D'hondt N1,2, Pool J1, Kiers H1, Terwee C3, Veeger D2,4
1HU University of Apllied Sciences Utrecht, Utrecht, Netherlands, 2VU University Amsterdam, Amsterdam, Netherlands, 3VU University Medical Center Amsterdam, Amsterdam, Netherlands, 4Delft University of Technology, Delft, Netherlands
Background: Deviant scapular motion and positioning are frequently mentioned as major contributing factors to the etiology and persistence of shoulder pain. As such, evaluation of scapular involvement in individuals with shoulder pain is considered to play a critical role in the clinical decision making process. However, it is yet unclear to what extent current clinical measurement instruments are valid to serve for this purpose.
Purpose: To review construct validity, criterion validity and responsiveness of clinical measurement instruments to evaluate scapular function.
Methods: Medline, Embase, CINAHL and SPORTDiscus were systematically searched from inception until March 2018. Studies published in Dutch, English or German were included when these evaluated at least one of the measurement properties of interest. Two reviewers independently evaluated study-quality using the 4-point-rating scale of the COSMIN-checklist and extracted and analysed data.
Results: Thirty-one measurement instruments in 14 studies were categorized into instruments to assess scapulothoracic (I) posture and (II) movement, determined by inclinometry and palpation-methods of scapulothoracic bony landmarks; and (III) scapular dyskinesis, determined by subjective observational methods based upon the assumption that deviation from normal scapolothoracic posture or movement-patterns would be dysfunctional. Data-analysis yielded at most moderate quality evidence for positive criterion validity of measurement instruments to assess scapulothoracic protraction/retraction posture and scapular rotation angles up to 120° of thoracohumeral elevation (I), and for negative criterion validity of instruments to assess asymmetrical scapulothoracic posture (I), range of motion (II) and the Lateral Scapular Slide Test (III). Levels of evidence for all other instruments were low or evidence was absent.
Conclusion(s): Current evidence is inadequate to recommend or to dissuade the selection of a specific clinical measurement instrument to validly assess scapular function in indivduals with shoulder pain. However, most criteria of measurement instruments to assess scapular dyskinesis are most likely based upon untenable theoretical constructs.
Implications: Using common sense currently seems the best way to clinically determine whether or not scapular motions are contributing to shoulder pain, rather than relying on the outcome of tests that use a standardized set of criteria aimed at establishing the presence of scapula dyskinesis.
Keywords: Scapula dyskinesis, Systematic Review, Validity
Funding acknowledgements: This study was funded in part by the The Netherlands Organisation for Scientific Research (NWO)
Purpose: To review construct validity, criterion validity and responsiveness of clinical measurement instruments to evaluate scapular function.
Methods: Medline, Embase, CINAHL and SPORTDiscus were systematically searched from inception until March 2018. Studies published in Dutch, English or German were included when these evaluated at least one of the measurement properties of interest. Two reviewers independently evaluated study-quality using the 4-point-rating scale of the COSMIN-checklist and extracted and analysed data.
Results: Thirty-one measurement instruments in 14 studies were categorized into instruments to assess scapulothoracic (I) posture and (II) movement, determined by inclinometry and palpation-methods of scapulothoracic bony landmarks; and (III) scapular dyskinesis, determined by subjective observational methods based upon the assumption that deviation from normal scapolothoracic posture or movement-patterns would be dysfunctional. Data-analysis yielded at most moderate quality evidence for positive criterion validity of measurement instruments to assess scapulothoracic protraction/retraction posture and scapular rotation angles up to 120° of thoracohumeral elevation (I), and for negative criterion validity of instruments to assess asymmetrical scapulothoracic posture (I), range of motion (II) and the Lateral Scapular Slide Test (III). Levels of evidence for all other instruments were low or evidence was absent.
Conclusion(s): Current evidence is inadequate to recommend or to dissuade the selection of a specific clinical measurement instrument to validly assess scapular function in indivduals with shoulder pain. However, most criteria of measurement instruments to assess scapular dyskinesis are most likely based upon untenable theoretical constructs.
Implications: Using common sense currently seems the best way to clinically determine whether or not scapular motions are contributing to shoulder pain, rather than relying on the outcome of tests that use a standardized set of criteria aimed at establishing the presence of scapula dyskinesis.
Keywords: Scapula dyskinesis, Systematic Review, Validity
Funding acknowledgements: This study was funded in part by the The Netherlands Organisation for Scientific Research (NWO)
Topic: Musculoskeletal: upper limb; Human movement analysis; Orthopaedics
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: This study involves a systematic review
All authors, affiliations and abstracts have been published as submitted.
