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Open Access 01-12-2021 | Research article

Development and validation of a shoulder-specific body-perception questionnaire in people with persistent shoulder pain

Authors: Tomohiko Nishigami, Akihisa Watanabe, Toshiki Maitani, Hayato Shigetoh, Akira Mibu, Benedict Martin Wand, Mark J. Catley, Tasha R. Stanton, G. Lorimer Moseley

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

Abstract

Background

There is evidence that people with persistent shoulder pain exhibit findings consistent with the presence of sensorimotor dysfunction. Sensorimotor impairments can manifest in a variety of ways, and further developing our understanding of sensorimotor dysfunction in shoulder pain may improve current models of care. The Fremantle Back Awareness Questionnaire (FreBAQ) has been developed to assess disturbed body perception specific to the back. The purpose of the present study was to develop a shoulder-specific self-perception questionnaire and evaluate the questionnaire in people with persistent shoulder pain.

Methods

The Fremantle Shoulder Awareness Questionnaire (FreSHAQ-J) was developed by modifying the FreBAQ. One hundred and twelve consecutive people with persistent shoulder pain completed the FreSHAQ-J. Thirty participants completed the FreSHAQ-J again two-weeks later to assess test-retest reliability. Rasch analysis was used to assess the psychometric properties of the FreSHAQ-J. Associations between FreSHAQ-J total score and clinical status was explored using correlational analysis.

Results

The FreSHAQ-J has acceptable category order, unidimensionality, no misfitting items, and excellent test-retest reliability. The FreSHAQ-J was moderately correlated with disability and pain catastrophization.

Conclusions

The FreSHAQ-J fits the Rasch measurement model well and is suitable for use with people with shoulder pain. Given the relationship between the FreSHAQ-J score and clinical status, change in body perception may be worth assessing when managing patients with shoulder pain.

Urwin M, Symmons D, Allison T, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis. 1998;57:649–55. https://doi.org/10.1136/ard.57.11.649.CrossRefPubMedPubMedCentral

Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73–81. https://doi.org/10.1080/03009740310004667.CrossRefPubMed

Croft P, Pope D, Silman A. The clinical course of shoulder pain: prospective cohort study in primary care. Primary care rheumatology society shoulder study group. BMJ. 1996;313:601–2.CrossRef

Van der Windt DAWM, Koes BW, Boeke AJ. Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract. 1996;46:519–23.PubMedPubMedCentral

Johansson K, Oberg B, Adolfsson L, Foldevi M. A combination of systematic review and clinicians’ beliefs in interventions for subacromial pain. Br J Gen Pract. 2002;52:145–52.PubMedPubMedCentral

Seitz AL, McClure PW, Finucane S, Boardman ND 3rd, Michener LA. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech. 2011;26:1–12. https://doi.org/10.1016/j.clinbiomech.2010.08.001.CrossRef

Paul TM, Soo Hoo J, Chae J, Wilson RD. Central hypersensitivity in patients with subacromial impingement syndrome. Arch Phys Med Rehabil. 2012;93:2206–9. https://doi.org/10.1111/papr.12502.CrossRefPubMedPubMedCentral

Coronado RA, Simon CB, Valencia C, George SZ. Experimental pain responses support peripheral and central sensitization in patients with unilateral shoulder pain. Clin J Pain. 2014;30:143–51. https://doi.org/10.1097/AJP.0b013e318287a2a4.CrossRefPubMed

Sanchis MN, Lluch E, Nijs J, Struyf F, Kangasperko M. The role of central sensitization in shoulder pain: a systematic literature review. Semin Arthritis Rheum. 2015;44:710–6. https://doi.org/10.1016/j.semarthrit.2014.11.002.CrossRefPubMed

10.

Bachasson D, Singh A, Shah SB, Lane JG, Ward SR. The role of the peripheral and central nervous systems in rotator cuff disease. J Shoulder Elb Surg. 2015;24:1322–35. https://doi.org/10.1016/j.jse.2015.04.004.CrossRef

11.

Noten S, Struyf F, Lluch E, D’Hoore M, Van Looveren E, Meeus M. Central pain processing in patients with shoulder pain: a review of the literature. Pain Pract. 2017;17:267–80.CrossRef

12.

Berth A, Pap G, Awiszus F, Neumann W. Central motor deficits of the deltoid muscle in patients with chronic rotator cuff tears. Acta Chir Orthop Traumatol Cechoslov. 2009;76:456–61.

13.

Fyhr C, Gustavsson L, Wassinger C, Sole G. The effects of shoulder injury on kinaesthesia: a systematic review and meta-analysis. Man Ther. 2015;20:28–37. https://doi.org/10.1016/j.math.2014.08.006.CrossRefPubMed

14.

