The purpose of the this survey study was twofold: 1) to examine different aspects of satisfaction with post-operative care in injured workers who have undergone rotator cuff surgery and 2) to examine the relationship between receiving a newly implemented summary report and the overall satisfaction with surgery and recovery.

The clinical communication summary report was given to injured workers following their review assessment to share with the family doctor or other health care providers. The form indicated a need for further assessments or investigations and return to work recommendations. The study involved using a satisfaction survey that examined different aspects of follow-up visit and workers’ opinion about their understanding of the nature of surgery, their progress, clinical management, and usefulness of the newly implemented summery report.

Eighty patients completed the questionnaire (mean age: 54 (8), 62(78%) males, of whom 26 (34%) had a rotator cuff decompression and 31 (40%) had a rotator cuff repair with 20 (26%) having both procedures and three missing data. There were no statistically significant relationships between the patient demographics (age, sex or type of surgery) and satisfaction. However, there was a significant correlation between how patients perceived the summary report in terms of helpfulness and the overall satisfaction with surgery (FTE<0.0004, p=0.001) and the satisfaction with recovery (FTE<0.0001, p=0.001). This may indicate that improvement in worker's understanding of their treatment recommendations and restrictions is associated with higher levels of overall satisfaction in this population.

Our results indicate a positive linear relationship between expressing a high satisfaction and the helpfulness of the summary report. As part of improving care, adding a summary report may facilitate sharing information with the injured workers, their care providers and their workplace.

Virtual physiotherapy has been provided to hundreds of patients at the Holland Centre during the COVID pandemic. As we plan for virtual care to be one part of our care delivery we want to evaluate it and ensure the care delivery is safe and effective.

The objectives of this project was two-fold: 1) to examine the outcome of virtual physiotherapy and/ or a hybrid of virtual and in-person care in patients who received post-operative treatment following total knee replacement at the Holland Centre, 2) to explore the challenges of virtual care participation in the joint replacement population.

Patients who received either virtual care or a combination of in-person and virtual care (hybrid model) based on the patients’ needs were included. Patient-related outcomes were the Patient Specific Functional Scale (PSFS) and pain scale. Flexion and extension range of motion were measured before and after treatment. A modified Primary Care Patient Experience Virtual Care Survey was used to examine barriers for virtual care.

Sixty patients, mean age 68(8), ranging between 45-83 years, 34(57%) females, who received either virtual care or a combination of in-person and virtual care based on the patients’ needs were included. Patients showed improvement in the PSFS and pain scores (p<0.0001). Flexion (p<0.0001) and extension (p=0.02) improved at a statistically significant level. A separate sample (N=54) (age range 50-85 years) completed the patient experience survey.

A well-designed post-operative virtual physiotherapy program, initially implemented to maintain continuity of care during the pandemic, continues to be an important part of our model of care as we normalize our activities. Clear understanding of barriers to virtual care and mitigation strategies will help us create virtual care standards, meet our patient needs, optimize our care delivery and potentially increase the use of virtual rehab in the future.

The Severity Scoring System (SSS) is a guide to interpreting findings across clinical, functional, and radiological findings, used by qualified, specially trained physiotherapists in the advanced practice role in order to provide consistency in determining the severity of the patient's condition and need for surgical consultation. The system has been utilized for over 14 years as a part of standardized assessment and management care and was incorporated into virtual care in 2020 following the pandemic restrictions. The present study examined the validity of the modified SSS in virtual care.

Patients who were referred to the Rapid Access Clinic (RAC), were contacted via phone by two experienced advanced practice practitioners (APPs) from May to July 2020, when in-person care was halted due to the pandemic. The virtual interview included taking history, completing self-reported measures for pain and functional ability and reviewing the radiological reports.

A total of 63 patients were interviewed (mean age 68, SD=9), 34 (54%) females. Of 63 patients, 33 (52%) were considered a candidate for total knee arthroplasty (TKA). Men and women were comparable in age, P4 and LEFS scores. The TKA candidates had a significantly higher SSS (p<0.0001) and pain scores (p=0.024). The variability of the total SSS score explained by the functional, clinical and radiological components of the tool were 55%, 48% and 4% respectively, highlighting the more important role of patient's clinical history and disability in the total SSS.

