Force measuring technology has been around for decades but has only recently become more affordable and accessible to the mass physiotherapy market. The ability to objectively measure force and track changes over time provides the patient with a source of motivation, takes the guess work out of manual strength testing, provides us with deeper insights into force production and provides funders with objective measures of progress.

​With increasing amounts of time and money being spent on equipment and collecting force data, maybe it’s a good time to pause and consider what value we are getting from these devices in our shoulder rehabilitation?

Shoulder pain, disability and psychosocial dimensions: Profile of patients attending shoulder physiotherapy clinics.
 
White, R. J., Olds, M., Cadogan, A., Betteridge, S., & Sole, G. (2022). Shoulder pain, disability and psychosocial dimensions across diagnostic categories: Profile of patients attending shoulder physiotherapy clinics. New Zealand Journal of Physiotherapy, 50(1), 6–20. https://doi.org/10.15619/NZJP/50.1.02

Full text link: https://pnz.org.nz/Attachment?Action=Download&Attachment_id=2436

Congratulations to Roger on this publication. This was a great project to be involved in and an example of what can be achieved with academic and clinician collaboration.

For me the most fulfilling part of any publication is the discussion and clinical applications where the rubber hits the road. There were so many interesting findings from this study. We've summarised a few of the key findings in this infographic. I've provided a few other reflections on the practicalities of collecting the data in the clinical setting here:

1️⃣  Be aware of 'questionnaire burden'. The reality of collecting this information in the clinical setting is that patients have varying tolerance for completing forms that they perceive 'don't apply to me', or where 'questions are repetitive'. Choose a small number of pre-appointment questionnaires that cover key dimensions in the majority of your clinical population (I include a health screen in mine), and use others as indicated for specific patients. As an example, I now only use the CSI score after I have assessed the patient if I suspect central sensitivity based on other clinical findings as the yield of high scores in this population is low (<10%).

2️⃣  Individual question responses can be helpful. Pre-appointment questionnaires are a good way of collecting baseline data, but the total scores often don't tell the full story. Responses to individual questions can provide good direction for follow-up questioning in specific patients.

3️⃣  Literacy. Some patients failed to return the electronic questionnaires before the appointment, and when asked to complete the 'hard copies' on arrival a few became agitated. On questioning, some reluctantly disclosed they have dyslexia, or can't read and we helped them complete the forms within the session. Be sensitive and ask if people need help if they appear reluctant to complete questionnaires.

4️⃣ Use questionnaires validated in your clinical population. Some questionnaires may not adequately capture pain and disability (or other measures) in certain clinical populations. Some pain and function scores ask only about ADLs (e.g 'brushing your hair', or 'reaching a shelf'). Where pain and function are being measured, consider the patient. If pain is not a major factor (sometimes instabilty is the primary symptom) and their activity demands are high choose a questionnaire that specifically addresses their symptoms and activities e.g 'instability' questionnaires (WOSI, Oxford) may be more appropriate for these patients.

Click here for links to shoulder outcome questionnaires.

#collaboration #psychosocial #physiotherapyspecialist #screening #pain #disability #shoulderpain #shoulderinstability

This infographic give a summary of a case I saw in 2021. This highlights the importance of red flag screening in physiotherapy. Click here for more information about red flag screening in physiotherapy.