A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial A combination of distribution- and anchor-based approaches determined minimally important differences (MIDs) for four endpoints in a breast cancer scale. The CSAW Study (Can Shoulder Arthroscopy Work?) – a placebo-controlled surgical intervention trial assessing the clinical and cost effectiveness of arthroscopic subacromial decompression for shoulder pain: study protocol for a randomised controlled trial Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial Responsiveness and Minimal Clinically Important Change: A Comparison Between 2 Shoulder Outcome Measures. Comparison of clinical and patient-based measures to assess medium-term outcomes following shoulder surgery for disorders of the rotator cuff. Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT): a protocol for a randomised trial comparing arthroscopic subacromial decompression and diagnostic arthroscopy (placebo control), with an exercise therapy control, in the treatment of shoulder impingement syndrome A specific exercise strategy reduced the need for surgery in subacromial pain patients Predictive value of preoperative clinical examination for subacromial decompression in impingement syndrome Radiofrequency-based plasma microtenotomy compared with arthroscopic subacromial decompression yields equivalent outcomes for rotator cuff tendinosis. Objective outcome evaluation using inertial sensors in subacromial impingement syndrome: a five-year follow-up study. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Is radiofrequency treatment effective for shoulder impingement syndrome? A prospective randomized controlled study. Arthroscopic subacromial decompression: results and factors affecting outcome. Clinical predictors of a positive response to guided diagnostic block into the subacromial bursa. Prospective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis.
Background Subacromial impingement syndrome ( SIS ) is the most frequently recorded shoulder disorder . When conservative treatment of SIS fails , a subacromial decompression is warranted . However , the best moment of referral for surgery is not well defined . Both early and late referrals have disadvantages – unnecessary operations and smaller improvements in shoulder function , respectively . This paper describes the design of a new interdisciplinary treatment strategy for SIS ( TRANSIT ) , which comprises rules to treat SIS in primary care and a well-defined moment of referral for surgery . Methods / Design The effectiveness of an arthroscopic subacromial decompression versus usual medical care will be evaluated in a r and omized controlled trial ( RCT ) . Patients are eligible for inclusion when experiencing a recurrence of SIS within one year after a first episode of SIS which was successfully treated with a subacromial corticosteroid injection . After inclusion they will receive injection treatment again by their general practitioner . When , after this treatment , there is a second recurrence within a year post-injection , the participants will be r and omized to either an arthroscopic subacromial decompression ( intervention group ) or continuation of usual medical care ( control group ) . The latter will be performed by a general practitioner according to the Dutch National Guidelines for Shoulder Problems . At inclusion , at r and omization and three , six and 12 months post-r and omization an outcome assessment will take place . The primary outcome measure is the patient-reported Shoulder Disability Question naire . The secondary outcome measures include both disease-specific and generic measures , and an economic evaluation . Treatment effects will be compared for all measurement points by using a GLM repeated measures analyses . Discussion The rationale and design of an RCT comparing arthroscopic subacromial decompression with usual medical care for subacromial impingement syndrome are presented . The results of this study will improve insight into the best moment of referral for surgery for SIS OBJECTIVE To determine distribution- and anchor-based minimal important difference ( MID ) estimates for four scores from the Functional Assessment of Cancer Therapy-Breast ( FACT-B ) : the breast cancer subscale ( BCS ) , Trial Outcome Index ( TOI ) , FACT-G ( the general version ) , and FACT-B. STUDY DESIGN AND SETTING We used data from a Phase III clinical trial in metastatic breast cancer ( ECOG study 1193 ; n=739 ) and a prospect i ve observational study of pain in metastatic breast cancer ( n=129 ) . One third and one half of the st and ard deviation and 1 st and ard error of measurement were used as distribution-based criteria . Clinical indicators used to determine anchor-based differences included ECOG performance status , current pain , and response to treatment . RESULTS FACT-B scores were responsive to