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    PRESENTASE JURNAL DI RSUD. DAYA MAKASSAR DISUSUN OLEH : SAHRUNI. ABDULLAH PO.71.5.241.19.2.010 POLTEKKES KEMENKES MAKASSAR JURUSAN FISIOTERAPI TAHUN AJARAN 2020 Dipindai dengan CamScanner MBAR PENGESAHAN, Laporan Presentase Jumal di RSUD. Daya Kota Makassar mulai tanggal 02 Januari 2020 sampai dengan tanggal 31 Januari 2020 dengan judul kasus “The effect of axioscapular and rotator cuff exereise training sequence in patient with subacromial impingement syndrom ” telah disctujui oleh Pembimbing Lahan (Clinical Educator) dan Preceptor (Dosen). Makassar, 25 Januari 2020 Clinical Educator, Preceptor, miati JanifS. Ft Hj. Hasbiah, S.ST.Ft., M. Kes NIP. gsostgpente4 021 NIP. Dipindai dengan CamScanner KATA PENGANTAR Puji Syukur penulis panjatkan kepada Allah SWT yang telah memberikan rahmat dan karunianya, schingga penulis dapat menyelesaikan laporan presentase jurnal ini dengan tepat waktu meskipun masih jauh dari tahap kesempurnaan. Praktek Klinik ini merupakan matakuliah Profesi Fisioterapi yang wajib ditempuh di Kampus Jurusan Fisioterapi. Adapun sub bagian dari laporan ini adalah analisis picot dari hasil penelitian internasional pada “The effect Of axioscapular and rotator cuff exercise training sequence in patient with subacromial impingement syndrom ” Dengan terselesaikannya laporan presentase jurnal ini tidak terlepas dari bantuan banyak pihak yang telah memberikan masukan-masukan kepada penulis. Untuk itu penulis mengueapkan banyak terimakasih kepada : 1. Pembimbing Klinik RSUD.Daya Kota Makassar 2. Pembimbing Akademik Penulis menyadari bahwa masih banyak kekurangan dari laporan ini, baik dari materi maupun teknik penyajiannya, mengingat kurangnya pengetahuan dan pengalaman penulis. Oleh karena itu, kritik dan saran_ yang sifatnya membangun sangat penulis harapkan. Terimakasih. Makassar, 25 Januari 2020 Penulis Dipindai dengan CamScanner ABSTRAK Latar Belakang : Walaupun terapi fisik merupakan elemen yang efektif dalam Penyembuhan penyakit rotator cuff (RC), penentuan intervensi exercise yang paling efektif belum bisa di tentukan. Tujuan : Tujuan dari penelitian ini adalah untuk menentukan apakah ada Perbedaan dalam penurunan nyeri atau fungsi pada pasien yang di berikan Penguatan RC sebelum atau setelah melakukan latihan stabilisasi scapula Metode : Ini adalah study prospektif dari 26 pria dan 14 wanita, dengan usia rata- rata 51 tahun yang di diagnosis dengan subacromial impingement syndrome (SAIS). Mereka secara acak dibagi menjadi 2 kelompok untuk mengikuti program rehabilitasi yang komprehensif dan standar selama 6 kali kunjungan di klinik. 1 kelompok di tentukan program 4 minggu latihan stabilisasi scapular sedangkan kelompok lain dengan latihan penguatan RC. Hasil : Menunjukkan peningkatan yang signifikan dalam nyeri (p<0,001), fungsi (p<0,001) dan kepuasan pasien (p<0,001) pada semua tindak lanjut untuk kedua kelompok. Sebelum latihan (p>0,05), secara statistic ada perubahan yang signifikan pada pasien pada follow- up 4 minggu sampai 8 minggu (p=0,04) atau 16 (p<0,001). Kesimpulan : Pasien dengan SAIS menunjukkan ada peningkatan dalam penurunan nyeri dan fungsi dalam kelompok exercise yang di beri program fisioterapi yang telah di tentukan latihannya. Kata kunci Kata kunci Kata kunci: Latihan rotator cuff, stabilisasi scapular,fisioterapi bahu Dipindai dengan CamScanner INTRODUKSI/PENDAHULUAN Subacromial impingement syndrome (SAIS) adalah diagnosis yang paling umum dari pasien yang datang ke klinik fisioterapi rawat jalan dengan nyeri bahu, mencakup hingga 36% kasus. Etiologi SAIS dapat berasal dari beberapa mekanisme yang salah di bahu. Degenerasi intrinsik dari tendon kronis yang berlebihan, pembentukan osteofit