Elsevier

Manual Therapy

Volume 15, Issue 6, December 2010, Pages 547-551
Manual Therapy

Original article
Scapular kinematics and impairment features for classifying patients with subacromial impingement syndrome

https://doi.org/10.1016/j.math.2010.06.003Get rights and content

Abstract

Subacromial impingement syndrome (SAIS), which is associated with pain and a loss of function, has a high occurrence in the physically active population. Not all patients respond positively to treatment. Classifying patients can improve decision-making. The scapular kinematic and clinical impairments can aid in classifying the patients who are more likely to respond to physical therapy treatment. Thirty-three subjects (males, 20–33 years) presenting SAIS were studied to determine altered scapular kinematics and clinical impairments. Three measurements were collected: (1) three-dimensional scapular kinematics during performing functional tasks; (2) impairment outcomes of range of motion and muscle force; and (3) self-reported measurements of pain, satisfaction, and function. All patients received 6-week (2 times per week) physical therapy treatment. Improvement with treatment was determined using the Global Rating of Change Scale. Scapular kinematics and clinical impairments were first identified by t-test in predicting improvement and then combined into a multivariate prediction method. A prediction method with three variables (Flexilevel Scale of Shoulder Function score < 41, muscle power of serratus anterior < 27.4% body weight, degree of scapular internal rotation at 30° shoulder elevation during descending arm phase in unloaded condition < 0.7°) were identified. It appears that scapular kinematics and impairment features can be used to classify subjects with SAIS in addition to self-report. Prospective validation of the proposed prediction method requires further investigation.

Section snippets

Design and subjects

This was a repeated-measures design and a predictive validity/diagnostic test study, with outcome measurements being taken before and after a 6-week physical therapy treatment. No control group was incorporated into this study. This study recruited 58 patients with SAIS from the orthopedics clinic in National Taiwan University Hospital and also through general announcements in local Internet media. After screening of the patients with the tests (criteria), 33 subjects met the criteria for the

Results

Of the 33 subjects recruited in this study, 32 patients completed the 6-week treatment. Subjects reported compliance rates of over 80% (sessions of actual treatment/sessions of proposed treatment). The final data were based on 33 subjects. In the case of the dropout, the sequence of variables was regarded as constant. After treatment, 23 subjects (69.7%) were classified as showing improvement and 10 (30.3%) as showing non-improvement (Table 2). The mean improvement in FLEX-SF scores in the

Discussion

In this study, we were primarily interested in classifying patients for improving clinical decision-making. Similar to previous studies (McClure et al., 2004, Walther et al., 2004), we were able to show adequate effects of 6 weeks of treatment in some of our patients. Additionally, our results support the classification in patients with SAIS. Less internal rotation of the scapula (0.7°), inadequate serratus anterior muscle force (27.4% body weight), and functional disability (FLEX-SF score < 41)

Conclusion

This investigation supports the assertion that classifying patients for improved clinical decision-making is possible. Based on the prediction method we found a subject with SAIS who meets 3 criteria (FLEX-SF score < 41, muscle force of serratus anterior < 27.4% body weight, degree of scapular internal rotation at 30° shoulder elevation < 0.7 degree) at baseline has a probability of 100% of demonstrating improvement at 6-week follow-up. Self-reported functional status and muscle force of the serratus

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    This study was funded by the National Science Council, Taiwan (NSC 97-2314-B-002-006-MY3).

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