SHOULDER ANALYSIS OF PRACTICE RESEARCH PROJECT REGIS UNIVERSITY DOCTOR OF PHYSICAL THERAPY PROGRAM Jason Chi, Bryce Crenshaw, Paul Killoren, Andy Kittleson, Elizabeth Ostrand, Austin Woods, Martina Young Faculty Advisor: Mike Keirns

Shoulder Practice The shoulder is a complex joint It has varied interactions with different pathologies making diagnosis difficult Treatment strategies are diverse Strong outcome measures exist to evaluate shoulder differential diagnosis and best practice However there is a lack of consistency from healthcare providers

Shoulder Analysis of Practice Goals: Evaluate clinical practice patterns Compound the best evidence for outcomes in post operative shoulder surgeries.

Data Collection Process 1 page form for each patient –No patient identification data collected 3 sections of data form: –Demographics/Comorbidities –Examination information –Interventions applied

Post- Operative Data Collection Form

Demographics Section Sex Age Involved shoulder Dominant arm Surgery ( Rotator Cuff, Labral Repair, Instability, Slap) Date of injury Date of surgery Other symptoms Comorbidities Medications Additional information (Scar healing, Sling, Protocol used)

Interventions

Outcome Measures

Elevation AROM Standing Active elevation in the scapular plane Thumb facing ceiling Measured using a goniometer

ER 90 Deg ABD PROM (Post-Op Only) Supine Measure External Rotation at 90 degrees of Abduction

Hand to Neck Patient is standing Shoulder abducted to 90 degrees Elbow flexed maximally

Hand to Scapula Shoulder internally rotated Elbow flexed greater than 90 degrees Dorsal surface of hand to contralateral scapula

Hand to Opposite Scapula Shoulder flexed to 90 degrees and horizontally adducted Flex elbow greater than 90 degrees Hand to contralateral spine of scapula

IR AROM Patient slides back of hand up the spine as far as possible Measured by level reached –“Unable” - pt unable to reach to buttock –“Buttock” - pt can place hand on buttock –“L-spine” - pt can reach lumbar spine –“T-spine” - pt can reach thoracic region but not as high as on the opposite side –“Full” - motion is symmetrical on both sides

Resistive External Rotation Standing Resist ER with elbow bent to 90 degrees and shoulder in 0 degrees of flexion and abduction –“Unable” - pt cannot hold position –“Diminished” - pt cannot resist as much force as in the opposite arm –“Normal” - pt can resist same amount of force as on opposite arm

NPRS (0-10) Patient is asked to rate worst pain experienced over previous 24 hours 0 (no pain) to 10 (worst pain imaginable)

QuickDASH Abbreviated form of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire 11 questions about ability to perform functional activities EVERY QUESTION MUST BE ANSWERED! If the activity has not been recently performed, make best estimate of an accurate response Does not matter which arm is used to perform the task, answer based on ability regardless of how task is performed

QuickDASH Scoring

GROC Patient is asked to fill out global rating scale Overall condition should be rated from first treatment to current time Any rating lower than than somewhat worse requires comment from the therapist

GROC Form Date: Rate overall condition of shoulder A very great deal worse A great deal worse Quite a bit worse Moderately worse Somewhat worse A little bit worse A tiny bit worse (almost the same) About the same A very great deal better A great deal better Quite a bit better Moderately better Somewhat better A little bit better A tiny bit better (almost the same) Any rating lower than somewhat worse requires comment from therapist

Additional Info

How the process works… Project members available to answer any questions. For assistance Mike Complete the data form for a patient –Fax to Mike Clinicians who submit at least one form will receive a summary of the data collected for the project