(Economic and decision analysis-developing an economic or decision model), Level II.

[ research report ] D uring arm elevation, the scapula generally upwardly rotates, tilts posteriorly, and either moves toward internal or external rotation. Alterations in what are considered normal scapulothoracic motions have been associated with various shoulder path ologies.19 Accordingly, the assessment and treatment of scapular mo tion have become key components of shoulder rehabilitation. 3,7,15,16,35 Based on their ease of use, low cost, and portability, elastic bands are frequently used in clinical practice to provide resistance during shoulder elevation exercises for individuals with a variety of shoulder pathologies.13 It is also common in clinical practice to have patients perform shoulder elevation against resistance as part of the evaluation process to determine the quality of scapular control under loaded conditions. While several studies have documented the influence of external loads provided by handheld weights, 6,10,17,21,23,25,31 there is little information on how scapular kinematics change with loading provided by elastic bands. Determining how shoulder elevation against a standard elastic resistance may affect scapulothoracic motion in individuals without shoulder pathology is important to establishing normal values that may be used to assess the effects of elastic resistance in symptomatic subjects.Therefore, the aim of this study was to determine the influence of resistance against shoulder elevation with an elastic band on scapulothoracic motion in healthy individuals with normal scapular control. It was hypothesized that the movements of scapular internal/external T T STUDY DESIGN: Controlled laboratory study using within-group comparisons. T T OBJECTIVES:To compare scapular kinematics between active and resisted shoulder elevation performed in the sagittal (flexion), frontal (abduction), and scapular (scapular abduction) planes. T T BACKGROUND:Several studies have documented scapular kinematics during arm elevation against an external load; however, there is little information on how scapular kinematics change with loading provided by elastic bands, an exercise approach often used in the clinic. T T METHODS:Thirty-two men without shoulder pathology participated in the study. The level of resistance to be used for each individual was determined prior to data collection and standardized by perceived effort on a Borg scale. Three-dimensional scapular kinematics were recorded with an electromagnetic tracking device in all 3 planes of shoulder elevation for both the unloaded (active) and loaded (resisted) conditions. Data for scapular kinematics were analyzed at 30°, 60°, 90°, and 120° of humerothoracic elevation and lowering. Comparisons between loading conditions were made using analysis-of-variance models. T T RESULTS:In general, for all 3 planes of movement, the scapula was more downwardly rotated and anteriorly tilted during the elevation phase and more so during the lowering phase of shoulder elevation when performed against elastic resistance. While some of the statistically signific...

The aim of this study was to determine whether patients receiving peritoneal dialysis (PD) experience an improvement in physical activity, quality of life and functional status as a result of exercise training at home by motivation about benefi ts of exercising. MATERIAL and METHODS: Twenty-one PD patients of 46.7±14.1 years participated in the study. Participants were encouraged by a physiotherapist to walk for 30 minutes, 3 days a week and motivated by explaining benefi ts of exercising. We assessed quality of life by Kidney Disease Quality of Life Questionnaire-Turkish Version (KDQOL-SF), functional status by Six Minute Walk Test (SMW), physical activity level by International Physical Activity Questionnaire-Long Form (IPAQ-LF). The antropometric measurements were performed with the bioelectrical impedance. Assessments were done at the beginning and 3 months later. RESULTS: Total physical activity score of IPAQ-LF increased signifi cantly 3 months later (p<0.05). There were no signifi cant differences in walking, moderate-intensity, vigorous intensity and sitting subscores of IPAQ-LF, SMW distance and anthropometric measurements (p>0.05). Improvements in pain and emotional score of KDQOL-SF were statistically signifi cant (p<0.05). CONCLUSION: Regular exercise should be allocated in the PD standard care. Participation of the patient into such a program could be possible by explaining the benefi ts of exercising at the beginning of the treatment.

