Number: RR-PO-12-01-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 PATIENT REPORTED SHOULDER FUNCTION IN PATIENTS WITH SUBACROMIAL IMPINGEMENT: THE ROLE OF MAXIMUM ISOMETRIC FORCE, RANGE OF MOTION AND PAIN M.B. Clausen 1,2 , A. Witten 2 , K.H. Holm 1 , K.B. Christensen 3 , P. Hölmich 2 , K. Thorborg 2 1 Metropolitan

University College, Department of Physiotherapy and Occupational Therapy, Copenhagen, Denmark; 2 Copenhagen University Hospital Amager-Hvidovre, Sports Orthopedic Research Center – Copenhagen, Copenhagen, Denmark; 3 University of Copenhagen, Department of Biostatistics, Copenhagen, Denmark Background: Subacromial impingement (SIS) is a common shoulder disorder, often causing long lasting symptoms and disability. Maximum isometric force in shoulder abduc-

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tion, protraction and horizontal-extension is decreased and maximum force in external-rotation correlates with selfreported shoulder-function in SIS-patients. Investigating the extent of these impairments and how force and pain influences self-reported shoulder-function will provide important knowledge guiding clinicians in monitoring SIS-patients and enhance knowledge on which treatment protocols can be developed and refined for this patient group. Purpose: (1) To describe and quantify the impairments related to maximum isometric force in shoulder abduction (ABD-force), external-rotation (ER-force), protraction (PRO-force), horizontal-extension (HE-force), active ROM in abduction (AB-ROM) and passive ROM in internalrotation (IR-ROM) in SIS-patients. (2) To investigate the influence of these impairments on self-reported shoulder-function in SIS-patients. Methods: From a consecutive cohort of 169 patients, all diagnosed with SIS using predefined and validated criteria’s, 156 (92%) filled in the shoulder function and disability scale (SPADI), and were included in this cross-sectional study. Impairments of the affected shoulder compared to the unaffected shoulder in ABD-force, ER-force, PRO-force, HE-force, ABD-ROM and IR-ROM were investigated in patients with unilateral shoulder pain. Five different testers were used and therefore inter-tester reliability was first established for tests of ER-force (ICC2,1 = 0.91), ABD-force (ICC2,1 = 0.93), PRO-force (ICC2,1 = 0.92) and HE-force (ICC2,1 = 0.79), as these were not described sufficiently in the literature. A priori, SPADI function score (SPADI-F), was chosen as the dependent variable in a stepwise multiple regression, with ABD-force, ER-force and ABD-ROM, pain during each test and during the last week as independent variables of interest. All analyses were adjusted for age, gender, job status, medication use, kinesiophobia and if the affected shoulder was the dominant. The issue of missing data was addressed using multiple imputation. Results: The mean SPADI score in this population was 57 (±20). Patients with unilateral pain had significant impairments in the affected shoulder compared to the healthy shoulder; ABD-ROM (−27%), IR-ROM (−12%), ER-force (−33%), ABD-force (−29%) and HEforce (−17%) (p < 0.0001). There was no evidence of a difference in PRO-force. All pain variables and ABD-ROM significantly influenced SPADI-F score (p < 0.02), but ABDforce (p = 0.145) and ER-force (p = 0.131) did not. In the stepwise multiple regression, only pain during tests of ERforce, ABD-force and ABD-ROM and pain last week were found to influence SPADI-F score (total variance explained: 24%, p < 0.001). Conclusion(s): This cohort of SIS-patients with low self-reported shoulder-function had significant impairments related to maximum abduction and external-rotation force and active abduction ROM. Also maximal horizontalextension force and passive internal-rotation ROM was affected, but protraction force was not. However, only pain last week, pain during active abduction ROM and pain during