The virtual SSS is a valid tool in directing patients for surgical management when used by highly trained advanced practice physiotherapists. A large component of the SSS is based on clinical data and patient disability and the APP's skillset rather than severity of pathology found on imaging.

The primary purpose of this longitudinal study was to examine the impact of physical and mental well-being on a successful return to work after cartilage or ligament knee injury. A secondary purpose was to examine the effectiveness of our program regarding ordering imaging (plain X-rays, US, MRI, CT scan), and the impact that costly investigations made in clinical management.

Workers who had sustained a work-related knee injury and were assessed at the lower extremity specialty clinic of our hospital program were followed up until they were discharged. All patients completed the numeric pain rating scale (NPRS), the Lower Extremity Functional Scale (LEFS), and the Hospital Anxiety and Depression Scale (HADS) on the initial assessment and at final follow-up.

We included 30 patients, mean age, 50(9), 11(37%) females, 19(63%) males. The most common mechanisms of injury were twisting (13, 45%) and falls (12, 41%). The knee injuries included 10 anterior collateral ligament (ACL), 3 posterior collateral ligament (PCL), 19 medical and lateral ligament injuries, and 22 meniscus injuries with some injuries overlapping. Ten patients (30%) underwent surgery (8 meniscectomy, two ligamentous repairs).

Patients showed improvement in pain scores (p<0.0001) and the LEFS scores (p=0.004). Seventeen patients (57%) returned to full-time work and 11 (37%) were not working at the time of discharge with one patient performing part-time work, and one on re-training. Higher levels of pre (p=0.02) and post-treatment (p=0.03) depression and post-treatment anxiety (p=0.02) had a negative impact on a successful return to work. Most clients had proper investigations ordered by their family physicians in the community (24 plain x-rays, 11 US, and 21 MRI). Our team ordered only 6 plain x-rays and 6 new MRI.

We found significant improvement in pain and disability in injured workers who received an expedited multidisciplinary care. Anxiety and depression were the most important predictors of poorer recovery and a less successful work status. The judicious use of costly imaging is expected to reduce the overall health care cost of an injury, while providing new important information such as adding a new diagnosis or changing the management.

Physiotherapy is a critical element in successful conservative management of low back pain (LBP). The aim of this study was to develop and evaluate a system with wearable inertial sensors to objectively detect sitting postures and performance of unsupervised exercises containing movement in multiple planes (flexion, extension, rotation).

A set of 8 inertial sensors were placed on 19 healthy adult subjects. Data was acquired as they performed 7 McKenzie low-back exercises and 3 sitting posture positions. This data was used to train two models (Random Forest (RF) and XGBoost (XGB)) using engineered time series features. In addition, a convolutional neural network (CNN) was trained directly on the time series data. A feature importance analysis was performed to identify sensor locations and channels that contributed most to the models. Finally, a subset of sensor locations and channels was included in a hyperparameter grid search to identify the optimal sensor configuration and the best performing algorithm(s) for exercise classification. Models were evaluated using F1-score in a 10-fold cross validation approach.

The optimal hardware configuration was identified as a 3-sensor setup using lower back, left thigh, and right ankle sensors with acceleration, gyroscope, and magnetometer channels. The XBG model achieved the highest exercise (F1=0.94±0.03) and posture (F1=0.90±0.11) classification scores. The CNN achieved similar results with the same sensor locations, using only the accelerometer and gyroscope channels for exercise classification (F1=0.94±0.02) and the accelerometer channel alone for posture classification (F1=0.91±0.03).

This study demonstrates the potential of a 3-sensor lower body wearable solution (e.g. smart pants) that can identify proper sitting postures and exercises in multiple planes, suitable for low back pain. This technology has the potential to improve the effectiveness of LBP rehabilitation by facilitating quantitative feedback, early problem diagnosis, and possible remote monitoring.

Summary

Data of 663 patients with three different pathologies were examined. We found that using patients with significant symptoms and functional difficulty in the opposite shoulder will not bias the results of observational studies if outcomes are based on routine disability measures such as ASES or Constant-Murley scores.

Summary

Analysis of existing data of patients who had undergone debridement procedure for osteoarthritis (OA) of glenohumeral joint showed improvement in disability at a minimum of one year following surgery. Injured workers were significantly younger and had a poorer outcome.