performance status and pain anchors , but not to treatment response . By combining the results of distribution- and anchor-based methods , MID estimates were obtained : BCS=2 - 3 points , TOI=5 - 6 points , FACT-G=5 - 6 points , and FACT-B=7 - 8 points . CONCLUSION Distribution- and anchor-based estimates of the MID do show convergence . These estimates can be used in combination with other measures of efficacy to determine meaningful benefit and provide a basis for sample size estimation in clinical trials Background Arthroscopic subacromial decompression ( ASAD ) is a commonly performed surgical intervention for shoulder pain . The rationale is that removal of a bony acromial spur relieves symptoms by decompressing rotator cuff tendons passing through the subacromial space . However , the efficacy of this procedure is uncertain . The objective of this trial was to compare the efficacy and cost-effectiveness of ASAD in patients with subacromial pain using appropriate control groups , including placebo intervention . Methods / Design The trial is a three-group , parallel design , pragmatic , r and omised controlled study . The intervention content for each group ( ASAD , active monitoring with specialist re assessment ( AMSR ) and investigational shoulder arthroscopy only ( AO ) ) enables assessment of ( 1 ) the efficacy of the surgery against no surgery ; ( 2 ) the need for a specific component of the surgery — namely , removal of the bony spur ; and ( 3 ) quantification of the placebo effect . Concealed allocation was performed using a 1:1:1 r and omisation ratio and using age , sex , baseline Oxford Shoulder Score ( OSS ) and centre as minimisation criteria . The primary outcome measure is the OSS at 6 months post r and omisation .  A total of 300 patients recruited over 24 months from a minimum of 14 UK shoulder units over 24 months were required to detect a difference of 4.5 points on the OSS ( st and ard deviation , 9 ) with 90 % power and to allow for 15 % loss to follow-up . Secondary outcomes include cost-effectiveness , pain , complications and patient satisfaction . A substantial qualitative research component is included . The primary analysis will be conducted on the modified intention-to-treat analysis . Sensitivity analysis will be used to assess the robustness of the results with regard to the underlying assumptions about missing data using multiple imputation . Discussion This trial uses an innovative design to account for the known placebo effects of surgery , but it also will delineate the mechanism for any benefit from surgery . The investigational AO group is considered a placebo intervention ( not sham surgery ) , as it includes all components of subacromial decompression except the critical surgical element . Some discussion is also dedicated to the challenges of conducting placebo surgery trials . Trial registration sUK Clinical Research Network UKCRN12104 . Registered 22 May 2012.International St and ard R and omised Controlled Trial IS RCT N33864128 . Registered 22 June 2012 . Clinical Trials.gov NCT01623011 . Registered 15 June 2012 Summary Background Arthroscopic sub-acromial decompression ( decompressing the sub-acromial space by removing bone spurs and soft tissue arthroscopically ) is a common surgery for subacromial shoulder pain , but its effectiveness is uncertain . We did a study to assess its effectiveness and to investigate the mechanism for surgical decompression . Methods We did a multicentre , r and omised , pragmatic , parallel group , placebo-controlled , three-group trial at 32 hospitals in the UK with 51 surgeons . Participants were patients who had subacromial pain for at least 3 months with intact rotator cuff tendons , were eligible for arthroscopic surgery , and had previously completed a non-operative management programme that included exercise therapy and at least one steroid injection . Exclusion criteria included a full-thickness torn rotator cuff . We r and omly assigned participants ( 1:1:1 ) to arthroscopic subacromial decompression , investigational arthroscopy only , or no treatment ( attendance of one re assessment appointment with a specialist shoulder clinician 3 months after study entry , but no intervention ) . Arthroscopy only was a placebo as the essential surgical element ( bone and soft tissue removal ) was omitted . We did the r and omisation with a computer-generated minimisation system . In the surgical intervention groups , patients were not told which type of surgery they were receiving ( to ensure masking ) . Patients were followed up at 6 months and 1 year after r and omisation ; surgeons coordinated their waiting lists to schedule surgeries as close as possible to r and omisation . The primary outcome was the Oxford Shoulder Score ( 0 [ worst ] to 48 [ best ] ) at 6 months , analysed by intention to treat . The sample size calculation was based upon a target difference of 4·5 points ( SD 9·0 ) . This trial has been registered at Clinical Trials.gov , number NCT01623011 . Findings Between Sept 14 , 2012 , and June 16 , 2015 , we r and omly assigned 313 patients to treatment groups ( 106 to decompression surgery , 103 to arthroscopy only , and 104 to no treatment ) . 