Hurd Wendy J, Morrow Melissa M, Miller Emily J, Adams Robert A, Sperling John W, Kaufman Kenton R
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Geriatr Phys Ther. 2018 Jul/Sep;41(3):126-133. doi: 10.1519/JPT.0000000000000112.
Documenting functional outcomes after reverse shoulder arthroplasty (RSA) is critical to advancing patient care. The interplay been self-reported and objectively measured outcome measures has not been widely described. The utilization of wearable devices to document upper extremity limb activity is a new approach for objectively measuring outcomes. Therefore, the purpose of this study was to evaluate changes in pain, and self-reported function and objectively measured limb activity after RSA. We also assessed the influence of pain on self-reported function and objectively measured limb activity to determine the impact of pain on outcomes after RSA.
This study implemented a prospective, repeated-measures design. Fourteen patients undergoing RSA underwent testing before surgery, and 2 and 12 months after surgery. Patient-reported instruments included pain, Disabilities of Arm, Shoulder and hands (DASH), and physical component summary (PCS) of the 36-Item Short Form Health Survey. Objective limb activity (mean activity value, m/s/min epoch; inactive time, %; low activity, %; and high activity, %) was captured with triaxial accelerometers worn on the upper and lower arm. A repeated-measures ANOVA tested for differences across time. The Spearman rank-order correlation was calculated to evaluate the influence of pain on DASH, PCS scores, and mean limb activity.
Patient-reported measures improved after surgery (pain, P < .01; DASH, P < .01; PCS, P = .01). No change in limb activity was found at 1 year compared with preoperative values for mean (forearm, P = 1.00; arm, P = .36), inactivity (forearm, P = .33; arm, P = .22), low (forearm, P = .77; arm, P = .11) or high (forearm, P = 1.00; arm, P = .20) activity. There was a relationship between pain and DASH scores 1 year after surgery (P = .04) but not before surgery (P = .16), or 2 months after surgery (P = .30). There was no relationship between pain and PCS scores at any time point (preoperative, P = .97; 2 months, P = .21; 1 year, P = .08) nor pain and limb activity (forearm: preoperative, P = .36; 2 months, P = .67; 1 year, P = .16; arm: preoperative, P = .97; 2 months, P = .59; 1 year, P = .51).
RSA reduced pain and enhanced patient-perceived function. Objectively measured upper extremity limb activity is not different 1 year after surgery compared with preoperative levels.
III.
记录反肩关节置换术（RSA）后的功能结果对于改善患者护理至关重要。自我报告和客观测量的结果指标之间的相互作用尚未得到广泛描述。利用可穿戴设备记录上肢肢体活动是一种客观测量结果的新方法。因此，本研究的目的是评估RSA术后疼痛、自我报告的功能以及客观测量的肢体活动的变化。我们还评估了疼痛对自我报告功能和客观测量肢体活动的影响，以确定疼痛对RSA术后结果的影响。
本研究采用前瞻性重复测量设计。14例行RSA的患者在手术前、术后2个月和12个月接受测试。患者报告的指标包括疼痛、手臂、肩部和手部功能障碍（DASH）以及36项简短健康调查问卷的身体成分总结（PCS）。通过佩戴在上臂和下臂的三轴加速度计记录客观肢体活动（平均活动值，米/秒/分钟时段；不活动时间，%；低活动，%；高活动，%）。采用重复测量方差分析来检验不同时间点之间的差异。计算Spearman等级相关以评估疼痛对DASH、PCS评分和平均肢体活动的影响。
患者报告的指标在术后有所改善（疼痛，P < .01；DASH，P < .01；PCS，P = .01）。与术前平均水平相比，1年时肢体活动无变化（前臂，P = 1.00；上臂，P = .36），不活动情况（前臂，P = .33；上臂，P = .22），低活动（前臂，P = .77；上臂，P = .11）或高活动（前臂，P = 1.00；上臂，P = .20）。术后1年疼痛与DASH评分之间存在相关性（P = .04），但术前（P = .16）或术后2个月（P = .30）不存在相关性。在任何时间点，疼痛与PCS评分之间均无相关性（术前，P = .97；2个月，P = .21；1年，P = .08），疼痛与肢体活动之间也无相关性（前臂：术前，P = .36；2个月，P = .67；1年，P = .16；上臂：术前，P = .97；2个月，P = .59；1年，P = .51）。
RSA减轻了疼痛并增强了患者感知的功能。与术前水平相比，术后1年客观测量的上肢肢体活动没有差异。
III级