Summary

In the sample studied, reparability of large and massive tears was associated with pre-op ASES and active external rotation in neutral position. Surgical factors affecting reparability were tear size, tendon mobility and shape of the tear.

Summary

In the sample studied, reparability of large and massive tears was associated with pre-op ASES and active external rotation in neutral position. Surgical factors affecting reparability were tear size, tendon mobility and shape of the tear.

Purpose

There is minimal information on outcome of glenohumeral debridement for treatment of shoulder osteoarthritis (OA). The purpose of this study was to examine the outcome of this procedure with or without acromioplasty /resection of clavicle in subjective perception of disability and functional range of motion and strength at one year following surgery.

Purpose

The introduction of alternate care provider roles is at the forefront of many new health human resource strategies and is one of the key approaches in reducing orthopaedic wait times in Canada. The present study was part of a formal evaluation of an expanded role for physiotherapists which included referral triage, comprehensive assessment and development of a management plan and post-surgical follow-ups. Specifically, we examined the efficacy and role of an Advanced Practice Physiotherapist (APP) with respect to reduction in wait times to care for patients with shoulder complaints referred to an orthopaedic surgeon with subspecialty in shoulder reconstruction.

Purpose: The purpose of this study was to examine the measurement properties of four commonly used disability measures. We hypothesized that all measures would have a high (0.8 or > 0.8) internal consistency and ability to discriminate between men and women’s level of disability. A moderate convergent validity (0.5 to 1.00).

Method: This was a prospective longitudinal study of patients with advanced primary osteoarthritis of glenohumeral joint who underwent a Total Shoulder Arthroplasty (TSA). Four measures [Western Ontario Osteoarthritis Shoulder (WOOS) Index, the American Shoulder and Elbow Surgeon’s (ASES) assessment, Constant-Murley Score (CMS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH)] were completed 2–3 weeks before surgery and at 6 months after surgery. The measurement properties were examined in:

internal consistency as a measure of reliability,

Analysis involved calculating Cronbach Coefficient Alpha to measure internal consistency. Convergent validity was examined by the Pearson correlation coefficient. Analysis of Variance examined the extent of known group validity. The Standardized Response Mean (SRM) was used to measure the relative sensitivity to change.

Results: Seventy patients (mean age: 65, range: 35–86, 44 females, 26 males) participated in the study. The Cronbach Coefficient Alpha was high at 0.91, 0.86, and 0.83 for WOOS, ASES, and QuickDASH respectively. Cross-sectional convergent validity was moderate with correlations varying from 0.54 to 0.79. Longitudinal convergent validity ranged from 0.58 to 0.88. All measures were able to discriminate between men and women at p< 0.05 with Cohen’s d of 1.07, 0.85, 0.82, and 0.55 for QuickDASH, CMS, WOOS, and ASES respectively. The SRM was 2.41, 2.17, 1.88, and 1.63 for WOOS, CMS, ASES and QuickDASH respectively.

Conclusion: All four disability measures were valid and reliable in candidates for TSA. The WOOS, a disease-specific outcome demonstrated a higher reliability and sensitivity to change than other measures. QuickDASH had a better ability to differentiate between men and women. Clinicians may not gain additional information by administrating multiple similar outcome measures. Researchers will decrease their chance of declaring a statistical significance by choosing one primary outcome measure.

Purpose: The purpose of this study was to investigate the difference in the level of pre and 6 months post operative objective and subjective measures of disability between patients with full-thickness rotator cuff tears and those with impingement syndrome/partial thickness rotator cuff tears.

Method: This study involved a review of prospectively collected data from a consecutive series of patients who had undergone surgery related to rotator cuff pathology (acromioplasty with or without resection of clavicle for impingement syndrome/partial thickness rotator cuff tears or repair for full-thickness rotator cuff tears). Exclusion criteria included previous surgery, concomitant pathologies, and work-related injuries with an active compensation claim related to the shoulder. Standardized pre and post-operative data (history and clinical examination, including strength assessment) were collected. To measure symptoms and functional levels, all patients completed a disease-specific outcome measure, the Western Ontario Rotator Cuff (WORC) Index which explores five domains of physical symptoms, life style, work, sports, and emotions. Paired and independent non-parametric (Wilcoxon two sample tests, and Wilcoxon signed rank tests) statistics were used where normality of data were violated.