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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426

maximum isometric external-rotation and abduction influenced the SPADI-F score (24%, p < 0.001), suggesting that SPADI-F score does not reflect cardinal and substantial physical impairments, such as reduced shoulder abduction movement and reduced maximum shoulder abduction and external-rotation force. Implications: Based on our findings, addressing cardinal physical impairments in the assessment of SIS-patients, as supplement to self-reported measures, seems important as these impairments are not reflected in self-reported measures. Keywords: Subacromial impingement; Self-reported function; Impairments Funding acknowledgements: No funding received. Ethics approval: Approved by The Danish Research Ethics Committee (H-3-2013-FSP29). http://dx.doi.org/10.1016/j.physio.2015.03.440 Research Report Poster Presentation Number: RR-PO-99-22-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 HOME ELECTRICAL STIMULATION FOR WOMEN WITH FECAL INCONTINENCE: A PRELIMINARY RANDOMIZED CONTROLLED TRIAL N. Cohen-Zubary 1 , R. Gingold-Belfer 2 , S. Levy 3 , N. Wasserberg 4 , R. Dickman 2 1 Sackler

Faculty of Medicine, Tel Aviv University, Physiotherapy Service, Petach Tikva, Israel; 2 Sackler Faculty of Medicine, Tel Aviv University, Gastroenterology, Petach Tikva, Israel; 3 The Academic College of Tel-Aviv-Yaffo, Israel, Biostatistics, Tel-Aviv-Yaffo, Israel; 4 Sackler Faculty of Medicine, Tel Aviv University, Surgery B, Petach Tikva, Israel Background: Home electrical stimulation and standardized biofeedback training are effective treatments for fecal incontinence. There is a lack of studies that prospectively randomized incontinent women to these two treatment methods. Purpose: To compare the effectiveness of home electrical stimulation and standardized biofeedback training in females with fecal incontinence, and to evaluate the cost analysis in each treatment arm. Methods: This preliminary, prospective, comparative, randomized study was conducted in a tertiary care university medical center. Thirty-six females suffering from fecal incontinence were randomized into two groups, matched for mean age (67.45 ± 7.2 years), mean body mass index [kg/m2 ] (26.2 ± 3.9), mean disease duration (4.1 ± 0.8 years), mean number of births (2.7 ± 1.3), and reports of obstetric trauma (25%). Questionnaires were used to evaluate their demographics, medical and childbearing history. Subjects were

randomized to home electrical stimulation or standardized biofeedback training for a period of 6 weeks. Subjective outcome measures included the frequency of fecal, urine and gas incontinence by Visual Analog Scale, Vaizey Incontinence Score, and subjects’ levels of fecal incontinence related anxiety. Objective outcome measures included pelvic floor muscle strength assessed by surface electromyography. Results: Only females who received home electrical stimulation reported a significant improvement in Vaizey Incontinence Score (p = 0.001), anxiety (p = 0.046, and in frequency of leaked solid stool (p = 0.013). A significant improvement in pelvic floor muscle strength was achieved by both groups. Conclusion(s): Home electrical stimulation may offer an alternative to standardized biofeedback training as it is effective, significantly cheaper, and is a generally well-tolerated therapy for females with fecal incontinence. Implications: In females with fecal incontinence, home electrical stimulation therapy is effective and may reduces costs. Keywords: Fecal incontinence; Biofeedback training; Home electrical stimulation therapy Funding acknowledgements: None. Ethics approval: Approved by the Human Subjects Protection Program of the Rabin Medical Center (Registry No. 6588). http://dx.doi.org/10.1016/j.physio.2015.03.441 Research Report Poster Presentation Number: RR-PO-03-06-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 EXPERIENCES OF FATIGUE FOLLOWING CRITICAL ILLNESS: A MIXED METHODS STUDY Z.E. Colman 1 , C.L. Johnston 1 , S. Ashby 1 , J.H. Mackney 1,2 1 The

University of Newcastle, School of Health Sciences, Newcastle, Australia; 2 Curtin University, School of Physiotherapy, Perth, Australia Background: Improvements in medical care and knowledge have led to an increase in the number of survivors of critical illness. These survivors have been reported to experience reduced quality of life for up to five years post hospital discharge, of which fatigue is perceived to be a contributing factor. In addition, survivors report that fatigue impacts on their physical functioning, and can contribute to delayed return to work post critical illness. However, the experiences of fatigue in survivors of critical illness have not yet been explored, and the impact of fatigue on the daily lives of survivors is unknown.