Fouad Fayad

Validation of the French version of the fear avoidance belief questionnaire.

Study Design. Observational prospective study. Objective. To assess the reliability, validity, and responsiveness of the French version of the Fear Avoidance Belief Questionnaire. Summary of Background Data. Fear, avoidance attitudes, and belief play pivotal roles in disability perceived by patients with chronic low back pain. The Fear Avoidance Belief Questionnaire is a two-part questionnaire assessing fear, avoidance, and beliefs about professional activity and physical activity. Methods. The Fear Avoidance Belief Questionnaire was translated by use of the forward and backward translation procedure. Test-retest reliability was assessed in 31 patients (Group 1) with the intraclass correlation coefficient and the Bland and Altman method. Construct validity was assessed in two groups of patients (Group 2, n = 147; Group 3, n = 70) with the Spearman rank correlation coefficient and factor analysis. Responsiveness was assessed in Group 3, after they underwent a functional restoration program, by the effect size and the standardized response mean. Results. Test-retest reliability was good, with an intra-class correlation coefficient value of 0.88 and 0.72 for fear, avoidance, and beliefs about professional activity and physical activity, respectively. Use of the Bland and Altman method produced a homogeneous distribution of the differences, with no systematic trend observed. The expected divergent validity was observed in Groups 2 and 3. Factor analysis extracted four factors in Group 2 and the two original factors of the English Fear Avoidance Belief Questionnaire in Group 3. The lowest effect size and standardized response mean values (0.30 and 0.31, respectively) were observed with the fear, avoidance, and beliefs about professional activity. Conclusions. The psychometric properties (test-retest reliability, construct validity, and responsiveness) of the French version of the Fear Avoidance Belief Questionnaire are acceptable, and fear, avoidance, and belief can now be assessed in French-speaking patients with low back pain.

Reliability, validity and responsiveness of the French version of the questionnaire Quick Disability of the Arm, Shoulder and Hand in shoulder disorders

We assessed the reliability, validity and responsiveness of the French short version of the scale Disability of the Arm, Shoulder and Hand-Disability/Symptom (F-QuickDASH-D/S) in patients with shoulder disorders. We extracted QuickDASH item responses from the responses to the full-length DASH questionnaire completed by 153 patients. In addition to collecting demographic and clinical data, subjective assessment of activities of daily living (ADL), active range of motion (ROM), and measurement of abduction strength (strength) were recorded by use of the Constant scale. Cronbachs alpha coefficient was 0.89. The intraclass correlation coefficient was 0.94, which suggested excellent test-retest reliability. Correlation of the F-QuickDASH-D/S score with scores for F-DASH-D/S (r=0.96), handicap (r=0.79), ADL (r=-0.73), pain during activities (r=0.63), strength (r=-0.58), pain at rest (r=0.57) and ROM (r=-0.51) indicated good construct validity. Factor analysis identified 2 factors accounting for 59.1% of the variance. The responsiveness of F-QuickDASH-D/S was excellent, with standardized response mean and effect size values of 1.09 and 1.23, respectively. The F-QuickDASH-D/S has good reliability, construct validity and responsiveness. The strong correlation of its score with the full-length DASH-D/S scale score suggests that the QuickDASH-D/S could be the preferred scale because it is easier to use.

Comparison of visual and ultrasound based techniques to measure head repositioning in healthy and neck-pain subjects.

Three-dimensional (3D) ultrasound based (US) and usual Revel visual techniques were compared to measure head repositioning ability in 41 healthy subjects and 41 subjects with neck pain. Head repositioning absolute value of the global error (AE) was calculated by both techniques after active head rotations. The AE was 3.6 degrees and 3.7 degrees for healthy subjects and 6.3 degrees and 6.1 degrees for neck-pain subjects for the visual and US techniques, respectively. The AE was higher in neck-pain subjects (p<0.001), and a value of 4.5 degrees was identified as a threshold of abnormal repositioning for both techniques. The test-retest reliability, calculated in the neck-pain subjects, was moderate (intraclass correlation coefficient [ICC]=0.68) for both techniques. The correlation between the two techniques for AE was poor for both groups with successive measurement of visual and US techniques (r=0.32 and 0.46, respectively) but excellent with simultaneous measurement (r=0.95 for both groups). Moreover, we showed substantial agreement between the techniques in discriminating healthy and neck-pain subjects (kappa=0.65). The Revel visual technique is more appropriate for clinical practice, but with improved software, the 3D US method could provide additional quantitative and qualitative data invaluable for research.

