Study Design Prospective, single-group observational design. Objectives To determine the minimal clinically important difference (MCID) for the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and its shortened version (QuickDASH) in patients with upper-limb musculoskeletal disorders, using a triangulation of distribution- and anchor-based approaches. Background Meaningful threshold change values of outcome tools are crucial for the clinical decision-making process. Methods The DASH and QuickDASH were administered to 255 patients (mean ± SD age, 49 ± 15 years; 156 women) before and after a physical therapy program. The external anchor administered after the program was a 7-point global rating of change scale. Results The test-retest reliability of the DASH and QuickDASH was high (intraclass correlation coefficient model 2,1 = 0.93 and 0.91, respectively; n = 30). The minimum detectable change at the 90% confidence level was 10.81 points for the DASH and 12.85 points for the QuickDASH. After triangulation of these results with those of the mean-change approach and receiver-operating-characteristic-curve analysis, the following MCID values were selected: 10.83 points for the DASH (sensitivity, 82%; specificity, 74%) and 15.91 points for the QuickDASH (sensitivity, 79%; specificity, 75%). After treatment, the MCID threshold was reached/surpassed by 61% of subjects using the DASH and 57% using the QuickDASH. Conclusion The MCID values from this study for the DASH (10.83 points) and the QuickDASH (15.91 points) could represent the lower boundary for a range of MCID values (reasonably useful for different populations and contextual characteristics). The upper boundary may be represented by the 15 points for the DASH and 20 points for the QuickDASH proposed by the DASH website. J Orthop Sports Phys Ther 2014;44(1):30–39. Epub 30 October 2013. doi:10.2519/jospt.2014.4893

Right-to-left shunt (RLS), usually due to patent foramen ovale, is a well-established risk factor for ischemic stroke in young patients, while the role of migraine as an independent factor is still debated. We evaluated 44 patients suffering from migraine with aura, and compared them with 73 patients younger than 50 with focal cerebral ischemia, and 50 controls, asymptomatic for cerebrovascular disease, and without a history of migraine. All the subjects underwent bilateral transcranial Doppler with injection of contrast medium in an antecubital vein. The test was performed during normal ventilation and during Valsalva maneuver, recording both the middle cerebral arteries and the basilar artery. Criteria for diagnosing RLS was the presence of at least 3 microbubbles within 15 s from injection. Eighteen out of 44 migraine patients (41%) showed RLS, as opposed to 8 of 50 controls (16%) (p < 0.005). Twenty-six out of 73 patients with cerebral ischemia had RLS (35%). We conclude that the prevalence of RLS in patients with migraine with aura is significantly higher than in normal controls, and is similar to the prevalence of RLS in young patients with stroke. These findings could be helpful in understanding the relationship between migraine and stroke.

The aim of this study was to assess the reliability of a smartphone-based application developed for photographic-based goniometry, DrGoniometer (DrG), by comparing its measurement of the knee joint angle with that made by a universal goniometer (UG). Joint goniometry is a common mode of clinical assessment used in many disciplines, in particular in rehabilitation. One validated method is photographic-based goniometry, but the procedure is usually complex: the image has to be downloaded from the camera to a computer and then edited using dedicated software. This disadvantage may be overcome by the new generation of mobile phones (smartphones) that have computer-like functionality and an integrated digital camera. This validation study was carried out under two different controlled conditions: (i) with the participant to measure in a fixed position and (ii) with a battery of pictures to assess. In the first part, four raters performed repeated measurements with DrG and UG at different knee joint angles. Then, 10 other raters measured the knee at different flexion angles ranging 20-145° on a battery of 35 pictures taken in a clinical setting. The results showed that inter-rater and intra-rater correlations were always more than 0.958. Agreement with the UG showed a width of 18.2° [95% limits of agreement (LoA)=-7.5/+10.7°] and 14.1° (LoA=-6.6/+7.5°). In conclusion, DrG seems to be a reliable method for measuring knee joint angle. This mHealth application can be an alternative/additional method of goniometry, easier to use than other photographic-based goniometric assessments. Further studies are required to assess its reliability for the measurement of other joints.

To date, VSS is the most widely used rating scale for scars but POSAS appears the most comprehensive, taking into account the important aspect of patient's perspective. The MSS has been never used for research, while SBSES has only been very recently proposed.