Results: Three hundred and five patients (130 women and 175 men) with a mean age of 58 years (range, 21–82) met inclusion criteria. One hundred and ninety eight (65%) patients had full-thickness rotator cuff tears and 107(35%) had impingement [59 (55%)] or partial thickness rotator cuff tears [48 (45%)]. Patients with full-thickness tears complained of greater weakness, had a higher prevalence of a specific injury such as fall on an outstretched hand, and reported a higher frequency of insidious onset of pain. The full-thickness tear group was significantly weaker in elevation both pre and post-operatively. Patients with impingement syndrome expressed more severe symptoms and more emotional disability prior to surgery and had more physical disability related to lifting and performing activities of daily living and more emotional disability 6 months after surgery. Both groups showed a statistically significant improvement in overall pain, WORC score, and strength 6 months following surgery.

Conclusion: Our results indicate that the extent of rotator cuff pathology and level of physical and emotional disability do not necessarily correlate positively in the early phase of recovery. Patients with less severe rotator cuff pathology tend to be more disabled both before and after surgery. This needs to be considered when planning for return to work and other activities and when assessing treatment outcomes.

Purpose: The purposes of this study were to examine factors that influenced the decision to repair a SLAP Type II lesion and to examine the difference between patients with and without a SLAP repair.

Method: Prospectively collected data of patients who had a SLAP Type II lesion were reviewed. Patients who had a repair were compared with those who did not have a clinical indication for repair. Disability outcome measures collected pre and 2 years post-operatively were the American Shoulder and Elbow Surgeons (ASES) and the Constant-Murley scores (CMS). Paired and independent t-tests and logistic regression were performed.

Results: One hundred and six patients (83 males, 23 females), mean age=50 (SD=14, range 18–81), with a SLAP Type II lesion were identified. Eleven patients (10%) had isolated SLAP pathology for which they received a repair. The remaining 95 (90%) patients had concurrent pathologies related to rotator cuff, instability, osteoarthritis, and other pathologies. Repair of the SLAP lesion was felt to be clinically indicated in 43(45%) of patients with combined lesions. Factors that influenced the decision to repair the SLAP lesion were age, nature of the associated pathology, the presence of a large or massive full thickness rotator cuff tear, anterior instability, and a partial biceps tear greater than 50% that required a tenodesis. Significant improvement was observed in the ASES and CMS scores (p < 0.0001) whether or not a SLAP repair was performed.

Conclusion: This study indicates that age and presence of certain associated pathologies influence the need for SLAP Type II repair. A statistically significant improvement in strength and disability level is observed in patients with SLAP Type II lesions associated with concomitant pathology, despite not having the SLAP lesion repaired. The indications for SLAP Type II repair in the presence of other pathologies are discussed.

Purpose: The purpose of this matched cohort study was to examine the clinical outcome of biceps tendon debridement at two years following surgery.

Method: The study group included patients who had undergone debridement of a tear of less than or equal to 50% of the biceps tendon. The control group did not have biceps pathology and was chosen from the same pool of data and was matched with the study group by sex, age and type of associated pathology. Standardized pre and post operative data on history and clinical examination of all patients had been collected prospectively. The outcome measures were the American Shoulder and Elbow Surgeons (ASES) assessment form, the relative Constant-Murley score (CMS), and the Western Ontario Rotator Cuff (WORC) Index. Paired and independent T-tests were performed.

Results: Review of data identified 122 patients (16 females, 45 males in each group). The mean age was 59 (SD: 11) and 57 (SD: 12) for the study and control groups respectively. Fifty six percent of the subjects in each group (34/61) had impingement or partial thickness rotator cuff tears treated with a decompression (acromioplasty/ decompression). Twenty two patients (36%) had rotator cuff repair, and 5 (8%) had a SLAP repair. A statistically significant improvement was observed in the scores of WORC, ASES and CMS (p< 0.0001) in both groups. The magnitude of change, based on the effect size showed a large change in both groups. There was no statistically significant difference in pre and post-operative scores or recovery between groups.