Bradnam L, Shanahan EM, Hendy K, Reed A, Skipworth T, Visser A, et al. Afferent inhibition and cortical silent periods in shoulder primary motor cortex and effect of a suprascapular nerve block in people experiencing chronic shoulder pain. Clin Neurophysiol. 2016;127:769–78. https://doi.org/10.1016/j.clinph.2015.03.012.CrossRefPubMed

15.

Smith RL, Brunolli J. Shoulder kinesthesia after anterior glenohumeral dislocation. Phys Ther. 1989;69:106–12.CrossRef

16.

Jerosch J, Wüstner P. Effect of a sensorimotor training program on patients with subacromial pain syndrome. Unfallchirurg. 2002;105:36Y43.

17.

Swanik KA, Lephart SM, Swanik CB, Lephart SP, Stone DA, Fu FH. The effects of shoulder plyometric training on proprioception and selected muscle performance characteristics. J Shoulder Elb Surg. 2002;11:579–86. https://doi.org/10.1067/mse.2002.127303.CrossRef

18.

Anderson VB, Wee E. Impaired joint proprioception at higher shoulder elevations in chronic rotator cuff pathology. Arch Phys Med Rehabil. 2011;92:1146–51. https://doi.org/10.1016/j.apmr.2011.02.004.CrossRefPubMed

19.

Botnmark I, Tumilty S, Mani R. Tactile acuity, body schema integrity and physical performance of the shoulder: a cross-sectional study. Man Ther. 2016;23:9–16. https://doi.org/10.1016/j.math.2016.02.001.CrossRefPubMed

20.

Worsley P, Warner M, Mottram S, Gadola S, Veeger HE, Hermens H, et al. Motor control retraining exercises for shoulder impingement: effects on function, muscle activation, and biomechanics in young adults. J Shoulder Elb Surg. 2013;22:e11–9. https://doi.org/10.1016/j.jse.2012.06.010.CrossRef

21.

Lephart SM, Warner JP, Borsa PA, Fu FH. Proprioception of the shoulder joint in normal, unstable and surgical individuals. J Shoulder Elb Surg. 1994;3:371Y80. https://doi.org/10.1016/S1058-2746(09)80022-0.CrossRef

22.

Marzetti E, Rabini A, Piccinini G, Piazzini DB, Vulpiani MC, Vetrano M, et al. Neurocognitive therapeutic exercise improves pain and function in patients with shoulder impingement syndrome; a single blinded randomized controlled trial. Eur J Phys Rehabil Med. 2014;50:255Y64.

23.

Louw A, Puentedura EJ, Reese D, Parker P, Miller T, Mintken PE. Immediate effects of Mirror therapy in patients with shoulder pain and decreased range of motion. Arch Phys Med Rehabil. 2017;98(10):1941–7. https://doi.org/10.1016/j.apmr.2017.03.031.CrossRefPubMed

24.

Sawyer EE, McDevitt AW, Louw A, Puentedura EJ, Mintken PE. Use of pain neuroscience education, tactile discrimination, and graded motor imagery in an individual with frozen shoulder. J Orthop Sports Phys Ther. 2018;48:174–84. https://doi.org/10.2519/jospt.2018.7716.CrossRefPubMed

25.

Pazzaglia M, Zantedeschi M. Plasticity and awareness of bodily distortion. Neural Plast. 2016;2016:9834340. https://doi.org/10.1155/2016/9834340.CrossRefPubMedPubMedCentral

26.

Cohen M, Quintner J, van Rysewyk S. Reconsidering the International Association for the Study of Pain definition of pain. Pain Rep. 2018;3:e634. https://doi.org/10.1097/PR9.0000000000000634.CrossRefPubMedPubMedCentral

27.

Galer GS, Jensen M. Neglect-like symptoms in complex regional pain syndrome: results of a self-administered survey. J Pain Symptom Manag. 1999;18(3):213–7.CrossRef

28.

Lewis JS, Schweinhardt P. Perceptions of the painful body: the relationship between body perception disturbance, pain and tactile discrimination in complex regional pain syndrome. Eur J Pain. 2012;16(9):1320–30. https://doi.org/10.1002/j.1532-2149.2012.00120.x.CrossRefPubMed

29.

Wand BM, James M, Abbaszadeh S, George PJ, Formby PM, Smith AJ, et al. Assessing self-perception in patients with chronic low back pain: development of a back-specific body-perception questionnaire. J Back Musculoskelet Rehabil. 2014;27:463–73. https://doi.org/10.3233/BMR-140467.CrossRefPubMed

30.

Nishigami T, Mibu A, Tanaka K, Yamashita Y, Shimizu ME, Wand BM, et al. Validation of the Japanese version of the Fremantle Back awareness questionnaire in patients with low Back pain. Pain Pract. 2018;18:170–9. https://doi.org/10.1111/papr.12586.CrossRefPubMed

31.