24 [ 23 % ] , 43 [ 42 % ] , and 12 [ 12 % ] of the decompression , arthroscopy only , and no treatment groups , respectively , did not receive their assigned treatment by 6 months . At 6 months , data for the Oxford Shoulder Score were available for 90 patients assigned to decompression , 94 to arthroscopy , and 90 to no treatment . Mean Oxford Shoulder Score did not differ between the two surgical groups at 6 months ( decompression mean 32·7 points [ SD 11·6 ] vs arthroscopy mean 34·2 points [ 9·2 ] ; mean difference −1·3 points ( 95 % CI −3·9 to 1·3 , p=0·3141 ) . Both surgical groups showed a small benefit over no treatment ( mean 29·4 points [ SD 11·9 ] , mean difference vs decompression 2·8 points [ 95 % CI 0·5–5·2 ] , p=0·0186 ; mean difference vs arthroscopy 4·2 [ 1·8–6·6 ] , p=0·0014 ) but these differences were not clinical ly important . There were six study -related complications that were all frozen shoulders ( in two patients in each group ) . Interpretation Surgical groups had better outcomes for shoulder pain and function compared with no treatment but this difference was not clinical ly important . Additionally , surgical decompression appeared to offer no extra benefit over arthroscopy only . The difference between the surgical groups and no treatment might be the result of , for instance , a placebo effect or postoperative physiotherapy . The findings question the value of this operation for these indications , and this should be communicated to patients during the shared treatment decision-making process . Funding Arthritis Research UK , the National Institute for Health Research Biomedical Research Centre , and the Royal College of Surgeons ( Engl and ) Study Design A prospect i ve cohort study nested in a r and omized controlled trial . Objectives To determine and compare responsiveness and minimal clinical ly important change of the  modified Constant score ( CS )  and the  Oxford Shoulder Score ( OSS ) .  Background The OSS and the CS are commonly used to assess shoulder outcomes . However , few studies have evaluated the measurement properties of the OSS and CS in terms of responsiveness and minimal clinical ly important change . Methods The study included 126 patients who reported having difficulty returning to usual activities 8 to 12 weeks after arthroscopic decompression surgery for subacromial impingement syndrome . The assessment at baseline and at 3 months included the  OSS , the CS  , and the  European Quality of Life-5 Dimensions-3 Level ( EQ-5D-3L ) index . Responsiveness was assessed as follows : by correlation analysis between the change scores of the OSS , CS , and EQ-5D-3L index , and the Patient Global Impression of Change ( PGIC ) scale ; by receiver-operating-characteristic ( ROC ) curve analysis using the PGIC scale as an external anchor ; and by effect-size statistics . Results At 3 months , a follow-up assessment of 112 patients ( 89 % ) was conducted . The change scores of the CS and the OSS were more strongly correlated with the external anchor ( PGIC scale ) than the change score of the EQ-5D-3L index . The areas under the ROC curves exceeded 0.80 for both shoulder scores , with no significant differences between them , and comparable effect-size estimates were observed for the CS and the OSS . Minimal clinical ly important change ROC values were 6 points for the OSS and 11 points for the CS , with upper 95 % cutoff limits of 12 and 22 points , respectively . Conclusion The CS and the OSS were both suitable for assessing improvement after decompression surgery OBJECTIVE To compare different assessment s following  shoulder surgery for impingement syndrome with or without rotator cuff tear or repair . METHODS A prospect i ve study of 93 patients was conducted . St and ard assessment s were performed before , at 6 months , and at 4 years following shoulder surgery using the patient-based Oxford Shoulder Score ( OSS ) , the Medical Outcomes Study Short Form-36 ( SF-36 ) question naire , and a surgeon-assessed Constant Shoulder Score . Patients were categorized according to the surgery received in relation to the presence of cuff tears : full repair , partial repair , cuff tear/no repair , no tear/no repair . RESULTS Most patients ( 57 % ) received subacromial decompression for impingement with no cuff tear . This group had the fewest pre- and postoperative symptoms . The category of patients who received only partial repair of a cuff tear had worse scores on all outcome assessment s compared with other groups . Patient-based measures