Pada akronion, kompresi ekstrinsik yang buruk semuanya merupakan sarana yang = menempati ruang subakromial dapat menjadi penyebab Trauma, Penggunaan tendon rotator cuff yang berlebihan, kesalahan dalam Menggerakkan rotator cuff yang salah, diskinesis skapula, dan sendi glenohumeral disebut sebagai penyebab mekanis yang berkontribusi terhadap SAIS. Diskinesis skapula dapat disebabkan oleh kelemahan trapezius, kyphosis toraks yang berlebihan, lemahnya serratus anterior, penyempitan kapsul ke posterior, dan fleksibilitas terbatas dari pemendekan biceps atau pectoralis minor. The Scapular Summit pada tahun 2013 lebih lanjut menjelaskan korelasi antara skapula diskinesis dan subacromial impingement, apakah diskinesis skapula merupakan penyebab atau akibat dari shoulder impingement. Selain itu, kejadian diskinesis skapular telah ditemukan hampir setara pada populasi orang dengan dan tanpa nyeri bahu selama peningkatan pada bidang skapular dan koronal. Terlepas dari ketidakkonsistenan ini, ada bukti kuat dalam mendukung perbaikan mekanika skapular untuk pengobatan sindrom subakromial impingement. Khusus intervensi fisioterapi yang bertujuan untuk meningkatkan ROM bahu, mobilitas sendi glenohumeral, dan kekuatan otot rotator cuff, trapezius, dan serratus anterior telah terbukti lebih efektif daripada intervensi latihan yang tidak spesifik. Dipindai dengan CamScanner ANALISIS PICOT A. Populasi dan sampel a. Populasi Populasi dalam penelitian ini adalah 50 pasien yang datang berobat di klinik fisioterapi rawat jalan di universitas medical centre yang telah dilakukan Pemeriksaan dan di diagnose SAIS (SubAcromial Impigiment Syndrom). b. Sampel Sampel yang digunakan berdasarkan hasil dari perubahan fungsi yang di laporkan sendiri oleh subyek yang di ukur dengan Skor American Shoulder dan Elbow Scale (ASES) dan memenuhi kriteria inklusi, dari 50 subyek, 10 tidak menyelesaikan protocol penelitian ( 4 didiagnose rotator cuff fullthikness , 2 menarik Persetujuan sekunder karena terkendala waktu dan 4 mangkit). Subyek yang berhasil memenuti kriteria inklusi yaity 40 orang, terdiri dari 26 wanita dan 14 pria. Mereka secara acak oleh peneliti melalui blind draw dibagi menjadi 2 kelompok untuk mengikuti program dan sebelumnya dilakukan informed consent. B: Intervensi Semua kelompok melakukan program pengobatan fisioterapi selama 6 kali kunjungan. Di bulan pertama yaitu manual terapi kurang dari 37 menit per sesi dan masing masing kelompok melakukan 4 exercise. Kelompok RC melakukan rotator cuff strengthening exercise secara intensive selama 4 minggu latihannya terdiri dari 1. External rotasi, 2. Short arc military press, 3. Internal rotation isolation dan 4. Shoulder pull apart. Sedangkan kelompok SS melakukan scapular stabilization exercise selama 4 minggu, latihannya terdiri dari 1 Shoulder punches, 2. Wide grib rows, 3. Resisted shoulder extension, 4. Resisted scapular retraction. Dipindai dengan CamScanner ¢. Comparison Comparison pada penelitian ini yaitu perbandingan rotator cuff exercise dengan menggunakan 4 latihan dengan scapular stabilization exercise dengan menggunakan 4 latihan juga. Hasilnya di bandingkan dengan waktu pengobatan antara kelompok RC dan SS. Dianalisis menggunakan uji chi square. Variable di nilai menggunakan analisis varian (ANOVA) berulang. Semua data di analisis menggunakan SAS 9.4 for windows (SAS 9.4, Cary,NC,USA). D. Outcome Dari penelitian ini, dari 40 pasien yang memenuhi kriteria inklusi untuk SAIS, kedua kelompok memiliki prevalensi yang sama. Skala untuk respons dirancang untuk mengukur tingkat pasien persepsi peningkatan atau penurunan ,menggunakan rentang skala ordinal 15 poin dari skala -7 hingga + 7. -7. mewakili "jauh lebih buruk", 0 mewakili tidak ada