Janssens L, Goossens N, Wand BM, Pijnenburg M, Thys T, Brumagne S. The development of the Dutch version of the Fremantle Back awareness questionnaire. Musculoskelet Sci Pract. 2017;32:84. https://doi.org/10.1016/j.msksp.2017.09.003.CrossRefPubMed

32.

Ehrenbrusthoff K, Ryan CG, Grüneberg C, Wand BM, Martin DJ. The translation, validity and reliability of the German version of the Fremantle Back awareness questionnaire. PLoS One. 2018;13:e0205244. https://doi.org/10.1371/journal.pone.0205244 eCollection 2018.CrossRefPubMedPubMedCentral

33.

Wand BM, Catley MJ, Rabey MI, O'Sullivan PB, O'Connell NE, Smith AJ. Disrupted self-perception in people with chronic low Back pain. Further evaluation of the Fremantle Back awareness questionnaire. J Pain. 2016;17:1001–12. https://doi.org/10.1016/j.jpain.2016.06.003.CrossRefPubMed

34.

Nishigami T, Mibu A, Tanaka K, Yamashita Y, Yamada E, Wand BM, et al. Development and psychometric properties of knee-specific body-perception questionnaire in people with knee osteoarthritis: the Fremantle knee awareness questionnaire. PLoS One. 2017;12:e0179225. https://doi.org/10.1371/journal.pone.0179225.CrossRefPubMedPubMedCentral

35.

Azimi P, Shahzadi S, Azhari S, Montazeri A. A validation study of the Iranian version of STarT Back screening tool (SBST) in lumbar central canal stenosis patients. J Orthop Sci. 2014;19(2):213–7. https://doi.org/10.1007/s00776-013-0506-y.CrossRefPubMed

36.

Butera KA, Lentz TA, Beneciuk JM, George SZ. Preliminary evaluation of a modified STarT Back screening tool across different musculoskeletal pain conditions. Phys Ther. 2016;96:1251–61. https://doi.org/10.2522/ptj.20150377.CrossRefPubMedPubMedCentral

37.

Hill JC, Afolabi EK, Lewis M, et al. Does a modified STarT Back tool predict outcome with a broader group of musculoskeletal patients than back pain? A secondary analysis of cohort data. BMJ Open. 2016;6:e012445. https://doi.org/10.1136/bmjopen-2016-012445.CrossRefPubMedPubMedCentral

38.

Bier JD, Ostelo RWJG, Koes BW, Verhagen AP. Validity and reproducibility of the modified STarT Back tool (Dutch version) for patients with neck pain in primary care. Musculoskelet Sci Pract. 2017;31:22–9. https://doi.org/10.1016/j.msksp.2017.06.006.CrossRefPubMed

39.

van Baar ME, Dekker J, Oostendorp RA, et al. The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial. J Rheumatol. 1998;25:2432–9.PubMed

40.

George SZ, Fritz JM, Erhard RE. A comparison of fear-avoidance beliefs in patients with lumbar spine pain and cervical spine pain. Spine (Phila Pa 1976). 2001;26:2139–45.CrossRef

41.

George SZ, Stryker SE. Fear-avoidance beliefs and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain conditions. J Orthop Sports Phys Ther. 2011;41:249–59.CrossRef

42.

Scopaz KA, Piva SR, Wisniewski S, Fitzgerald GK. Relationships of fear, anxiety, and depression with physical function in patients with knee osteoarthritis. Arch Phys Med Rehabil. 2009;90:1866–73.CrossRef

43.

Linacre JM. Sample size and item calibration stability. Rasch Meas Transac. 1994;7:328.

44.

Chen WH, Lenderking W, Jin Y, Wyrwich KW, Gelhorn H, Revicki DA. Is Rasch model analysis applicable in small sample size pilot studies for assessing item characteristics? An example using PROMIS pain behavior item bank data. Qual Life Res. 2014;23(2):485–93.CrossRef

45.

Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7:524–32.CrossRef

46.

Matsuoka H, Sakano Y. Assessment of cognitive aspect of pain: development, reliability, and validation of Japanese version of pain Catastrophizing scale. Jpn J Psychosom Med. 2007;47:95–102.

47.

Beaton DE, Wright JG, Katz JN. Development of the QuickDASH: comparison of the three item-reduction approaches. J Bone Joint Surg Am. 2005;87:1038–46. https://doi.org/10.2106/JBJS.D.02060.CrossRefPubMed

48.

Imaeda T, Toh S, Wada T, Uchiyama S, Okinaga S, Kusunose K, et al. Validation of the Japanese Society for Surgery of the hand version of the quick disability of the arm, shoulder, and hand (QuickDASH-JSSH) questionnaire. J Orthop Sci. 2006;11:248–53. https://doi.org/10.1007/s00776-006-1013-1.CrossRefPubMedPubMedCentral

49.

