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James L. Farnsworth II, Todd Evans, Helen Binkley and Minsoo Kang

The use of patient-reported outcome measures (PROMs) has been shown to increase adherence to rehabilitation and improve communication between patients and their clinician through measurement of important subjective outcomes, such as quality of life and other psychological, sociological, and

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James L. Farnsworth II, Todd Evans, Helen Binkley and Minsoo Kang

Patient-reported outcome measures (PROMs) help clinicians evaluate patients’ perceptions of changes in their own health status. These tools are especially valuable for measuring attributes that cannot be directly measured, such as pain, or that are not pragmatic or feasible to measure (eg

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Annie C. Jeffries, Lee Wallace, Aaron J. Coutts, Shaun J. McLaren, Alan McCall and Franco M. Impellizzeri

provide the ability to measure constructs and dimensions that are not objectively measurable. Patient-reported outcome measures are commonly used in clinical research and belong to the research field termed clinimetrics. Accordingly, international guidelines and initiatives have been established for the

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Mackenzie Holman, Madeline P. Casanova and Russell T. Baker

. Black N . Patient reported outcome measures could help transform healthcare . BMJ . 2013 ; 346 : f167 . PubMed ID: 23358487 doi: 10.1136/bmj.f167 23358487 2. Nelson EC , Eftimovska E , Lind C , Hager A , Wasson JH , Lindblad S . Patient reported outcome measures in practice

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Luke M. Mueller, Ben A. Bloomer and Chris J. Durall

Clinical Scenario:

Anterior cruciate ligament (ACL) injuries are associated with a lengthy recovery time, decreased performance, and an increased rate of reinjury. To improve performance of the injured knee, affected athletes often undergo surgical reconstruction and rehabilitation. Determining when an athlete is ready to safely return to play (RTP), however, can be challenging for clinicians. Although various outcome measures have been recommended, their ability to predict a safe RTP is questionable.

Focused Clinical Question:

Which outcome measures should be used to determine readiness to return to play after ACL reconstruction?

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Lori A. Michener

Outcome measures can be classified as clinician rated and patient rated. Clinician-rated measures predominantly assess impairments, whereas patient-rated measures, also known as patient-based measures, are designed to evaluate the impact of the injury on a patient’s daily activities, work, and recreation. Currently, there is a greater reliance on clinician-rated impairment measures for clinical decision making, specifically with treatment planning and assessing outcomes of care. To comprehensively evaluate the effect of an injury, patient-rated outcome measures must be used because they allow for the assessment of a patient’s ability to perform daily activities and participate in work and recreation that is affected by an injury. Clinician-rated impairment measures should be used to guide the development of a treatment program, and patient-rated measures should be used for both treatment-program development and assessing treatment outcomes in daily clinical practice. The purposes of this article are to describe patient- and clinician-rated outcome measures and to provide guidance and illustrate the benefits of the use of these measures in clinical decision making and documenting outcomes of care.

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Patti Syvertson, Emily Dietz, Monica Matocha, Janet McMurray, Russell Baker, Alan Nasypany, Don Reordan and Michael Paddack

Context:

Achilles tendinopathy is relatively common in both the general and athletic populations. The current gold standard for the treatment of Achilles tendinopathy is eccentric exercise, which can be painful and time consuming. While there is limited research on indirect treatment approaches, it has been proposed that tendinopathy patients do respond to indirect approaches in fewer treatments without provoking pain.

Objective:

To determine the effectiveness of using a treatment-based-classification (TBC) algorithm as a strategy for classifying and treating patients diagnosed with Achilles tendinopathy.

Participants:

11 subjects (mean age 28.0 ±15.37 y) diagnosed with Achilles tendinopathy.

Design:

Case series.

Setting:

Participants were evaluated, diagnosed, and treated at multiple clinics.

Main Outcome Measures:

Numeric Rating Scale (NRS), Disablement in the Physically Active Scale (DPA Scale), Victorian Institute of Sport Assessment–Achilles (VISA-A), Global Rating of Change (GRC), and Nirschl Phase Rating Scale were recorded to establish baseline scores and evaluate participant progress.

Results:

A repeated-measures ANOVA was conducted to analyze NRS scores from initial exam to discharge and at 1-mo follow-up. Paired t tests were analyzed to determine the effectiveness of using a TBC algorithm from initial exam to discharge on the DPA Scale and VISA-A. Descriptive statistics were evaluated to determine outcomes as reported on the GRC.

Conclusion:

The results of this case series provide evidence that using a TBC algorithm can improve function while decreasing pain and disability in Achilles tendinopathy participants.

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Ellen C. Jørstad-Stein, Klaus Hauer, Clemens Becker, Marc Bonnefoy, Rachel A. Nakash, Dawn A. Skelton and Sarah E. Lamb

The purpose of the study was to identify physical activity questionnaires for older adults that might be suitable outcome measures in clinical trials of fall-injury-prevention intervention and to undertake a systematic quality assessment of their measurement properties. PubMed, CINAHL, and PsycINFO were systematically searched to identify measurements and articles reporting the methodological quality of relevant measures. Quality extraction relating to content, population, reliability, validity, responsiveness, acceptability, practicality, and feasibility was undertaken. Twelve outcome measures met the inclusion criteria. There is limited evidence about the measures’ properties. None of the measures is entirely satisfactory for use in a large-scale trial at present. There is a need to develop suitable measures. The Stanford 7-day Physical Activity Recall Questionnaire and the Community Health Activities Model Program for Seniors questionnaire might be appropriate for further development. The results have implications for the designs of large-scale trials investigating many different geriatric syndromes.

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Alison R. Snyder and Tamara C. Valovich McLeod

Edited by Gary Wilkerson

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Shana Harrington, Corinne Meisel and Angela Tate

Context:

The prevalence of shoulder pain in the competitive swimming population has been reported to be as high as 91%. Female collegiate swimmers have a reported shoulder-injury rate 3 times greater than their male counterparts. There has been little information on how to best prevent shoulder pain in this population. The purpose of this study was to examine if differences exist in shoulder range of motion, upper-extremity strength, core endurance, and pectoralis minor length in NCAA Division I female swimmers with and without shoulder pain and disability.

Methods:

NCAA Division I females (N = 37) currently swimming completed a brief survey that included the pain subscale of the Penn Shoulder Score (PSS) and the sports/performing arts module of the Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure. Passive range of motion for shoulder internal rotation (IR) and external rotation (ER) at 90° abduction was measured using a digital inclinometer. Strength was measured using a handheld dynamometer for scapular depression and adduction, scapular adduction, IR, and ER. Core endurance was assessed using the side-bridge and prone-bridge tests. Pectoralis minor muscle length was assessed in both a resting and a stretched position using the PALM palpation meter. All measures were taken on the dominant and nondominant arms.

Results:

Participants were classified as positive for pain and disability if the following 2 criteria were met: The DASH sports module score was >6/20 points and the PSS strenuous pain score was ≥4/10. If these criteria were not met, participants were classified as negative for pain and disability. Significant differences were found between the 2 groups on the dominant side for pectoralis muscle length at rest (P = .003) and stretch (P = .029).

Conclusions:

The results provide preliminary evidence regarding an association between a decrease in pectoralis minor length and shoulder pain and disability in Division I female swimmers.