Prevalence and associations of axillary web syndrome in Asian women after breast cancer surgery undergoing a community-based cancer rehabilitation program.

BACKGROUND: Patients who have breast cancer surgery are at risk of axillary web syndrome (AWS), an under-recognized postsurgical complication which can result in shoulder morbidity and functional impairment. Emerging studies have indicated that AWS may persist beyond the first few months after surgery, although few studies have assessed the prevalence and association of AWS beyond a year after diagnosis. Therefore, the aim of this study was to investigate the prevalence and associations for AWS in post-operative breast cancer patients up to 3 years after surgery. METHODS: This cross sectional observational study was conducted at a community-based cancer rehabilitation center. Patients were evaluated for the presence of AWS via physical examination. Disease-related data was obtained from clinical review and medical records. Descriptive statistics were utilized to illustrate patient demographics and clinical characteristics. Logistic regression analyses were used to determine associations of AWS. RESULTS: There were 111 Asian women who were recruited, who had undergone breast surgery and were referred to a national outpatient rehabilitation center. The prevalence of AWS in this population was 28.9%. In the multivariate regression model, significant factors were age < 50 years (OR = 3.51; 95% CI = 1.12-11.0; p = 0.031) and ALND (OR = 6.54; 95% CI = 1.36-31.3; p = 0.019). There was reduced shoulder flexion ROM (p < 0.001) in patients with AWS compared to patients without AWS. CONCLUSIONS: A high prevalence of AWS was reported in breast cancer survivors even at 3 years after breast surgery. Our findings highlight the need to identify breast cancer survivors with AWS even in the survivorship phase, and develop strategies to raise awareness and minimize functional impairment in these patients.

Cross-cultural adaptation and validation of the Romanian Oxford Shoulder Score.

BACKGROUND: The use of validated patient reported outcome scores is critical to the reporting and monitoring of the effectiveness of clinical treatment. The aim of this study was to translate and culturally validate the English Oxford Shoulder Score (OSS) to Romanian. METHODS: Approximately, 125 patients with disorders of the rotator cuff and proximal humerus fractures completed the translated Oxford Shoulder Score (OSS_RO), the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and EuroQol 5-Dimension (EQ-5D-5L). The patients repeated the evaluation using the OSS_RO after 2 days. RESULTS: The OSS_RO had a high degree of internal consistency and reliability with a Cronbach's α of 0.954 at the initial completion and 0.945 at the second testing. The intraclass correlation coefficient (ICC, 2-way mixed effects model) was 0.953 (single measures) and 0.976 (average), P < .001. The OSS_RO was reproducible (Pearson's r = 0.953; P < .001). The OSS_RO was divergently valid with QuickDASH score (Pearson's r = -0.633 first and r = -0.672 second; P < .001) and convergent with the EQ-5D VAS (Pearson's r = 0.627 first and r = 0.640 second; P < .001) and the EQ-5D Index (Pearson's r = 0.759 first and r = 0.771 second; P < .001). CONCLUSION: Our study showed that the Romanian translation of the OSS is a reliable, reproducible and valid measure of shoulder function in patients with variable shoulder pathology.

Patient self-report section of the ASES questionnaire: a Spanish validation study using classical test theory and the Rasch model.

BACKGROUND: The aim of the current study was to validate the self-report section of the American Shoulder and Elbow Surgeons questionnaire (ASES-p) into Spanish. METHODS: Shoulder pathology patients were recruited and followed up to 6 months post treatment. The ASES-p, Constant, SF-36 and Barthel scales were filled-in pre and post treatment. Reliability was tested with Cronbach's alpha, convergent validity with Spearman's correlations coefficients. Confirmatory factor analysis (CFA) and the Rasch model were implemented for assessing structural validity and unidimensionality of the scale. Models with and without the pain item were considered. Responsiveness to change was explored via standardised effect sizes. RESULTS: Results were acceptable for both tested models. Cronbach's alpha was 0.91, total scale correlations with Constant and physical SF-36 dimensions were >0.50. Factor loadings for CFA were >0.40. The Rasch model confirmed unidimensionality of the scale, even though item 10 "do usual sport" was suggested as non-informative. Finally, patients with improved post treatment shoulder function and those receiving surgery had higher standardised effect sizes. CONCLUSIONS: The adapted Spanish ASES-p version is a valid and reliable tool for shoulder evaluation and its unidimensionality is supported by the data.

A longitudinal study on risk factors for neck and shoulder pain among young adults in the transition from technical school to working life.

