What are People That Seek Care for Rotator Cuff Tendinopathy Experiencing in Their Daily Life?

This qualitative study sought to answer three questions: What is it like to live with rotator cuff tendinopathy? What are the barriers and facilitators of a healthy lifestyle with an aging shoulder? And, what are the outcomes that matter most to people seeking care for rotator cuff tendinopathy? Patients diagnosed with rotator cuff tendinopathy participated in group discussions using semi-structured guides that focus on diagnosis, daily experiences living with rotator cuff tendinopathy, goals, concerns, and clinical care experiences. A hybrid of initial inductive coding of themes and subsequent deductive consideration of these themes within the capability, comfort, and calm framework was utilized. Themes associated with rotator cuff tendinopathy were less restful sleep, difficulty with work and life transitions, loss of baseline abilities, and limitation in social roles in the capability realm; physical pain, despair, and loneliness in the comfort realm; and lack of direction or progress and feeling uncared for in the calm realm. Barriers identified included: the sense that rotator cuff tendinopathy is something correctable rather than age-associated and the sense that painful activities will make the tendinopathy worse (common misconceptions); tenuous relationships and limited trust with clinicians; loss of hope; and a sense that care is directionless. What matters most to a person seeking specialty care for shoulder pain are feeling that they are getting effective care and not being dismissed; maintaining meaningful activity and life roles; and replacing despair and frustration with hope and progress. Anticipating these needs may facilitate the design of more effective care models. Level of Evidence: N/A.

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The Value of Real-World Data in Understanding Prostate Cancer Risk and Improving Clinical Care: Examples from Swedish Registries

Cancers ◽

10.3390/cancers13040875 ◽

2021 ◽

Vol 13 (4) ◽

pp. 875

Author(s):

Kerri Beckmann ◽

Hans Garmo ◽

Ingela Franck Lissbrant ◽

Pär Stattin

Keyword(s):

Prostate Cancer ◽

Real World ◽

Clinical Care ◽

Prostate Cancer Risk ◽

Real World Data ◽

Level Of Evidence ◽

World Data ◽

Cancer Data ◽

Using Data ◽

Randomised Controlled

Real-world data (RWD), that is, data from sources other than controlled clinical trials, play an increasingly important role in medical research. The development of quality clinical registers, increasing access to administrative data sources, growing computing power and data linkage capacities have contributed to greater availability of RWD. Evidence derived from RWD increases our understanding of prostate cancer (PCa) aetiology, natural history and effective management. While randomised controlled trials offer the best level of evidence for establishing the efficacy of medical interventions and making causal inferences, studies using RWD offer complementary evidence about the effectiveness, long-term outcomes and safety of interventions in real-world settings. RWD provide the only means of addressing questions about risk factors and exposures that cannot be “controlled”, or when assessing rare outcomes. This review provides examples of the value of RWD for generating evidence about PCa, focusing on studies using data from a quality clinical register, namely the National Prostate Cancer Register (NPCR) Sweden, with longitudinal data on advanced PCa in Patient-overview Prostate Cancer (PPC) and data linkages to other sources in Prostate Cancer data Base Sweden (PCBaSe).

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Ultrasonographic Evaluation of the Shoulders and Its Associations with Shoulder Pain, Age, and Swim Training in Masters Swimmers

Medicina ◽

10.3390/medicina57010029 ◽

2020 ◽

Vol 57 (1) ◽

pp. 29

Author(s):

Yuta Suzuki ◽

Noriaki Maeda ◽

Junpei Sasadai ◽

Kazuki Kaneda ◽

Taizan Shirakawa ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Pain ◽

Structural Changes ◽

Partial Tear ◽

Increased Risk ◽

High Prevalence ◽

History Of ◽

Long Head ◽

Competitive Swimmers ◽

Rotator Cuff Tendinopathy

Background and objectives: The long head of the biceps (LHB) and rotator cuff tendinopathy is the major cause of shoulder pain in competitive swimmers. The risk of tendinopathy increases with aging; however, the structural changes of LHB and rotator cuff in populations of masters swimmers have not been well examined. The purpose of this study was to investigate the prevalence of ultrasonographic abnormalities of the shoulders in masters swimmers, and the association of pain, age, and swim training with structural changes in this population. Materials and Methods: A total of 60 subjects participated in this study, with 20 masters swimmers with shoulder pain, 20 asymptomatic masters swimmers, and 20 sex- and age-matched controls. All swimmers completed a self-reported questionnaire for shoulder pain, their history of competition, and training volume. Each subject underwent ultrasonographic examination of both shoulders for pathologic findings in the LHB tendon, rotator cuff (supraspinatus (SSP) and subscapularis (SSC)) tendons, and subacromial bursa (SAB) of both shoulders and had thickness measured. Results: The prevalence of tendinosis (LHB, 48.8%; SSP, 17.5%; SSC, 15.9%), partial tear (SSP, 35.0%), and calcification (SSC, 10.0%) were higher in swimmers than in controls. LHB and SSP tendinosis were associated with shoulder pain. Older age and later start of competition were associated with an increased risk of LHB tendinosis and SSC calcification. Earlier initiation of swimming and longer history of competition were associated with an increased risk of SSP and SSC tendinosis. The thicker SSP tendon significantly increased the risk of tendinosis and partial tear. Conclusions: A high prevalence of structural changes in the rotator cuff and biceps tendons in masters swimmers reflects the effect of shoulder symptoms, aging, and swim training.