Conclusion: Low grade tears of the biceps tendon do not appear to produce more disability prior to surgical treatment and are effectively treated with biceps debridement in addition to surgical treatment of associated pathologies.

Purpose: There is controversial information on recovery of patients with compensable injuries. The purpose of this matched case-control study was to examine the impact of an active compensation claim following a work-related shoulder injury on reporting disability as measured by subjective and objective outcomes at 1 year post-operatively.

Method: Data of 506 consecutive patients who had undergone a decompression or rotator cuff repair were reviewed. One hundred and fourteen patients were on compensation related to their shoulder problems. Patients were matched with a historical control group (patients without a compensation claim) based on age (4 age groups: < 40, 40–49, 50–59, 60–70), sex, and pathology (full-thickness tear vs. no tear). Outcome measures used were a disease-specific outcome, the Western Ontario Rotator Cuff Index (WORC) and two shoulder specific instruments, the American Shoulder and Elbow Score (ASES) and the Constant Murley (CM) score. Paired and independent t-tests and an analysis of covariance were performed.

Results: Data of the 214 patients (72 males and 35 females in each group) was used for analysis (mean age 48, SD: 10, range 20–69). Out of 107 patients in each group, 42 patients (58%) had undergone a full-thickness repair and 65 (61%) had surgeries related to impingement syndrome. Paired and independent t-tests showed that both groups improved significantly regardless of their claim status. However, the compensation group had a significantly lower level of improvement than the non-compensation group. An analysis of covariance which adjusted for pre-operative differences in disability scores showed that an active claim was indeed a strong predictor of follow up scores.

Conclusion: This is the first study that has used a matched case-control design to control for potential confounding factors in injured worker population. Our results indicate that although patients with work-related injuries demonstrate a lower level of recovery, they still benefit from surgery.

There is an association between SLAP lesions and laxity of the shoulder. The relationship between rotator cuff disease and hypermobility has also been implied. The purpose of this case-control study was to assess the impact of rotator cuff and superior labral pathologies on degree of glenohumeral translation and range of motion of the shoulder in comparison with individuals with normal shoulders.

This study involved individuals with asymptomatic shoulders (control group), and individuals with Rotator Cuff (RC) and Superior Labral Anterior and Posterior (SLAP) pathologies who underwent a repair. Subjects were matched by age, gender and hand dominance side. To assess laxity, all subjects including the control group were examined under anesthesia. The degree of humeral head translation was recorded in three (anterior, posterior and inferior) directions. Range of motion was documented in five directions.

Forty-six females and forty-four males with RC pathology and twenty-seven men with SLAP pathology were compared with the age and gender matched control group. The number of women with SLAP pathology was not sufficient for analysis. Rotator cuff pathology reduced range of motion of the affected side in all directions including flexion, elevation in scapular plane, internal rotation at ninety degrees of abduction and external rotation at zero and ninety degrees of abduction (p=0.02 to p< 0.001) as compared to normal population. Men with SLAP pathology had reduced range of motion in all directions (p< 0.001) except external rotation at ninety degrees of abduction. There were no statistically significant differences in glenohumeral glides between the normal group and SLAP group. However, the affected side of the patients with RC pathology had less laxity than normal population in anterior and posterior directions.

Presence of rotator cuff and superior labral pathologies affect biomechanics and consequently range of motion and accessory movements of the glenohumeral joint. We were unable to confirm a positive relationship between laxity and SLAP and RC pathologies. Prolonged disuse of the shoulder in these pathologies might have played a role in our findings.

Type II SLAP lesions account for 22–55% of all SLAP lesions and are described as detachment of the superior labrum along with the biceps anchor from the superior glenoid rim. This detachment may be associated with glenohumeral joint instability. The majority of SLAP lesions are associated with other pathologies such as rotator cuff tears, Bankart and other instability lesions. The purpose of this study was to evaluate the effectiveness of arthroscopic repair of type II SLAP lesions, two years following arthroscopic repair with suture anchors.

Data on thirty-eight consecutive patients (thirty-four males, four females, mean age: forty-five years, range, twenty-two to seventy years) were used for analysis. Outcome measures were the American Shoulder and Elbow Surgeons (ASES) assessment form and the Constant-Murley score. Thirteen patients had work-related injuries. Specific tests for SLAP lesion (i.e. New pain provocation test, O’Brien test, Yergason’s Test) were conducted pre-operatively.