perubahan status, dan + 7 mewakili "jauh lebih baik lebih baik", Alat penilaian ini telah terbukti andal, valid, dan responsif dengan perubahan perubahan yang berarti yang dikirim oleh setidaknya + 5 poin. Skor Hasil Fungsional ASES, Interaksi antara pengobatan dan waktu pada skor hasil ASES secara statistik tidak signifikan p = 0,47. Tidak ada perbedaan yang signifixan secara statistik .Efek utama waktu menunjukkan perbedaan yang signifikan secara statistik pada skor hasil ASES antara titik waktu dengan p <.0001,dengan analisis efek sederhana tidak ada perbedaan kelompok perlakuan pada setiap periode tindak fanjut (tindak lanjut satu perbedaan rata-rata = 1,15, p = 0,21; tindak lanjut dua perbedaan rata-rata = 0,1, p = 0,90; tindak lanjut tiga perbedaan rata-rata 1,15, p = 0,11). Sehubungan dengan perbandingan faktor waktu dalam kelompok perlakuan RC, tidak ada perbedaan statistik dalam skor yang dilaporkan sepanjang waktu dengan semua nilai p> 0,91 (tindak lanjut 1 p= 4. 7 + 2.4; tindak lanjut 2,p=5.0 + 2.7; tindak lanjut 3,p= 4.8 + 2.9. Pada kelompok perlakuan SS, dengan analisis tidak ada perbedaan kelompok pertakuan pada setiap periode tindak lanjut (tindak lanjut satu perbedaan rata-rata = 4,15, p = 0,21; tindak lanjut dua perbedaan rata-rata = 0,1, p = 0,90; tindak lanjut tiga perbedaan rata-rata 1,15, p = 0,11). : Hasil menunjukkan peningkatan yang Dipindai dengan CamScanner signifikan dalam nyeri (p <0,001), fungsi (p <0,001), dan kepuasan pasien (p <0,001) pada semua waktu tindak lanjut untuk kedua kelompok. Tidak ada perbedaan yang signifikan secara statistik dalam rasa sakit atau fungsi pada periode follow-up untuk memulai satu kelompok latihan sebelum yang lain (p> 0,05). ‘Saya ada interaksi yang signifikan secara statistik antara peringkat global perubahan pasien pada follow-up 4 minggu dibandingkan dengan 8 minggu (p = 0,04) atau 16 (p <0,001 Dan dari hasil outcome dapat di diskusikan bahwa terlepas dari pemberian rotator cuff exercise dan scapular stabilization exercise subjek mengalami peningkatan dalam penurunan rasa nyeri dan fungsi sambil menunjukkan kepuasan keseluruhan dengan pengobatan. E. Time Penelitian ini di lakukan di Klinik fisioterapi universitas medical centre, tahun 2012 dan 2014. Dipublikasikan pada februari 2016 oleh students in the Physical Therapy program at UT Southwestern Medical Centre School of Healt Professions. IMPLIKAS! KLINIS Memberikan informasi terhadap mahasiswa dan fisioterapi bahwa rotator cuff strengthening exercise dan scapular mobilization exercise efektif dalam menurunkan nyeri dan fungsi pada SAIS (Subacromial Impigiment Syndrom). KESIMPULAN Hasil penelitian menunjukkan ada perbaikan yang lebih baik dirasakan oleh pasien setelah melakukan latihan baik Rotator Cuff exercise maupun Scapular Stabilization exercise, Sangat mungkin bahwa kedua bentuk latihan tersebut berkontribusi dalam penelitian ini. Dipindai dengan CamScanner ORIGINAL RESEARCH 7 THE EFFECT OF AXIOSCAPULAR AND ROTATOR CUFF n EXERCISE TRAINING SEQUENCE IN PATIENTS WITH — SUBACROMIAL IMPINGEMENT SYNDROME: rea ARANDOMIZED CROSSOVER TRIAL Edwant P. Mulligan, PT, ppT Mu Huang, Pr, DPT ‘Tara Dickson, Pr, DPT Michael Khazzam, 1D While physical therapy is an effective element in the reh: most effective sequence of exercise training. inte jlitation of rotator cufF (RC) disease, the centions has nat heen defined Hypothesis /Purpose: ‘The purpose of this study is to determine ifthere is a difference in pain or fanetion in patients who are given RC strengthening prior to or after initiati apular stabilization exercises, Study Design: Level | randomized crossover trial Methods: ‘This was a prospective study of 26 me mpingement syndrome (SAIS). "The: and 14 women with a mean age 