were more stable over time than the Constant . CONCLUSION The shoulder-specific measures had greater sensitivity than the SF-36 in registering significant differences in outcomes between comparison groups at 6 months and 4 years Introduction Arthroscopic subacromial decompression ( ASD ) is the most commonly performed surgical intervention for shoulder pain , yet evidence on its efficacy is limited . The rationale for the surgery rests on the tenet that symptom relief is achieved through decompression of the rotator cuff tendon passage . The primary objective of this superiority trial is to compare the efficacy of ASD versus diagnostic arthroscopy ( DA ) in patients with shoulder impingement syndrome ( SIS ) , where DA differs only by the lack of subacromial decompression . A third group of supervised progressive exercise therapy ( ET ) will allow for pragmatic assessment of the relative benefits of surgical versus non-operative treatment strategies . Methods and Analysis Finnish Subacromial Impingement Arthroscopy Controlled Trial is an ongoing multicentre , three-group r and omised controlled study . We performed two-fold concealed allocation , first by r and omising patients to surgical ( ASD or DA ) or conservative ( ET ) treatment in 2:1 ratio and then those allocated to surgery further to ASD or DA in 1:1 ratio . Our two primary outcomes are pain at rest and at arm activity , assessed using visual analogue scale ( VAS ) . We will quantify the treatment effect as the difference between the groups in the change in the VAS scales with the associated 95 % CI at 24 months . Our secondary outcomes are functional assessment ( Constant score and Simple shoulder test ) , quality of life ( 15D and SF-36 ) , patient satisfaction , proportions of responders and non-responders , reoperations/treatment conversions , all at 2 years post-r and omisation , as well as adverse effects and complications .  We recruited a total of 210 patients from three tertiary referral centres . We will conduct the primary analysis on the intention-to-treat basis . Ethics and Dissemination The study was approved by the Institutional Review Board of the Pirkanmaa Hospital District and duly registered at Clinical Trials.gov . The findings of this study will be disseminated widely through peer- review ed publications and conference presentations . Trial registration number NCT00428870 ; Pre- results Background and purpose A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up . The purpose s of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score , rotator cuff status and radiological findings influenced the outcome . Patients and methods 97 patients on the waiting list for arthroscopic subacromial decompression had been r and omised to a specific exercise programme or unspecific exercises ( controls ) .  After 3 months of exercises , the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up . 1 year after inclusion or 1 year after surgery , the number of patients who decided to have surgery in each group was compared . The choice of surgery was related to the baseline Constant-Murley score , ultrasound and radiographs taken at inclusion . Results All patients had improved significantly ( p<0.0001 ) in the Constant-Murley score at the 1-year follow-up . Significantly more patients in the control group decided to have surgery ( 63 % ) than those in the specific exercise group ( 24 % ; p<0.0001 ) . Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear . Patients with partial tears did not differ from those with intact tendons . Interpretation The positive short-term results of specific exercises were maintained after 1 year , and this exercise strategy reduces the need for surgery . Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome . Trial registration number Clinical trials NCT01037673 Purpose Subacromial decompression is the st and ard surgical treatment of subacromial impingement syndrome . Unsatisfactory results have been reported for concomitant lesions as well as inadequate diagnosis . We sought to determine the predictive value of the preoperative examination for the results of arthroscopic subacromial decompression in impingement syndrome . Methods Forty-nine shoulder joints in 47 patients receiving arthroscopic subacromial decompression were prospect ively followed for a mean 3.7 ± 0.4 years . Prior to surgery , the impingement tests according to Neer , Hawkins – Kennedy ( in the neutral as well as abducted position ) , and the Jobe test ( empty can position ) were evaluated as well as the presence of a painful arc . The association between the presence of these sings , success of the operation , and improvement in Constant scores as well as WORC indices was analysed . Results Pre- to postoperative improvement in Constant scores as well as WORC indices was greater in case of a positive test result for every test