Twenty-three patients had surgery on the right side. The O’Brien test was positive in 51% of the patients. The minimum follow up period was twenty-four months. Five patients had isolated SLAP type II lesion. Thirty-three had associated pathologies. Ten patients had rotator cuff repair. Twelve patients required acromioplasty and one patient underwent the long head of biceps tenodesis. Three patients had associated Bankart lesions. All patients showed significant improvement in ASES scores (p< 0.0001). However, Patients with work-related injuries did not show a significant improvement in Constant-Murley scores (p=0.20). Associated pathologies did not affect level of disability or subjective scores post-operatively. Strength did not change to a statistically significant level following SLAP repairs.

Arthroscopic SLAP repair provides significant improvement in subjective scores of the ASES. Patients with work-related injuries demonstrate a different pattern of recovery.

The purpose of this historical prospective study was to compare the pre and post-operative Quality of Life (QOL) outcomes twelve months post-operatively in patients with partial thickness rotator cuff tears.

Data of ninety-three consecutive patients diagnosed with Partial Thickness Tear (PTT) who had undergone decompression, acromioplasty, or repair were used to compare the outcome between patients with Articular Tears (AT) and Bursal Tears (BT). The QOL outcome measures included one disease specific outcome measure, the Western Ontario Rotator Cuff Index (WORC) and two shoulder specific measures, the American Shoulder & Elbow Surgeons standardised shoulder assessment form (ASES) and the Constant-Murley score. A statistical paired t-test (pre vs. twelve months) and an independent t-test analysis (Articular vs. Bursal) were conducted to examine the impact of the tear site.

Forty-four Articular and forty-nine Bursal tears (forty-eight females and forty-five males) were included in the analysis. The mean age was 55.5 (SD: 13) and 53.3 (SD: 12) for the AT and BT groups respectively. There was no statistically significant difference between the two groups in pre-operative QOL outcome scores. Both groups showed significant improvement in the above outcomes (p< 0.0001) one year following surgery. However, the AT group was significantly less improved than the BT group in the post-op ASES scores (p=0.04), Constant-Murley scores (p=0.006) and WORC (p=0.01).

The intent of this study was to compare the pre and post operative scores and rate of improvement in two groups of patients suffering from rotator cuff pathology at different sites. The results indicate that the quality of life improves significantly regardless of the tear site. The pattern of recovery however is different indicating that patients with Bursal tears show a higher degree of improvement in their functional measures. The findings suggest that two types of tears are different in their etiology and pathomechanics.

Introduction: Type II SLAP lesion account for 22–55% of all SLAP lesions and described as detachment of the superior labrum along with the biceps anchor from the superior glenoid rim. This detachment leads to a significant Gleno Humeral Joint instability at the anterior-posterior and superior inferior directions. Majority of SLAP lesions are associated with rotator cuff tears, and partial or complete Bankart lesions.

Purpose: The purpose of this study was to evaluate the effectiveness of arthroscopic repair of type II SLAP lesions 2 years following arthroscopic repair with suture anchors.

Type of study: Prospective historical.

Methods: Data of consecutive thirty-eight patients (34 males, 4 females, mean age: 45 years, range, 22 to 70 years were used for analysis. Outcome measures were the ASES and Constant Murley. Thirteen patients had work-related injuries. Specific tests for SLAP lesion (i.e. New pain provocation test, O’Brien test, Yergason’s Test) were conducted pre-operatively.

Results: Twenty-three patients had surgery on the right side. The minimum follow up period was 24 months. Five patients had isolated SLAP II lesion repair. Thirty-three had associated pathologies. Ten patients had rotator cuff repair. Twelve patients required acromioplasty and 12 patients underwent the long head of biceps tenodesis. Three patients had associated Bankart lesions. ALL patients showed significant improvement in ASES scores (p< 0.0001). However, Patients with work-related injuries did not show a significant improvement in Constant scores (p=0.20). Pathology did not affect level of disability or subjective scores post-operatively. Strength did not change following SLAP repairs.

Conclusions: Arthroscopic SLAP repair provides significant improvement in subjective scores of joint-specific measures (ASES). Patients with work-related injuries demonstrate a different pattern of recovery.