Introduction
Methods
Study design
Setting and sample
Data collection
Analysis
Groups | Patients who have received treatment (n = 6) | Patients yet to be exposed to treatment (n = 4) | Clinicians (n = 6) | Measurement Researchers (n = 10) |
---|---|---|---|---|
Mean age (years) | 76 | 44 | 34 | 31 |
Female (%) | 67 | 50 | 50 | 50 |
Male (%) | 33 | 50 | 50 | 50 |
Professional status (%) | ||||
Student | 0 | 25 | 33 | 100 |
Employed | 33 | 50 | 67 | 0 |
Unemployed | 0 | 0 | 0 | 0 |
Sick-leave | 0 | 0 | 0 | 0 |
Retired | 67 | 25 | 0 | 0 |
Affected shoulder (%) | ||||
Left | 33 | 25 | N/A | N/A |
Right | 50 | 25 | N/A | N/A |
Bilateral | 17 | 50 | N/A | N/A |
Diagnosis (%) | ||||
Shoulder pain | 67 | 75 | N/A | N/A |
Rotator cuff tear | 67 | 25 | N/A | N/A |
TSA | 67 | 0 | N/A | N/A |
OA | 67 | 0 | N/A | N/A |
Results
Item | Comprehension | Perspective Modifiers | Reference Point | Calibration Across Items | Inadequate Response definition | Relevance |
---|---|---|---|---|---|---|
1. Sleeping | Understood well | Overall, found to be relevant (73%) Few participants felt it was only relevant if the injured arm was slept on. | ||||
2. Styling your hair | Understod well | Gender issues arose (30%). E.x. men who were bald found this inapplicable | Some participants calibrated this answer with the item of sleeping (19%) | Overall, relevant to 79% of participants | ||
3. Dressing or undressing | Understood well | Some gender issues arose, i.e. men who did not rate this item as important (19%) | Some participants calibrated this answer with the item of sleeping and styling hair (19%) | Overall, relevant to 70% of participants | ||
4. Daily activities about the house or yard | Some comprehension issues with defining daily activities and yard work | Overall was relevant for 80% of participants 12% found work in the yard irrelevant to their Qol | ||||
5. Working above the shoulder | Understood well | Overall, 90% of participants found it was relevant to their QoL | ||||
6. Compensate with unaffected arm | Understood well | 88% of participants found this relevant to their QoL. 12% found if the injury was on the non-dominant hand it was not relevant. | ||||
7. Lifting heavy objects at or below shoulder level | Understood well | 92% of participants found this to be relevant to QoL |
Short-WORC items
Instructions on short- WORC
Some participants also struggled with the interpretation of the word “lifestyle”. When asked to define, the majority of participants associated lifestyle with only activities of daily living.“Okay so here I have to answer and think about my lifestyle and what I do on an average day in the week, and how much my shoulder has been kinda affecting or altering those activities.” – Measurement Researcher #1, female
“Lifestyle is my activities during the day. Would the term activities of daily living be better suited instead of lifestyle, is this what you are asking?” - Clinician #4, female
Additionally, some participants in the patient group (19%) described compensator strategies that allowed them to sleep better at night. Participants in the patient groups further discussed themes of intense shoulder pain, which translated to modifications of their sleeping position to comfortably rest.“I always sleep on my left side so my right shoulder (injured) is fine at night.”- Patient #8, female
“Since the surgery was on my left shoulder, my left shoulder was out, and so I mostly slept on my back.” – patient #4, male.
Furthermore, some participants in the group of patients who had not received treatment (19%), used the item of sleeping, as a reference point to calibrate their response to the item of styling your hair. Additionally, female participants in the patient group and measurement researcher group identified that styling their hair was critical to their QoL, and so needed to compensate with the uninjured arm, seek assistance or allot more time in their day for styling.“I’m bald, I don’t need to style my hair!” – Patient #5, male.
“If I were to injure my shoulder, I would still style my hair …I would get someone (roommate) to just help me out if I needed a specific style.”- Measurement Researcher #1, female.
Furthermore, participants in the patient group identified the importance of completing this task and the need to compensate to complete it. Strategies for compensation included: requiring assistance from a device or family member, increasing the allotted time for changing of clothes, or changing the types of clothing worn in order to decrease shoulder movement.“I would say my answer would be the same as styling my hair…if I chose 5 or 6 in question 2, then I would choose the same answer for question 3.” – Measurement Researcher #2, male
“I can’t reach my back to put on my bra…that’s why my husband helps me out.” – Patient #6, female.
In contrast, definitions of “about the house or the yard” resulted in phrases of: “chores, eating, cleaning, cooking, gardening and yard /outdoors work”. Only one female participant in the clinician group initially misinterpreted the meaning of about the house or yard, and defined it as occupational labour that involves working outdoors.“Yeah my daily activities are defined by my work and hobbies. My life is my job, family and other activities I do.” – Patient #5, female.
Overall, all participants in all groups (80%) identified this item to be relevant to their overall quality of life, but some (12%) were concerned with the phrasing of “work in the yard”. Due to patient participants’ living conditions, some did not require the need to do yard work, i.e. living in an apartment or having designated help prior to the injury.“This means work outside of the house like employment that you get paid for or yard work. This is both inside or outside the house and external jobs…that’s what I think”- Clinician #6, Female
Additionally, some compensatory strategies were mentioned from patients such as: seeking assistance from someone else to do their daily activities or modifying the time period or frequency of activities they participated in.“No, I do not do any yard work, my husband always does that.” – Patient #8, female.
Definitions of “working above the shoulder” included phrases such as: “overhead reaching, lifting above my head and raising my arms”, indicating comprehension was generally good for this item. Participants in the patient group frequently mentioned compensating strategies in order to continue to work above shoulder level, such as: modifying the placement of items for easier access or seeking assistance when needing to reach above shoulder level.“I have an office job, I don’t need to raise my arms much.” – Patient #8, female.
“I try to use my left hand a lot more to help out and then I keep things within reach. The shelves are much lower in my house and if something is too high for me I use a step ladder.” – Patient #10, female.
In contrast, some female participants in the patient group (12%) indicated that compensating was less relevant, as their injury was on their non-dominant arm.“I use my left hand a lot, which is much harder since I am very right-hand dominant.” – patient #6, female.
“I am right handed; my injury was on my left shoulder…do I compensate? Not frequently”.– Patient #3, female.
Additionally, some participants in the patient group discussed compensatory strategies such as re-allocating the task to someone else in order to feel less discomfort.“I do some yard work and cleaning that can be difficult to bend and pick up things from time to time...I think something in the middle?”- Patient, #3, female
“Now with the snow coming, I will have to shovel myself since the weather is bad and I will have to find help.”- Patient #7, female.