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Clausen MB1,2,3, Witten A2, Christensen KB4, Zebis MK1, Foverskov M2, Cools A5, Hölmich P2, Thorborg K2,3
1University College Copenhagen, Faculty of Health and Technology, Copenhagen, Denmark, 2Copenhagen University Hospital, Amager-Hvidovre, Sports Orthopedic Research Center - Copenhagen, Department of Orthopedic Surgery, Hvidovre, Denmark, 3Copenhagen University Hospital, Amager-Hvidovre, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Hvidovre, Denmark, 4University of Copenhagen, Section of Biostatistics, Copenhagen, Denmark, 5Ghent University, Department of Rehabilitation Sciences and Physiotherapy, Ghent, Belgium
Background: Higher level of shoulder disability is linked to more societal costs and worse health-related quality-of-life, but it is unknown how disability differs among the most common shoulder disorders in orthopedic specialist care settings. Furthermore, rating of shoulder disability using patient-reported outcomes (PROMs) in every-day clinical settings is time-consuming, why a more time-efficient approach is needed.
Purpose: The purposes are to
1) compare shoulder disability among common shoulder disorders,
2) subgroup patients using the time-efficient Copenhagen Shoulder Abduction Test (C-SAT), and
3) compare shoulder disability among C-SAT subgroups.
Methods: We conducteda cross-sectional study including 325 consecutive patients with shoulder disorders in an orthopedic specialist care setting. Shoulder disability was assessed with the Shoulder Pain and Disability Index (SPADI), using the total SPADI scores as wells as the function (SPADI-function) and pain (SPADI-pain) sub-scale scores. Abduction range-of-motion (ROM) and pain during testing (NRS:0-10) was also assessed. Orthopedic surgeons, blinded to SPADI-scores and assessments, examined patients and categorized them according to diagnoses. The Copenhagen Shoulder Abduction Test (C-SAT), which is based on ROM and pain during testing, was used to subgroup patients into Severe (ROM 90°), Medium (ROM>90°, NRS:>5), and Mild (ROM>90°, NRS:≤5) disability rating. Shoulder disability, being all SPADI scores, was compared among diagnostic categories and C-SAT rating subgroups using ANCOVA models. Effect-sizes (ES) were estimated from mean differences. A significance level of 5% was used.
Results: Adhesive capsulitis was related to worse scores compared to subacromial impingement (SIS) in SPADI (ES: 0.5, p=.025) and SPADI-function (ES 0.5, p=.020), but not in SPADI-pain (ES 0.4, p=.059). Glenohumeral-injury was related to better SPADI, SPADI-pain and SPADI-function compared to all other diagnostic groups (ES 0.7 to 1.3, p .01). Distribution of C-SAT ratings were heavily skewed for patients with adhesive capsulitis and glenohumeral-injury, why comparisons of SPADI scores among C-SAT subgroups were only done for patients with SIS and complete rotator-cuff tear, combining the two diagnostic groups. Differences in shoulder disability between the Mild and Medium C-SAT subgroups were large for SPADI total and both sub-scales (ES: 0.9 to 1.0, p .0001). SPADI-function differed between the Severe and Medium C-SAT subgroups (ES: 0.4, p=.025). Patients with adhesive capsulitis (n=22) and those with SIS or complete rotator-cuff tear combined with Severe C-SAT rating (n=64) scored similar in SPADI.
Conclusion(s): Patients with adhesive capsulitis displayed the highest level of shoulder disability, while glenohumeral-injury was associated with lower disability compared to all other diagnostic groups. The C-SAT, a simple test combining abduction ROM and pain-rating, was able to identify three distinct subgroups of patients with rotator-cuff related disorders, who differed in shoulder disability. Future studies should investigate the relevance of stratified care based on the C-SAT disability rating, as the same treatment modalities might not be relevant across subgroups with different degrees of shoulder disability.