studied . With the numbers available , significant greater improvements in Constant scores were observed only for patients with a positive Hawkins – Kennedy sign in the neutral position , Neer and Jobe tests , compared to patients with negative signs , respectively . No significant differences were observed for the improvement in WORC indices . Patients with at least four positive tests out of the five studied had greater improvement in Constant scores than patients with three or less positive test results . Five patients went on to receive subsequent shoulder surgery . There was no association between the necessity for revision surgery and the presence or absence of impingement signs . Conclusion The impingement tests according to Hawkins – Kennedy , Neer , and Jobe are valid predictors of outcome after subacromial decompression , as is the presence of multiple impingement tests . This study may aid in improving patient outcome and especially patient selection for subacromial decompression . Level of evidence Prognostic , Level PURPOSE This study aim ed to determine whether radiofrequency (RF)-based plasma microtenotomy ( microdebridement ) was effective for treating chronic supraspinatus tendinosis . METHODS The institutional ethics committee approved the study design , and all patients signed informed consent forms . Patients ( age range , 30 to 70 years ) were considered for enrollment if 6 months of active conservative treatment had failed and they had Neer stage II impingement syndrome , positive radiographic evidence of type II acromion , and magnetic resonance imaging or ultrasound evidence of supraspinatus tendinosis . Patients ( N = 60 ) were r and omly assigned to undergo arthroscopic subacromial decompression or RF-based plasma microtenotomy .  For microtenotomy , a bipolar RF-based probe ( TOPAZ ; ArthroCare , Austin , TX ) was used to perform microdebridement in the supraspinatus tendon ; patients did not undergo acromioplasty . Outcomes evaluation consisted of self-reported pain via a visual analog scale , as well as functional assessment ( American Shoulder and Elbow Surgeons [ ASES ] survey , Constant score , and University of California , Los Angeles [ UCLA ] question naire ) . Statistical analyses were performed by use of factorial dependent- measures analysis of variance tests . RESULTS Age and baseline scores on the visual analog scale ( mean + /- SD ) were 52.0 + /- 6.7 and 53.2 + /- 6.6 years and 8.4 + /- 0.9 and 8.2 + /- 0.8 points in the microtenotomy and arthroscopic subacromial decompression groups , respectively . A significant reduction in pain ( P < .001 ) and improved function ( P < .001 for all measures ) were observed in both groups postoperatively . Both treatment groups had almost identical longitudinal recovery profiles for pain relief ( P = .416 ) and restoration of function ( P = .964 for ASES score , P = .978 for Constant score , and P = .794 for UCLA score ) . At 1 year , the median pain score was 1.0 , and all patients had ASES , Constant , and UCLA scores of greater than 90 , greater than 80 , and greater than 30 , respectively . CONCLUSIONS Both procedures were associated with significant improvement postoperatively , but the RF-based plasma microtenotomy procedure draws into question the need for a more extensive procedure such as subacromial decompression in this patient population . LEVEL OF EVIDENCE Level I , therapeutic r and omized controlled study Shoulder-related dysfunction is the second most common musculoskeletal disorder and is an increasing burden on health-care systems . Commonly used clinical question naires suffer from subjectivity , pain dominance and a ceiling effect . Objective functional measurement has been identified as a relevant issue in clinical rehabilitation . Inertia based motion analysis ( IMA ) is a new generation of objective outcome assessment tool ; it can produce objective movement parameters while being fast , cheap and easy to operate . In this prospect i ve study , an inertial sensor comprising a three-dimensional accelerometer and gyroscope is attached at the humerus to measure shoulder movements during two motion tasks in patients with subacromial impingement syndrome at baseline and at five-year after treatment . One hundred healthy subjects served as healthy reference data base and 15 patients were measured pre- and post-treatment . IMA was better able to detect improvement in shoulder movements compared to the clinical question naires ( Disability of Arm , Shoulder and H and ( DASH ) and Simple Shoulder Test ( SST ) ; p < 0.05 ) and was hardly correlated with the clinical question naires ( Pearson R = 0.39 ) . It may therefore add an objective functional dimension to outcome assessment . The fast assessment ( t < 5 min ) of a simple motion test makes it suitable for routine clinical follow-up Objective To evaluate if a