School of Human Sciences, University of Western Australia, Perth, WA, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
School of Human Sciences, University of Western Australia, Perth, WA, Australia.
J Shoulder Elbow Surg. 2020 Nov;29(11):2308-2318. doi: 10.1016/j.jse.2020.03.030. Epub 2020 Jun 9.
Accelerometers provide a new method to objectively measure recovery of movement and physical activity in patients following reverse total shoulder arthroplasty (RTSA) and may overcome common limitations associated with patient-reported outcome measures (PROMs). The aim of this study was to assess changes in upper limb movement using accelerometers following RTSA and investigate their association with other clinical outcome measures.
Thirty-six patients who underwent RTSA wore accelerometers on both wrists and arms for 3 days at 3, 6, and 12 months postsurgery. PROMs (Constant score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, visual analog scale for pain, Single Assessment Numerical Evaluation, Shoulder Activity Level) and isometric shoulder strength were also assessed. Accelerometer outcomes were calculated to quantify counts of forearm and arm activity and the contribution of both arms to activity (limb symmetry and magnitude ratio). Changes and differences in all clinical measures and objective movement measures were evaluated with within-subjects analysis of variance. Correlations between limb activity and other clinical measures were investigated using Spearman correlation coefficients.
Objective movement of the operated arm increased from 3-6 months postsurgery (P = .004), but not from 6-12 months (P = .240). Limb asymmetries were observed at 3 and 6 months and improved by 12 months postsurgery. No associations were demonstrated between PROMs and objective upper limb movement at 12 months postsurgery.
Despite early recovery of function and pain relief assessed by PROMs, objective movement using accelerometers showed delayed recovery of the operated arm postoperatively, before normalizing by 12 months postsurgery. Accelerometers provide a unique insight into functional recovery following RTSA.
加速度计为客观测量反向全肩关节置换术（RTSA）后患者运动和身体活动的恢复提供了一种新方法，并且可能克服与患者报告的结果测量（PROM）相关的常见局限性。本研究的目的是使用加速度计评估 RTSA 后上肢运动的变化，并研究其与其他临床结果测量的关系。
36 例接受 RTSA 的患者在手术后 3、6 和 12 个月的 3 天内分别在手腕和手臂上佩戴加速度计。还评估了 PROM（Constant 评分，美国肩肘外科医生协会标准化肩部评估表，疼痛视觉模拟评分，单项评估数值评估，肩部活动水平）和等长肩部力量。计算加速度计结果以量化前臂和手臂活动的计数以及两只手臂对活动的贡献（肢体对称性和幅度比）。使用受试者内方差分析评估所有临床测量和客观运动测量的变化和差异。使用 Spearman 相关系数研究肢体活动与其他临床测量之间的相关性。
手术后 3-6 个月，手术手臂的客观运动增加（P =.004），但手术后 6-12 个月未增加（P =.240）。在手术后 3 个月和 6 个月观察到肢体不对称，并在手术后 12 个月得到改善。在手术后 12 个月时，未显示 PROMs 与客观上肢运动之间存在相关性。
尽管通过 PROM 评估术后功能和疼痛缓解得到早期恢复，但术后使用加速度计显示手术手臂的运动恢复延迟，直到手术后 12 个月才恢复正常。加速度计为 RTSA 后功能恢复提供了独特的见解。