Linacre JM. Optimizing rating scale category effectiveness. J Appl Meas. 2002;3:85–106.PubMed

50.

Bond TG, Fox CM. Applying the Rasch model: fundamental measurement in the human sciences. 2nd ed. Mahwah: Lawrence Erlbaum Associates Inc; 2007.

51.

Cronbach LJ, Shavelson RJ. My current thoughts on coefficient alpha and successor procedures. Educ Psychol Meas. 2004;64:391–418. https://doi.org/10.1177/0013164404266386.CrossRef

52.

Tennant A, Conaghan PG. The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper? Arthritis Rheum. 2007;57:1358–62. https://doi.org/10.1002/art.23108.CrossRefPubMed

53.

Wright BD, Linacre JM. Reasonable mean-square fit values. Rasch Measurement Transactions. 1994;8:370.

54.

Linacre JM. A User’s guide to WINSTEPS. Chicago: Winsteps.com; 2005.

55.

Tennant A, McKenna SP, Hagell P. Application of Rasch analysis in the development and application of quality of life instruments. Value Health. 2004;7(Suppl 1):S22–6. https://doi.org/10.1111/j.1524-4733.2004.7s106.x.CrossRefPubMed

56.

Ramp M, Khan F, Misajon RA, Pallant JF. Rasch analysis of the multiple sclerosis impact scale MSIS-29. Health Qual Life Outcomes. 2009;7:58. https://doi.org/10.1186/1477-7525-7-58.CrossRefPubMedPubMedCentral

57.

Moreton BJ, Walsh DA, Turner KV, Lincoln NB. Rasch analysis of the chronic pain acceptance questionnaire revised in people with knee osteoarthritis. J Rehabil Med. 2015;47:655–61. https://doi.org/10.2340/16501977-1977.CrossRefPubMed

58.

Fisher RA. On the interpretation of χ2 from contingency tables, and the calculation of P. J R Stat Soc. 1922;85:87–94.CrossRef

59.

Hungi N. Employing the Rasch modelto detect biased items. In: Alagumalai S, Curtis D, Hungi N, editors. Applied Rasch measurement: a book of exemplars. Dordrecht: Springer; 2005.

60.

Fleiss JL. Reliability of measurement. In: Fleiss JL, editor. The design and analysis of clinical experiments. New York: John Wiley & Sons, Inc; 1999.CrossRef

61.

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum; 1998.

62.

de Vignemont F. Body schema and body image--pros and cons. Neuropsychologia. 2010;48(3):669–80.CrossRef

63.

Viceconti A, Camerone EM, Luzzi D, Pentassuglia D, Pardini M, Ristori D, et al. Explicit and implicit Own's body and space perception in painful musculoskeletal disorders and rheumatic diseases: a systematic scoping review. Front Hum Neurosci. 2020;14:83.CrossRef

64.

Streiner DL, Norman GR. Health measurement scales: a guide to their development and use. 3rd ed. New York: Oxford University Press Inc.; 2003.

65.

Mallinson T. Why measurement matters for measuring patient vision outcomes. Optom Vis Sci. 2007;84:675–82. https://doi.org/10.1097/OPX.0b013e3181339f44.CrossRefPubMed

66.

van Dieen J, Selen LPJ, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol. 2003;13:333–51. https://doi.org/10.1016/S1050-6411(03)00041-5.CrossRefPubMed

67.

Hodges PW. Pain and motor control: from the laboratory to rehabilitation. J Electromyogr Kinesiol. 2011;21:220–8. https://doi.org/10.1016/j.jelekin.2011.01.002.CrossRefPubMed

68.

Bowering KJ, Butler DS, Fulton IJ, Moseley GL. Motor imagery in people with a history of back pain, current back pain, both, or neither. Clin J Pain. 2014;30:1070–5. https://doi.org/10.1097/AJP.0000000000000066.CrossRefPubMed

69.

Lotze M, Moseley GL. Role of distorted body image in pain. Curr Rheumatol Rep. 2007;9:488–96. https://doi.org/10.1007/s11926-007-0079-x.CrossRef

70.

Lee H, Lamb SE, Bagg MK, Toomey E, Cashin AG, Moseley GL. Reproducible and replicable pain research: a critical review. Pain. 2018;159(9):1683–9. https://doi.org/10.1097/j.pain.0000000000001254.

Title: Development and validation of a shoulder-specific body-perception questionnaire in people with persistent shoulder pain
Authors: Tomohiko Nishigami
Akihisa Watanabe
Toshiki Maitani
Hayato Shigetoh
Akira Mibu
Benedict Martin Wand
Mark J. Catley
Tasha R. Stanton
G. Lorimer Moseley
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-021-03944-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Development and validation of a shoulder-specific body-perception questionnaire in people with persistent shoulder pain

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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