OBJECTIVES: The study examined the course of neck and shoulder pain among a cohort of technical school students entering working life. We also aimed to identify work-related and individual risk factors for neck and shoulder pain during this transition period. METHODS: The study was designed as a prospective cohort study following 420 technical school students (167 student hairdressers, 118 student electricians, and 135 media/design students) from school, through their apprenticeship and into working life. Every 4 (th)month over a 6.5 year period (2002-2009), the participant`s neck and shoulder pain for the preceding four weeks was assessed. Mechanical and psychosocial workplace factors as well as individual factors were evaluated at baseline and/or during the follow-up period. Data were analyzed by generalized estimating equations (GEE). RESULTS: We found a significant increase in neck and shoulder pain over time in the transition from technical school to working life. High mechanical workload was associated with neck and shoulder pain among women, while a high level of shoulder muscle endurance capacity was associated with lower rates of neck and shoulder pain among men. Perceived muscle tension and ethnicity were the most consistent predictors for neck and shoulder pain, found among both women and men. CONCLUSION: Increased neck and shoulder pain was found in the transition from technical school to working life, and both work-related and individual factors were associated with pain development.

Clinimetric testing supports the use of 5 questionnaires adapted into Brazilian Portuguese for patients with shoulder disorders.

STUDY DESIGN: Clinical measurement. OBJECTIVES: To cross-culturally adapt the Shoulder Pain and Disability Index (SPADI) into Brazilian Portuguese and to test the measurement properties of the Brazilian Portuguese versions of the SPADI, the short form of the Disabilities of the Arm, Shoulder and Hand, the Patient-Specific Functional Scale, a numeric pain rating scale, and the Global Perceived Effect scale in patients with shoulder disorders. BACKGROUND: Most instruments for shoulder disorders were developed in English. For their use in Brazil, translation into Brazilian Portuguese, cross-cultural adaptation, and testing of measurement properties of these instruments are required. METHODS: The SPADI was translated and cross-culturally adapted according to current guidelines. Measurement properties of internal consistency, reproducibility, construct validity, ceiling and floor effects, and responsiveness of all instruments were tested in 100 patients with shoulder disorders. The patients filled out the questionnaires on 3 occasions: at baseline, 24 to 48 hours after baseline, and 4 weeks after baseline. RESULTS: The instruments showed adequate internal consistency (Cronbach alpha between .78 and .93) and a good level of agreement, as reflected by low standard errors of measurement and minimal detectable change. The reliability (intraclass correlation coefficients) of the instruments varied from 0.82 to 0.96. Most instruments presented good levels of construct validity. All instruments showed acceptable levels of internal and external responsiveness. CONCLUSION: The Portuguese Brazilian versions of the SPADI; the short form of the Disabilities of the Arm, Shoulder and Hand; a numeric pain rating scale; the Patient-Specific Functional Scale; and the Global Perceived Effect scale are reproducible, valid, and responsive instruments for assessing patients with shoulder disorders.

Typology of chronic pain among overweight Mexican Americans.

Having a better understanding of the intersection between chronic pain and obesity in the Mexican American community can be valuable for pain management specialists in determining treatment, service, and prevention strategies. The objectives of this study were (1) to describe the type and severity of chronic pain among overweight/obese Hispanic adults aged 40 years and older, and (2) to determine the association between chronic pain indices and key demographic variables, including excessive weight. Hispanic adults (N=101) were interviewed using validated questionnaires and measured for BMI and waist circumference. Data analyses revealed that most participants had widespread pain; 60% were suffering severe pain (including back, knee, and shoulder pain); the most common pain location was head (headache, 80%), followed by knee and upper back (75-76%), shoulder (73%) and lower back (73%). Greater obesity was associated with some negative pain outcomes. Results are relevant for pain management with this at-risk population.

Musculoskeletal morbidity: the growing burden of shoulder pain and disability and poor quality of life in diabetic outpatients.

OBJECTIVE: To investigate shoulder pain and disability and quality of life (QoL) over 12 months in patients with diabetes and in a non-diabetic control group. METHODS: Cross-sectional study with 12-month follow-up in diabetic (n=189) and medical (n=99) outpatients employing the Shoulder Pain and Disability Index (SPADI) and SF-36 version 2. The results were analysed using restricted maximum likelihood (REML). RESULTS: The prevalence of current shoulder symptoms was 35% in diabetics and 17% in controls. Shoulder pain and disability as calculated by the SPADI were independently associated with diabetes (vs controls) and current shoulder symptoms, and worsened over 12 months. Disability scores worsened with age in diabetics, and pain scores were higher in diabetics than controls among patients reporting current shoulder symptoms. Poor physical QoL worsened over time in patients with diabetes and was worse in patients with current shoulder symptoms, whether they had diabetes or not. Mental QoL was worse only in patients with current shoulder symptoms. CONCLUSION: Shoulder symptoms are common, affecting 1 in every 3 diabetic patients and 1 in every 6 control patients. In this study shoulder pain, disability and physical QoL were poorer among diabetics and patients reporting current shoulder symptoms, and worsened over time. Mental QoL was worse in patients reporting current shoulder symptoms and was independent of diabetes. Therefore, shoulder symptoms are common, are associated with poor physical and mental QoL in addition to shoulder pain and disability, and are worse in patients with diabetes, even in a population with relatively moderate shoulder pain and disability.