Developing attributes and Attribute-Levels for subacromial pain syndrome: A systematic review and qualitative study.

BACKGROUND: Subacromial pain syndrome (SAPS), the most common cause of shoulder pain, can be treated through different treatments with similar effects. Therefore, in terms of deciding on the right treatment fit, patient preferences need to be understood. We aimed to identify treatment characteristics that delineate interventions (attributes) and corresponding sets of specific categorical range (attribute-levels) for SAPS. METHODS: This multiple method study systematically reviewed both qualitative and quantitative studies on patient preferences for treatment of SAPS, which informed semi-structured interviews with nine clinicians and 14 patients. The qualitative data from the interviews was analyzed using the framework analysis formulated by Ritchie and Spencer. Attributes and attribute levels of the systematic review and interviews were summarized and categorized. RESULTS: The search resulted in 2.607 studies, 16 of which met the eligibility criteria. The review identified 120 potential attributes, which were synthesized into 25 potential attributes. Fourteen new potential attributes were identified through the interviews, equaling a total of 39 attributes across 11 categories. Levels for 37 attributes were identified through systematic review and interviews, we were unable to identify levels for two attributes. CONCLUSIONS: This study identified attributes and attribute levels for the treatment of SAPS. There was a discrepancy in the frequency of the represented attributes between the literature and interviews. This study may improve the understanding of patient preferences for the treatment of SAPS and help individualize care. Our study informs a future discrete choice experiment and supports shared decision-making in clinical practice.

Using a target as external focus of attention results in a better jump-landing technique in patients after anterior cruciate ligament reconstruction - A cross-over study.

BACKGROUND: Improving jump-landing technique during rehabilitation is important and may be achieved through different feedback techniques, i.e., internal focus of attention (IF) or external focus of attention using a target (EF). However, there is a lack of evidence on the most effective feedback technique after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to investigate the potential difference in jump-landing techniques between IF and EF instructions in patients after ACLR. METHODS: Thirty patients (12 females, mean age 23.26 ± 4.91 years) participated after ACLR. Patients were randomly assigned into two groups that each followed a different testing sequence. Patients performed a drop vertical jump-landing test after receiving instructions with varying types of focus of attention. The Landing Error Scoring System (LESS) assessed the jump-landing technique. RESULTS: EF was associated with a significantly better LESS score (P < 0.001) compared with IF. Only EF instructions led to improvements in jump-landing technique. CONCLUSION: Using a target as EF resulted in a significantly better jump-landing technique than IF in patients after ACLR. This indicates that increased use of EF could or might result in a better treatment outcome during ACLR rehabilitation.

"I had already tried that before going to the doctor" - exploring adolescents' with knee pain perspectives on 'wait and see' as a management strategy in primary care; a study with brief semi-structured qualitative interviews.

OBJECTIVES: The aim of this study was to examine how the "wait-and-see" recommendation affects adolescents' understanding of their illness and symptoms and their care-seeking behavior. METHODS: This study included brief qualitative, semi-structured online interviews. Adolescents (age 10-19 years) with long-term knee pain, who had been recommended "wait-and-see" by their general practitioner (GP), were recruited via previous studies and social media. Two researchers conducted brief semi-structured interviews through Microsoft Teams. An interview guide with open questions was created prior to the interviews and updated as new questions emerged. The extracted data was transcribed and analyzed via a reflexive thematic approach in NVivo. RESULTS: Eight adolescents (mean age 17.8) with longstanding or recurrent knee pain (mean duration 3.5 years) were included. The analysis identified four main themes: (1) The perception of wait and see over time, (2) The GP's acknowledgement and consideration, (3) experienced limitation from knee pain and (4) the importance of getting a diagnosis. The perception of "wait-and-see" approach changed from positive to negative when adolescents received the recommendation multiple times. Adolescents experienced frustration with their situation and a lack of consideration from their GP made them cautious about seeking additional care. Knee pain significantly limited the adolescents' physical-and social activities. Receiving a diagnosis was important and helped adolescents dealing with their pain. CONCLUSIONS: The connotation of wait-and-see changed from positive to negative for adolescents when receiving the recommendation multiple times. The participants felt getting a clinical diagnosis was a relief. Furthermore, the lack of consideration and acknowledgement from the GP plays an essential role in the adolescent's understanding of their knee pain. IMPLICATIONS: Recommending adolescents to "wait-and-see" multiple times in relation to their knee problems can lead adolescents experience frustration and a lack of consideration from their GP. It would be advisable for GPs to provide adolescents with a diagnosis as it can facilitate them in dealing with their pain and to use simple language when explaining adolescents their condition to improve communication.

Care-seeking behaviour of adolescents with patellofemoral pain: a retrospective cohort study.

AIM: The aim of this study was to assess the care-seeking behaviour among adolescents with patellofemoral pain (PFP). METHODS: This retrospective study included data on 121 adolescents with PFP enrolled in a randomized controlled trial. A questionnaire was sent to the general practitioner (GP) of each adolescent, assessing information on the consultation dates for knee pain, potential diagnoses, and treatment provided. RESULTS: 106/121 adolescents had been in contact with their GP, and 95 medical records of adolescents were available. Of the 95 adolescents with available medical records 60 had consulted their GP for knee pain. The median number of contacts was 1.5 (range 1-7). The GPs initiated treatment for 48 of the 60 adolescents and in most cases it was information and advice (36/48) or pain medication to a minor extent (6/48). Out of the 60 adolescents who consulted their GP 26 were subsequently referred to different types of health care professionals, in 11 out of 26 to physiotherapy, but also to the department of rheumatology or orthopaedics. Conclusions : 63% of adolescents diagnosed with PFP had previously consulted their GP due to knee pain. Several types of treatments were initiated by the GP, but most commonly advice and information were given. Standardized and evidence-based treatment guidelines for adolescent knee pain in general practice are needed.