Background Scapular dyskinesis is alternations in scapular position and motion, has been associated with various shoulder pathologies [1]. An appropriate scapular upward rotation is considered to be essential for normal shoulder function and serratus anterior and trapezius muscles works together as a force couple to dynamically control this movement [2]. However, the effect of muscular strength of force couple on scapular kinematics hasn’t been studied. Objectives To investigate the muscular strength of force couple muscles on scapular upward rotation during shoulder abduction in asymptomatic shoulders with or without scapular dyskinesis. Methods Sixty-four asymptomatic shoulders without were included to the study. Observational clinical assessment has used to categorize the presence of scapular dyskinesis using yes/no method [3]. Maximal isometric strength of serratus anterior, upper trapezius and lower trapezius muscles was evaluated with handle-hand dynamometer to assess muscular strength [4]. Three-dimensional scapular orientation was recorded by electromagnetic system during shoulder elevation in frontal plane according to ISB recommendations to assess amount of scapular upward rotation [5]. Student t-test and Pearson’s correlation were used for statistical comparisons. Results The results of observational assessment showed that 62.5% (n=40) of asymptomatic shoulders were with scapular dyskinesis and 37.5% (n=24) were normal. Comparison the muscle strength and scapular upward rotation between shoulders with or without scapular dyskinesis showed no statistical difference (p>0.05). Also, there were no correlation between muscular strength and scapular upward rotation through humerothoracic elevation in both study groups (p>0.05). Conclusions Scapular dyskinesis may be observed in asymptomatic shoulders and surprisingly, shoulders with scapular dyskinesis have not any kinematic differences when comparing to the shoulders without scapular dyskinesis. It may be possible to have kinematic alternation in presence of pain and further studies needed in this area. Another important finding of this study showed that muscular strength of force couple seems not affect the related scapular rotation in asymptomatic shoulders. Neuromuscular properties such as activation levels and recruitment patterns of the scapular muscles would have critical role on normal scapular movement patterns. References Kibler, W.B. and J. McMullen, Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg, 2003. 11(2): p. 142-51. Bagg, S.D. and W.J. Forrest, Electromyographic study of the scapular rotators during arm abduction in the scapular plane. Am J Phys Med, 1986. 65(3): p. 111-24. Uhl, T.L., et al., Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy, 2009. 25(11): p. 1240-8. Michener, L.A., et al., Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Phys Ther, 2005. 85(11): p. 1128-38. Wu, G., et al., ISB recommendation on defini...

Background To obtain full range of motion in shoulder scapular mobility has an important role and alternations in scapular mobility and posterior capsular thickening are thought to be problems leading abnormal movement pattern in frozen shoulder [1]. Restoring the range of motion and function are treatment objectives and scapular mobilization and joint capsule stretching were recommended in frozen shoulder rehabilitation. Objectives To investigate the acute effect of manual posterior capsule stretching, scapular mobilization and combination of these two manual therapy methods on range of motion in patients with frozen shoulder. Methods Forty patients diagnosed with frozen shoulder (average age: 49.05±10 years, BMI: 25.2±3.1 kg/m2) were included to the study. Randomly subjects divided to 3 intervention groups; manual posterior capsule stretching group (n=8), scapular mobilization group (n=12) and combination of two methods (n=20). Before and immediately after mobilization shoulder flexion, abduction, external and internal rotation range of motion were evaluated by using standard goniometer. Posterior capsule tightness was assessed with ruler that the amount of shoulder horizontal adduction on fixed scapula in side lying position in according to show the effectiveness of intervention on posterior capsule tightness. The amount of active shoulder internal rotation and active total elevation performed as a functional test. Statistical comparisons were carried out by using Wilcoxon signed-rank test and for between-groups comparisons Kruskal-Wallis test was used. Results Comparisons showed that there were statistically significant improvements in shoulder flexion (p=.003), external rotation (p=.009) and active total elevation (p=.005) after scapular mobilization, and shoulder flexion (p=.02), active total elevation (p=.02) and posterior capsule tightness (p=.01) after manual posterior capsule stretching. Combination of two methods resulted in improvements in shoulder flexion (p=.001), abduction (p=.005), external rotation (p=.004), internal rotation (p=.003), active total elevation (p=.003), active internal rotation (p=.003) and posterior capsule tightness (p=.001). There were no statistical differences in the amount of changes in studied parameters between three intervention groups (p>.05). Image/graph Conclusions Acute effect of manual posterior capsule stretching and scapular mobilization showed improvements in limited shoulder range of motion in frozen shoulder and combination of these two methods were showed additional gain in shoulder abduction, internal rotation and active internal rotation function. Applying such techniques in clinical setting is recommended, but the durability of these effects and long terms results of repetitive intervention are needed further research. References Loyd, J.A. and H.M. Loyd, Adhesive capsulitis of the shoulder: arthrographic diagnosis and treatment. South Med J, 1983. 76(7): p. 879-83. Disclosure of Interest None Declared