Reliability of a modified Modic classification of bone marrow changes in lumbar spine MRI

OBJECTIVE The purpose of this study was to determine the intra- and interobserver reliability of a modified Modic classification for bone marrow changes seen on lumbar spine magnetic resonance imaging (MRI), taking into consideration mixed signals. METHODS Lumbar MRI scans from 94 patients with low back pain were assessed independently by 2 spine specialists (senior [senior1], junior) and a radiologist (senior2). One reviewer (senior1) assessed the MR images twice at a three-week interval for evaluation of intraobserver reliability. Senior2 and junior reviewers assessed the MR images once. Pure edema endplate signal changes were classified as Modic type I, and pure fatty endplate changes as Modic type II. A mixture of types I and II but predominantly edema signal changes was classified as Modic I-2 and a mixture of types I and II but predominantly fatty changes was classified as Modic II-1. RESULTS The intraobserver agreement was excellent (weighted kappa 0.85). The interobserver agreement was moderate to substantial (weighted kappa range 0.56-0.74). Interobserver reliability depended on the experience of the observer, thus highlighting the importance of a learning curve. CONCLUSION This study shows that the modified Modic classification is reliable and easy to apply for observers with different clinical experience. The inclusion of mixed marrow changes in the modified classification may have clinical and therapeutic implications.

ReLATIONSHIP OF GLeNOHUMeRAL eLeVATION AND 3-DIMeNSIONAL SCAPULAR KINeMATICS WITH DISABILITY IN PATIeNTS WITH SHOULDeR DISORDeRS

OBJECTIVE To determine variables among glenohumeral elevation and 3-dimensional scapular rotations that are related to shoulder function as assessed by the Disability of the Arm, Shoulder and Hand-Disability/Symptom (DASH-D/S) scale. DESIGN Prospective, cross-sectional study. PATIENTS Eighty-eight patients with shoulder pain and limited range of motion were included. METHODS Each patient performed 2 full active range of motion activities, forward flexion and abduction, and 2 activities of daily living, combing hair and simulating washing the back. Glenohumeral elevation and scapular rotations were measured by the Polhemus Fastrak electromagnetic system. RESULTS On multiple regression analysis, glenohumeral elevation in combing hair and scapular lateral rotation in both abduction and simulating washing the back were the best predictors of shoulder function and explained 39.7% of the variance of the DASH-D/S score. CONCLUSION These findings support the classical rehabilitation of the shoulder based on glenohumeral elevation and suggest the importance of attention paid to scapular lateral rotation.

Modified 3D scapular kinematic patterns for activities of daily living in painful shoulders with restricted mobility: A comparison with contralateral unaffected shoulders

There is a lack of studies of 3D scapular kinematic patterns for patients with shoulder conditions comparing affected and contralateral nonaffected shoulders during self-care activities of daily living (ADL). In this study, we compared 48 patients - 11 with glenohumeral osteoarthritis (GHOA), 20 with frozen shoulder (FS) and 17 with rotator cuff tendinopathies (RCT) - as they performed two ADL: hair combing and back washing. 3D scapular rotations and humerothoracic elevation (HTE) of the affected and contralateral nonaffected shoulders were recorded with use of a 6 degrees-of-freedom electromagnetic device. The HTE of affected and nonaffected shoulders were compared for each pathology group at rest and at the HTE used to perform the ADL: 30°, 45° and 60° of HTE for hair combing, and 30° of HT elevation for back washing. For hair combing, mean peak HTE was significantly lower for affected than nonaffected shoulders. Mean scapular lateral rotation was significantly greater at each HTE degree for GHOA and RCT groups, and mean scapular posterior tilt was significantly lower at 30° of HTE for the FS group. For back washing, mean peak HTE was lower for affected than nonaffected shoulders for the FS group only. Mean scapular medial rotation was significantly lower at 30° of HTE for the RCT group. 3D scapular kinematics appear to be specific to the shoulder pathology and to the task studied. Specific scapular kinematic patterns must be considered for appropriate therapeutic management.

Specific scapular kinematic patterns to differentiate two forms of dynamic scapular winging.

BACKGROUND Dynamic scapular winging (DSW) is a rare and misdiagnosed disorder causing considerable disability due to reduced scapular stability and abnormal motion. Two common causes are long thoracic nerve lesions resulting in serratus anterior muscle palsy and spinal accessory nerve lesions resulting in trapezius muscle palsy. The aim of this study was to analyse 3D scapular kinematic patterns in patients with DSW due to long thoracic (LTNL) or spinal accessory nerve lesions (SANL). METHODS 3D scapular kinematics were assessed using a non invasive method involving an electromagnetic device during arm elevation in the frontal and sagittal planes in 9 patients (4 with SANL and 5 with LTNL) with unilateral DSW confirmed by electrical evidence. Within subject affected-unaffected differences were measured and compared between pathological groups (Mann-Whitney). FINDINGS Differences between affected and unaffected shoulders were significantly greater for scapular posterior tilt (at rest and 30° for sagittal arm elevation, at rest, 30° and 60° for frontal arm elevation) in the LTNL compared to the SANL group. Differences between affected and unaffected shoulders were significantly greater for scapular protraction (at rest and 60° of sagittal arm elevation, at rest, 30° and 60° of frontal arm elevation) and scapular lateral rotation at 60° for frontal arm elevation in the SANL compared to the LTNL group. INTERPRETATIONS These kinematic findings show two different scapular patterns that are specific to the neurological lesion. Moreover our kinematic data relate to specific clinical signs and the functional roles of the muscles involved.