specific exercise strategy , targeting the rotator cuff and scapula stabilisers , improves shoulder function and pain more than unspecific exercises in patients with subacromial impingement syndrome , thereby decreasing the need for arthroscopic subacromial decompression . Design R and omised , participant and single assessor blinded , controlled study . Setting Department of orthopaedics in a Swedish university hospital . Participants 102 patients with long st and ing ( over six months ) persistent subacromial impingement syndrome in whom earlier conservative treatment had failed , recruited through orthopaedic specialists . Interventions The specific exercise strategy consisted of strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilisers in combination with manual mobilisation . The control exercise programme consisted of unspecific movement exercises for the neck and shoulder . Patients in both groups received five to six individual guided treatment sessions during 12 weeks . In between these supervised sessions the participants performed home exercises once or twice a day for 12 weeks . Main outcome measures The primary outcome was the Constant-Murley shoulder assessment score evaluating shoulder function and pain . Secondary outcomes were patients ’ global impression of change because of treatment and decision regarding surgery . Results Most ( 97 , 95 % ) participants completed the 12 week study . There was a significantly greater improvement in the Constant-Murley score in the specific exercise group than in the control exercise group ( 24 points ( 95 % confidence interval 19 to 28.0 ) v 9 points ( 5 to 13 ) ; mean difference between group : 15 points ( 8.5 to 20.6 ) ) . Significantly more patients in the specific exercise group reported successful outcome ( defined as large improvement or recovered ) in the patients ’ global assessment of change because of treatment : 69 % ( 35/51 ) v 24 % ( 11/46 ) ; odds ratio 7.6 , 3.1 to 18.9 ; P<0.001 . A significantly lower proportion of patients in the specific exercise group subsequently chose to undergo surgery : 20 % ( 10/51 ) v 63 % ( 29/46 ) ; odds ratio 7.7 , 3.1 to 19.4 ; P<0.001 ) . Conclusion A specific exercise strategy , focusing on strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilisers , is effective in reducing pain and improving shoulder function in patients with persistent subacromial impingement syndrome . By extension , this exercise strategy reduces the need for arthroscopic subacromial decompression within the three month timeframe used in the study . Trial registration Clinical trials OBJECTIVES To compare the effect of grade d physiotherapeutic training of the rotator cuff versus arthroscopic subacromial decompression in patients with subacromial impingement . METHODS R and omised controlled trial with 12 months ' follow up in a hospital setting . Ninety consecutive patients aged 18 to 55 years were enrolled . Symptom duration was between six months and three years . All fulfilled a set of diagnostic criteria for rotator cuff disease , including a positive impingement sign . Patients were r and omised either to arthroscopic subacromial decompression , or to physiotherapy with exercises aim ing at strengthening the stabilisers and decompressors of the shoulder . Outcome was shoulder function as measured by the Constant score and a pain and dysfunction score . " Intention to treat " analysis was used , with comparison of means and control of confounding variables by general equation estimation analysis . RESULTS Of 90 patients enrolled , 84 completed follow up ( 41 in the surgery group , 43 in the training group ) . The mean Constant score at baseline was 34.8 in the training group and 33.7 in the surgery group . After 12 months the mean scores improved to 57.0 and 52.7 , respectively , the difference being non-significant . No group differences in mean pain and dysfunction score improvement were found . CONCLUSIONS Surgical treatment of rotator cuff syndrome with subacromial impingement was not superior to physiotherapy with training . Further studies are needed to qualify treatment choice decisions , and it is recommended that sample s are stratified according to disability level BACKGROUND To determine whether radiofrequency based plasma microtenotomy has a positive effective in the treatment of shoulder impingement syndrome with cuff tendinosis . MATERIAL S AND METHODS Eighty patients with impingement syndrome and cuff tendinosis that were treated arthroscopically were enrolled in the study . The patients were r and omly assigned to receive either arthroscopic subacromial decompression ( ASD ) alone ( ASD group , n = 40 ) or arthroscopic subacromial decompression combined with radiofrequency ( RF ) based plasma microtenotomy ( RF group , n = 40 ) . Clinical outcome data including VAS pain score , shoulder range of motion ( ROM ) , ASES , UCLA , Constant-Murley , and SST score were recorded preoperatively and at 3 weeks , 6 weeks , 3 months , 6 months , and 1 year postoperatively . RESULTS Sixty-five out of eighty patients ( 81.3 % ) were available for the final follow-up at 1 year postoperation . There were 32 patients in the ASD group and 33 in the RF group . Both treatment groups showed significantly ( P = .031 in the ASD group vs P = .017 in the RF group ) reduced pain 3 weeks postoperatively . Both treatment groups showed significantly improved functional scores 3 months postoperatively . Both treatment groups showed significantly improved flexion elevation ( FE ) and external rotation ( ER ) 1 year postoperatively and internal rotation ( IR ) 6 months postoperatively . No significant difference between the 2 groups was found in any of the outcome measurements at any time point postoperatively . CONCLUSION Arthroscopic subacromial decompression is a reliable treatment for refractory impingement syndrome . The additional radiofrequency based plasma microtenotomy did not show any significant positive effects regarding pain relief , ROM , or functional recovery Arthroscopic subacromial decompression was performed on 114 patients with rotator cuff impingement who had not responded to nonoperative measures . None of the patients had a full-thickness cuff tear . Patients with associated instability , symptomatic acromioclavicular joint disease , or ruptures of the long head of biceps were not included . Results were determined by question ing patients about their satisfaction with the outcome of surgery and by functional assessment of the shoulder with the parameters of pain , ability to perform daily activities , and range of motion according to the Constant scoring system . When review ed at a mean interval of 19 months after surgery , 85 patients ( 75 % ) were satisfied with the outcome . Pain scores improved by an average of 8.6 points ; " activities of daily living " scores improved by an average of 5.8 points ; range-of-motion scores improved by an average of 3.6 points . The improvements in all 3 parameters scored were significant ( P < .05 ) . The following variables were statistically analyzed to assess their influence on final outcome : age , sex , occupation , duration of symptoms before surgery , dominance of the affected shoulder , outcome of the impingement test , state of the cuff , and experience of the surgeon performing the operation . The duration of symptoms before surgery was the most significant predictor of outcome . Symptoms of prolonged duration were associated with an unsatisfactory subjective results ( P < .01 ) and with smaller improvements in the parameters of the Constant score ( P < .001 ) . Recovery after arthroscopic subacromial decompression and eventual outcome were related to the extent of cuff damage . Patients with partial thickness tears or fraying of the cuff had a delayed return to work ( P < .001 ) and were found to have smaller increases in the pain and range-of-motion scores ( P < .05 ) . A satisfactory subjective result was most often associated with a positive impingement test ( P < .05 ) . Unsatisfactory outcomes were associated with a question able diagnosis and lack of clear evidence of impingement at arthroscopy , inadequate decompression of the subacromial space , or the presence of calcium deposits in the rotator cuff OBJECTIVE To compare the accuracy of combinations of clinical examination findings for predicting a positive response to injection of local anaesthetic into the subacromial bursa . DESIGN Prospect i ve , cohort , diagnostic validity design . SUBJECTS Consecutive patients with shoulder pain recruited from primary care physiotherapy and general medical practice s. METHODS All subjects underwent a st and ardised clinical examination ( index test ) followed by a diagnostic injection of xylocaineTM into the subacromial bursa ( reference st and ard test ) performed under ultrasound guidance . Clinical examination variables associated with a positive anaesthetic response ( ≥ 80 % post-injection reduction in pain intensity ) were identified ( p < 0.20 ) and diagnostic accuracy was calculated . RESULTS Of the 196 subjects who received a subacromial bursa injection , 66 subjects ( 34 % ) reported a positive anaesthetic response . Strain injury ( adjusted odds ratio ( AOR ) 2.3 ) , anterior shoulder pain ( AOR 2.3 ) and absence of pain with external rotation at 90º abduction ( AOR 3.9 ) were the strongest clinical predictors of positive anaesthetic response . Clinical prediction model variables demonstrated 100 % specificity ( 3 positive tests ) but low sensitivity ( maximum 40 % ) for a positive anaesthetic response . Combinations of 9 other clinical variables also demonstrated 100 % specificity ( 7 or more positive tests ) , and improved sensitivity ( 95 to 100 % ) for