Measurement properties of exsisting clinical assessment methods evaluating scapular positioning and function. A systematic review.

MEASUREMENT PROPERTIES OF EXISTING CLINICAL ASSESSMENT METHODS EVALUATING SCAPULAR POSITIONING AND FUNCTION. A SYSTEMATIC REVIEW1,2Camilla Marie Larsen, 1,3Birgit Juul-Kristensen, 1,3Hans Lund, 1Karen Søgaard1Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark2Department of Research and Innovation, University College Lillebaelt, Denmark3Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway

INTRODUCTION

From a biomechanical perspective, the scapula plays a key role in the shoulder and arm function as a stable base for optimal muscle activation both at rest and during functional tasks. There is evidence suggesting that scapular positioning are altered in patients with musculoskeletal shoulder disorders, e.g. in shoulder impingement syndrome and in patients with glenohumeral osteoarthritis [1,2]. Rehabilitation exercises are aiming at altering abnormal/asymmetric scapular positioning and/or function. Numerous assessment methods have measured the degree of scapular dyskinesis, subjectively by visual evaluation and objectively by measurements of static and dynamic scapular positioning, by either a 3-dimensional electromagnetic device [3] or 2-dimensional clinically applicable methods [4]. Since advanced equipment (i.e. 3D motion analysis) is rarely available in the clinic, the clinician needs applicable assessment tools to characterise scapular alterations. The aims were to compile a schematic overview of the available clinical scapular assessment methods and critically appraise the methodological quality of the involved studies.

METHODS

A systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October 2013. Reference lists in articles were also screened for publications. The overall method used in this review can be divided into four steps: 1) Compile an exhaustive list of scapular assessment methods on the basis of an initial search; 2) Additionally search for studies including clinimetric outcome measures of the identified assessment methods; 3) Critically appraise the methodological quality of the identified measurement properties in each study; and 4) Identify the assessment methods with acceptable results in the domains of validity and reliability as well as responsiveness, from studies which best meet the standards for acceptable methodological quality. Furthermore, the review sought to recommend clinical scapular assessment methods on the basis of acceptable results in the domains of validity and reliability as a minimum.

RESULTS AND DISCUSSION

From 50 articles, 54 method names were identified and categorised into three groups: Static positioning assessment (n=19), Semi-dynamic (n=13), and Dynamic functional assessment (n=22). Fifteen studies were excluded for evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist), the methodological quality in the reliability and validity domains was ‘fair’ (57%) to ‘poor’ (43%), with only one study rated as ‘good’. The reliability domain was most often investigated. Fewof the assessment methods in the included studies that had ‘fair’ or ‘good’ measurement properties demonstrated acceptable results for both reliability and validity.CONCLUSIONSWe found a substantially larger number of clinical scapular assessment methods than previously reported and the methodological quality of the included measurement properties in the reliability and validity domains were in general ‘fair’ to ‘poor’. None were examined for all three domains: reliability, validity and responsiveness. Clinically applicable assessment methods of visual observation and inclinometer measurement of scapular rotation for evaluation of scapular kinematics seem suitably evidence-based for clinical use. Future studies should test and improve the clinimetric properties of clinical assessment methods, especially also the diagnostic accuracy and responsiveness, to increase utility in clinical practice.

REFERENCES

1.Fayad F, et al. Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder. Journal of biomechanics, 41:326-332, 2008.2.Ludewig PM & Reynolds JF. The Association of Scapular Kinematics and Glenohumeral Joint Pathologies. Journal of orthopaedic & sports physical therapy, 39(2):91-104, 2009.3.Shaheen AF, et al., Scapular taping alters kinematics in asymptomatic subjects. Journal of Electromyography and Kinesiology, 23:326-33, 20134.Johnson MP, et al. New Method to Assess Scapular Upward Rotation in Subjects With Shoulder Pathology, Journal of Orthopaedic & Sports Physical Therapy,31(2):81-89, 2001.