Implications: Patients with SIS or complete rotator-cuff tear combined with a Severe C-SAT rating includes a large proportion of the patients with high levels of shoulder disability, why improved care for this sub-group will likely have a substantial impact on the socio-economic consequences of shoulder disorders.
Keywords: Shoulder, Assessment, Disability
Funding acknowledgements: Funded by Praksisfonden (15/808).
Purpose: The purposes are to
1) compare shoulder disability among common shoulder disorders,
2) subgroup patients using the time-efficient Copenhagen Shoulder Abduction Test (C-SAT), and
3) compare shoulder disability among C-SAT subgroups.
Methods: We conducteda cross-sectional study including 325 consecutive patients with shoulder disorders in an orthopedic specialist care setting. Shoulder disability was assessed with the Shoulder Pain and Disability Index (SPADI), using the total SPADI scores as wells as the function (SPADI-function) and pain (SPADI-pain) sub-scale scores. Abduction range-of-motion (ROM) and pain during testing (NRS:0-10) was also assessed. Orthopedic surgeons, blinded to SPADI-scores and assessments, examined patients and categorized them according to diagnoses. The Copenhagen Shoulder Abduction Test (C-SAT), which is based on ROM and pain during testing, was used to subgroup patients into Severe (ROM 90°), Medium (ROM>90°, NRS:>5), and Mild (ROM>90°, NRS:≤5) disability rating. Shoulder disability, being all SPADI scores, was compared among diagnostic categories and C-SAT rating subgroups using ANCOVA models. Effect-sizes (ES) were estimated from mean differences. A significance level of 5% was used.
Results: Adhesive capsulitis was related to worse scores compared to subacromial impingement (SIS) in SPADI (ES: 0.5, p=.025) and SPADI-function (ES 0.5, p=.020), but not in SPADI-pain (ES 0.4, p=.059). Glenohumeral-injury was related to better SPADI, SPADI-pain and SPADI-function compared to all other diagnostic groups (ES 0.7 to 1.3, p .01). Distribution of C-SAT ratings were heavily skewed for patients with adhesive capsulitis and glenohumeral-injury, why comparisons of SPADI scores among C-SAT subgroups were only done for patients with SIS and complete rotator-cuff tear, combining the two diagnostic groups. Differences in shoulder disability between the Mild and Medium C-SAT subgroups were large for SPADI total and both sub-scales (ES: 0.9 to 1.0, p .0001). SPADI-function differed between the Severe and Medium C-SAT subgroups (ES: 0.4, p=.025). Patients with adhesive capsulitis (n=22) and those with SIS or complete rotator-cuff tear combined with Severe C-SAT rating (n=64) scored similar in SPADI.
Conclusion(s): Patients with adhesive capsulitis displayed the highest level of shoulder disability, while glenohumeral-injury was associated with lower disability compared to all other diagnostic groups. The C-SAT, a simple test combining abduction ROM and pain-rating, was able to identify three distinct subgroups of patients with rotator-cuff related disorders, who differed in shoulder disability. Future studies should investigate the relevance of stratified care based on the C-SAT disability rating, as the same treatment modalities might not be relevant across subgroups with different degrees of shoulder disability.
Implications: Patients with SIS or complete rotator-cuff tear combined with a Severe C-SAT rating includes a large proportion of the patients with high levels of shoulder disability, why improved care for this sub-group will likely have a substantial impact on the socio-economic consequences of shoulder disorders.
Keywords: Shoulder, Assessment, Disability
Funding acknowledgements: Funded by Praksisfonden (15/808).
Topic: Musculoskeletal: upper limb; Orthopaedics; Outcome measurement
Ethics approval required: No
Institution: Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre
Ethics committee: Capitol Region Committee on Health Research Ethics in Denmark
Reason not required: The study was evaluated by the Committee on Health Research Ethics in Denmark as not requiring formal ethical approval.
All authors, affiliations and abstracts have been published as submitted.