a PAR compared with clinical prediction model variables when less than two findings were present . CONCLUSION Combinations of these clinical tests may assist the clinician to differentiate subacromial pain from other shoulder conditions and guide selection of targeted pain management interventions . Additional diagnostic tests may be required when clinical criteria are not satisfied BACKGROUND CONTEXT Objective measures including neurological findings , radiographic evaluation , and the Japanese Orthopaedic Association ( JOA ) score are commonly used for the evaluation of surgical outcomes . Because many surgeries are performed primarily to improve quality of life , a patient 's subjective evaluations are also important for accurately assessing surgical outcomes . Currently available instruments for assessing quality of life include the Short-Form 36 ( F-36 ) , the Oswestry disability index ( ODI ) , and the visual analog scale ( VAS ) clinical pain scale . PURPOSE The aims of this study were to measure surgical outcomes by using both objective measures and subjective measures including patient self- assessment s and psychological changes ; to assess the adequacy of the JOA alone for measuring outcome ; and to determine which measures , the SF-36v2 , ODI , VAS , or JOA correlate with the VAS pain scale score in lumbar canal stenosis . STUDY DESIGN We performed a prospect i ve study to measure surgical outcomes for lumbar canal stenosis using traditional objective measures such as neurological findings and subjective measures such as performance of ADLs , patient self- assessment s , and psychological changes . PATIENT SAMPLE Forty-two surgical patients with a mean age of 66.8+/-10.9 years at the time of surgery were included in the study . All cases were followed for more than 2 years . Surgical indications included no response to conservative treatment and neurological deterioration . Neurological symptoms were classified as nerve root type , cauda equine type , or combined type . We performed surgical decompression at the location of the dural or root indentation by myelography . The concomitant diagnosis causing the spinal stenosis was degenerative spondylolisthesis in 20 cases undergoing posterolateral fusion with pedicle screws . OUTCOME MEASURES Surgical outcomes were assessed by comparing preoperative and 24-month postoperative JOA scores for low back pain , SF-36v2 , ODI-v2 , and VAS scores . Statistical analysis was performed by using the analysis of variance . A p value<0.05 was considered statistically significant . METHODS Objective clinical measures , patient self- assessment s , and psychological changes were measured before and at 24 months postoperatively . We also examined which measurements correlated with the VAS scale for pain evaluation , thereby relating patient satisfaction to surgery outcome . RESULTS All JOA , SF-36v2 , ODI-v2 , and VAS scores significantly improved postoperatively . The physical component summary ( PCS ) of the SF-36 v2 showed significant improvement , although all scores remained less than the Japanese norm-based scores ( NBSs ) . The mental component summary ( MCS ) exhibited such a significant improvement that all postoperative subscales were higher than the Japanese NBS . JOA scores significantly correlated only with postoperative lower-extremity VAS score . All PCS and two MCS scores significantly correlated with the VAS score for low back pain . Parts of the PCS and MCS significantly correlated with the lower-extremity VAS . The ODI significantly correlated with both the preoperative and postoperative VAS scores for low back pain as well as with the postoperative lower-extremity VAS score . CONCLUSIONS The JOA , SF-36 , ODI , and VAS question naires are all useful instruments for measuring surgical outcomes . The VAS score is a better assessment of physical rather than mental health . The ODI is more reflective of patients ' subjective symptoms . Finally , the SF-36 is particularly informative because it includes questions addressing both psychological and physical status . Therefore , when combined , the SF-36v2 , VAS , and ODI scores are a valuable complement to the JOA scores in evaluating outcomes of surgery for lumbar canal stenosis
Our review provides anchor-based MID estimates , as well as a rating of their credibility , for PROMs for patients with shoulder conditions .
The MID estimates inform the interpretation for a linked systematic review and guideline addressing subacromial decompression surgery for shoulder pain , and could also prove useful for authors addressing other interventions for shoulder problems .
OBJECTIVES To identify credible anchor-based minimal important differences ( MIDs ) for  patient-reported outcome measures  ( PROMs ) relevant to a BMJ Rapid Recommendations addressing subacromial decompression surgery for shoulder pain .