A new description of scapulothoracic motion during arm movements in healthy subjects

The participation of scapula motion in arm movement is clinically well known and recent three dimensional (3D) analyses using kinematic techniques have confirmed its importance. Scapular motion relative to the thorax has a theoretical maximum of 6 degrees of freedom (DoF), resulting from rotations at both clavicular joints (3 rotational DoF each). However, most recent kinematic studies have only analysed the 3D rotations of the scapula relative to the thorax. In the present study, the 3D translations of the barycentre of the scapula were considered in order to complete the description of movement at the shoulder complex. Eight healthy subjects performed arm elevation in the sagittal and frontal planes, simulated activities of daily living (hair combing and back washing) and maximum voluntary scapula movement (forward and backward rolling). Measurements were recorded using a 6 DoF electromagnetic device and the acromial method of analysis was used. The results showed that 3D scapular rotations and translation of its barycentre were functionally consistent for all tasks. A principal component analysis (PCA) yielded three factors, explaining 97.6% of the variance. The first two factors (protraction and shrug, according to clinical descriptions) combined rotations and translations, consistent with the hypothesis that the scapula rolls over the curved thoracic surface. The third factor related to lateral-medial rotation, thus representing rotation in the plane tangential to the thorax. The PCA suggested that scapular motion can be described using these 3 DoF. This should be studied in a larger group of individuals, including patients with pathological conditions.

The trunk as a part of the kinematic chain for arm elevation in healthy subjects and in patients with frozen shoulder.

During arm elevation, the trunk may have both a postural and synergic role, but few 3-D experimental studies exist of the phenomenon, and the contribution of trunk rotations to arm elevation has not been studied in patients with frozen shoulder. Thirty healthy volunteers performed maximal dominant arm elevation in 2 planes, sagittal (anteflexion) and frontal (abduction), and 13 patients with unilateral frozen shoulder performed arm elevation on the unaffected then affected side. Trunk rotations and humeral elevation were measured with use of an electromagnetic system (Polhemus Fastrak). Flexion/extension, inclination (lateral bending) and torsion (rotation around the main axis) of the trunk were measured at intermediate (45 degrees and 60 degrees ) and maximal levels of arm elevation. For patients, trunk rotations were also measured during elevation on the unaffected side at a level corresponding to maximal arm elevation of the contralateral affected side. Healthy volunteers made a small (4 degrees -9 degrees ) but consistent pattern of trunk rotations characterized mainly by extension during anteflexion and torsion during abduction associated with biphasic inclination (ipsilateral then contralateral). As expected, patients showed restricted arm elevation of the affected shoulder but performed larger trunk extension and torsion at intermediate levels of elevation with a similar pattern as above. Inclination range was limited during elevation of the affected shoulder, with no initial ipsilateral inclination on any side. Our results suggest that the trunk contributes to the kinematic chain for arm elevation in both groups. Trunk extension and torsion may compensate for impaired arm elevation. Conversely, the irregularities in trunk inclination may contribute to the impairment and be a target for rehabilitative management.

Precision of 3D scapular kinematic measurements for analytic arm movements and activities of daily living

Electromagnetic devices allow the non invasive and accurate measurement of 3D scapula kinematics. The acromial method allows continuous dynamic measurement using a skin surface sensor fixed to the acromion. Inter-session intra and inter-observer repeatability of 3D scapular kinematics have only been partially assessed for analytical movements and never for functional tasks. Inter-session intra and inter-observer repeatability of 3D scapular kinematics were assessed for arm elevation in the sagittal and frontal planes and for two activities of daily living (ADL), hair combing and back washing, in both shoulders of 15 healthy subjects, using the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), the small real difference (SRD) and the Bland and Altmans graphical method. Intra-observer repeatability was good to excellent for every scapular rotation for both arm elevation in isolated planes and ADL (ICC ranged from 0.64 to 0.95). Inter-observer repeatability of scapular rotations was fair to excellent for arm elevation in isolated planes (ICC ranged from 0.49 to 0.92) and poor to excellent for ADL (ICC ranged from 0.35 to 0.89). Inter-observer repeatability of scapular protraction/retraction had the lowest ICC. For both inter-session intra and inter-observer reliability, the SEM and SRD remained low and Bland and Altmans graphical method showed a good repeatability of the measurement method. Longitudinal monitoring of a subjects scapular kinematics by a trained observer is reliable. The inter-observer repeatability of scapular protraction/retraction must be improved.