Translation, validity and reliability of the Danish version of the Adolescent Insomnia Questionnaire.

Background: The Adolescent Insomnia Questionnaire (AIQ), English version, is the only validated screening measure developed specifically to identify insomnia symptoms in adolescents. To date, no specific screening tool for adolescent insomnia is present in Danish language. The aim of this study was to translate and validate the AIQ in a sample of Danish adolescents. Methods: The AIQ underwent a process of forward-backward translation and pilot testing. Subsequently, data were collected at baseline and two-week follow-up from adolescents aged 11-19, who completed both the AIQ and an available adult measure of insomnia (the Athens Insomnia Scale, AIS). The internal consistency, test-retest reliability and convergent validity were assessed. Exploratory factor analysis was conducted to identify the latent factors underlying the questionnaire. Results: At baseline 185 adolescents (18% males and 82% females, mean age 16.0 years) and 102 (55.1%) at two-week follow-up completed the questionnaires. The AIQ showed excellent internal consistency for the total score (Cronbach's a: 0.88) and good convergent validity with the AIS total score (Pearson's correlation value= 0.86, P<0.001). The test-retest reliability at two weeks was very satisfactory (ICC coefficient = 0.89; 95% CI 0.84, 0.92). Results from the exploratory factor analysis identified a three-model solution corresponding to the same three-model solution identified within the original development sample. Conclusions: The Danish version of the AIQ demonstrated satisfactory psychometric properties in terms of internal consistency, test-retest reliability and validity, which supports its use as a screening tool for the identification of insomnia symptoms in adolescents, including Danish-speaking adolescents.

The Adolescent Knee Pain (AK-Pain) prognostic tool: protocol for a prospective cohort study.

Background: One in three children and adolescents experience knee pain. Approximately one in two adolescents with knee pain will continue to experience pain even five years later and have low quality of life. The general practitioner (GP) is the first point of contact for children and adolescents with knee pain in Denmark. There is a variety of treatments being delivered in general practice, despite similar symptoms and patients' characteristics. This suggests a need to support the GPs in identifying those at high risk of a poor outcome early on, in order to better allocate resources. The aim of this study is to develop a user-friendly prognostic tool to support GPs' management of children and adolescents' knee pain. Methods: A preliminary set of items in the prognostic tool were identified using systematic reviews and meta-analysis of individual participant data. Following feedback from GPs and children and adolescents on the content and understanding, the tool was piloted and implemented in general practice. A cohort of approximately 300 children and adolescents (age 8-19 years old) is being recruited from general practices (recruitment period, July 2019 - June 2020). Clinically meaningful risk groups (e.g. low/medium/high) for the recurrence/persistence of knee pain (at 3 and 6 months) will be identified. Discussion: If successful, this prognostic tool will allow GPs to gain insights into the likely prognosis of adolescents with knee pain and subsequently provide the first building blocks towards stratified care, where treatments will be matched to the patients' prognostic profile. This has the potential to improve the recovery of children and adolescents from knee pain, to improve the allocation of resources in primary care, and to avoid the decline in physical activity and potential associated health and social consequences due to adolescent knee pain. Registration: Registered with ClinicalTrials.gov on 24 June 2019 (ID NCT03995771).

Concentric and eccentric time-under-tension during strengthening exercises: validity and reliability of stretch-sensor recordings from an elastic exercise-band.

BACKGROUND: Total, single repetition and contraction-phase specific (concentric and eccentric) time-under-tension (TUT) are important exercise-descriptors, as they are linked to the physiological and clinical response in exercise and rehabilitation. OBJECTIVE: To investigate the validity and reliability of total, single repetition, and contraction-phase specific TUT during shoulder abduction exercises, based on data from a stretch-sensor attached to an elastic exercise band. METHODS: A concurrent validity and interrater reliability study with two raters was conducted. Twelve participants performed five sets of 10 repetitions of shoulder abduction exercises with an elastic exercise band. Exercises were video-recorded to assess concurrent validity between TUT from stretch-sensor data and from video recordings (gold standard). Agreement between methods was calculated using Limits of Agreement (LoA), and the association was assessed by Pearson correlation coefficients. Interrater reliability was calculated using intraclass correlation coefficients (ICC 2.1). RESULTS: Total, single repetition, and contraction-phase specific TUT - determined from video and stretch-sensor data - were highly correlated (r>0.99). Agreement between methods was high, as LoA ranged from 0.0 to 3.1 seconds for total TUT (2.6% of mean TUT), from -0.26 to 0.56 seconds for single repetition TUT (6.9%), and from -0.29 to 0.56 seconds for contraction-phase specific TUT (13.2-21.1%). Interrater reliability for total, single repetition and contraction-phase specific TUT was high (ICC>0.99). Interrater agreement was high, as LoA ranged from -2.11 to 2.56 seconds for total TUT (4.7%), from -0.46 to 0.50 seconds for single repetition TUT (9.7%) and from -0.41 to 0.44 seconds for contraction-phase specific TUT (5.2-14.5%). CONCLUSION: Data from a stretch-sensor attached to an elastic exercise band is a valid measure of total and single repetition time-under-tension, and the procedure is highly reliable. This method will enable clinicians and researchers to objectively quantify if home-based exercises are performed as prescribed, with respect to time-under-tension.