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The role of a clinician amid the rise of mobile health technology

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocz131 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1385-1388 ◽

Cited By ~ 1

Author(s):

William E Yang ◽

Lochan M Shah ◽

Erin M Spaulding ◽

Jane Wang ◽

Helen Xun ◽

...

Keyword(s):

Mobile Health ◽

Healthy Lifestyle ◽

Clinical Care ◽

Critical Role ◽

Lifestyle Changes ◽

Mhealth Intervention ◽

Early Results ◽

Modification Technique ◽

Behavior Modification Technique

Abstract Mobile health (mHealth) interventions have demonstrated promise in improving outcomes by motivating patients to adopt and maintain healthy lifestyle changes as well as improve adherence to guideline-directed medical therapy. Early results combining behavioral economic strategies with mHealth delivery have demonstrated mixed results. In reviewing these studies, we propose that the success of a mHealth intervention links more strongly with how well it connects patients back to routine clinical care, rather than its behavior modification technique in isolation. This underscores the critical role of clinician-patient partnerships in the design and delivery of such interventions, while also raising important questions regarding long-term sustainability and scalability. Further exploration of our hypothesis may increase opportunities for multidisciplinary clinical teams to connect with and engage patients using mHealth technologies in unprecedented ways.

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Development of a self-managed loaded exercise programme for rotator cuff tendinopathy

Physiotherapy ◽

10.1016/j.physio.2012.12.002 ◽

2013 ◽

Vol 99 (4) ◽

pp. 358-362 ◽

Cited By ~ 15

Author(s):

Chris Littlewood ◽

Peter Malliaras ◽

Sue Mawson ◽

Stephen May ◽

Stephen Walters

Keyword(s):

Rotator Cuff ◽

Exercise Programme ◽

Rotator Cuff Tendinopathy

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Structural vulnerability: migration and health in social context

BMJ Global Health ◽

10.1136/bmjgh-2021-005109 ◽

2021 ◽

Vol 6 (Suppl 1) ◽

pp. e005109

Author(s):

Lauren Carruth ◽

Carlos Martinez ◽

Lahra Smith ◽

Katharine Donato ◽

Carlos Piñones-Rivera ◽

...

Keyword(s):

Clinical Care ◽

Professional Associations ◽

Humanitarian Assistance ◽

Structural Vulnerability ◽

Global Migration ◽

Humanitarian Interventions ◽

Care Models ◽

The Usa ◽

Mexico Border ◽

Training And Support

Based on the authors’ work in Latin America and Africa, this article describes and applies the concept ‘structural vulnerability’ to the challenges of clinical care and healthcare advocacy for migrants. This concept helps consider how specific social, economic and political hierarchies and policies produce and pattern poor health in two case studies: one at the USA–Mexico border and another in Djibouti. Migrants’ and providers’ various entanglements within inequitable and sometimes violent global migration systems can produce shared structural vulnerabilities that then differentially affect health and other outcomes. In response, we argue providers require specialised training and support; professional associations, healthcare institutions, universities and humanitarian organisations should work to end the criminalisation of medical and humanitarian assistance to migrants; migrants should help lead efforts to reform medical and humanitarian interventions; and alternative care models in Global South to address the structural vulnerabilities inherent to migration and asylum should be supported.

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Is manual therapy efficacious for the treatment of rotator cuff tendinopathy: a systematic review and meta-analysis

Physiotherapy ◽

10.1016/j.physio.2015.03.508 ◽

2015 ◽

Vol 101 ◽

pp. e309-e310

Author(s):

A. Desjardins-Charbonneau ◽

J.-S. Roy ◽

C.E. Dionne ◽

P. Frémont ◽

J.C. MacDermid ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Manual Therapy ◽

Meta Analysis ◽

Rotator Cuff Tendinopathy

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Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546518801014 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3155-3164 ◽

Cited By ~ 9

Author(s):

Vasanth Seker ◽

Lisa Hackett ◽

Patrick H. Lam ◽

George A.C. Murrell

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

External Rotation ◽

Case Series ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Level Of Evidence ◽

Irreparable Tear ◽

Pain At Rest

Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.

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Uncovering the Truth

American Journal of Lifestyle Medicine ◽

10.1177/1559827617737938 ◽

2017 ◽

Vol 12 (1) ◽

pp. 49-50

Author(s):

George E. Guthrie

Keyword(s):

Randomized Controlled Trial ◽

Basic Science ◽

Healthy Lifestyle ◽

Controlled Trial ◽

Lifestyle Changes ◽

Level Of Evidence ◽

Lifestyle Medicine ◽

Randomized Controlled ◽

Standards Of Practice ◽

Guidelines And Standards

Finding the truth is important. In the field of lifestyle medicine the randomized controlled trial has significant limitations. Physicians and patients need to know the truth about the healthy lifestyle changes and their ability to prevent and reverse disease. To meet this challenge, the American College of Lifestyle Medicine has established a committee of experts (HEaLM), under the leadership of David Katz to create a level of evidence construct for ranking lifestyle medicine evidence that includes evidence from basic science and epidemiologic trials. This tool will be used by the new Expert Lifestyle Medicine Panel to create guidelines and standards of practice.

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