31 re randomly assigned to one of two groups fora comprehensive and ndardized rehabilitation program over sig visits at an orthopedic outpatient clinic. One group was prescribed & week program of scapular stabilization exercises while the other group began with RC strengthening exercises. The crossover design had each group add the previously excluded four exercises to their second month of rehabilitation, ‘ho were diagnosed with sub- Results: The results showed significant improvements in pain (p) < 0.001), function (p < 0.001), tion (p < 0.001) at all follow-up times for both groups. Th not a statistically significant differ function at any follow-up period for initiating one group of exercise before the other (p > 0.05), There was cally significant interaction between the patient's global rating of dl cks (p = 0.04) oF 16 (p < 0.001). Conclusion; Patients with SAIS demonstrate improve ent in pain and function with a standardized program of physical therapy regardless of group exercise sequencing, Level of Evidence: 1b Keywords: Rotator cuff training, scapular stabilization, shoulder physical therapy “Medicine fe Shoulder Service, Department of Orthopaedic Surgery, Dallas, Texas USA Acknovledgementa _ ‘The authors ke w thank eth Watson, PDIP, and CORRESPONDING AUTHOR el, ate ne pa he Ealward Mulligan Sottneseen eden Cen sh Professions, 1901 Pintail Parkway for their valuable assistance with data collection, 76039 mulligan@utsouthwesternedu Disclosures: The authors declare no conilicts of interest “The International journal of Sporis Physical Therapy | Volume I, Number 1 | February 2016 | Rage 94 Dipindai dengan CamScanner ee eee INTRODUCTION Soacromial implagement syndrom syndrome (SAIS) is the svoat common dlagnoais af patients whe mo at patient orthoped pr of SAIS can originate from several faulty ci ms within the shoulder, Intrinsic dj eneratlan from chronic tendon overload, carmeptyte ‘rma ing have all been implicated as possible means by which soft tissues occupying the subacromial ae may become symptomatic: Trauma, overuse of the rotator cuff t s, faulty force-coupling of the rotator cuff, scapular dyskinesis, and a tight poste- ror capsule of the glenohumeral joint are cit mechanical causes contributing to SAIS.***" as scapular dyskinesis can be caused from weakness of the trapezius, excessive thoracic kyphosis, weak- ness of the serratus anterior, tightness of the pos- terior capsulc, and limited flexibility of the short head of the biceps or pectoralis minor.* The Scapu- tar Summit in 2013 further elucidated the correla- tion between scapular dyskinesis and subacromial impingement s \denoy for patients who have subacromial impingement to also present with scapular dyskinesis, What is not known is whether scapular dyskinesis is a cause or ‘a result of subacromial impingement. Furthermore, the incidence of scapular dyskinesis has been found to be nearly equivalent in populations of people ‘with and without shoulder pain during elevation in the scapular and coronal planes.” Despite these inconsistencies, there is a preponder. ance of evidence in support of improving scapular mechanics for the treatment of subacromial impinge ment syndrome Specifically, physical therapy Intervention that is aimed to improve shoulder rane of motion, glenohumeral joint mobility, and mus- cular strength of the rotator ‘cuff, trapezius, and ser- ratus anterior has been proven t0 be mor effective than non-specific exercise interventions." surthor ‘more, scapular stabilization exercises 1 adn (© traditional physical therapy ereatment (200 only on the rotator cuff has proven 10 be mor effective than standard physical therapy ‘eatment alone! In theory, scapular stabilization exercises provide am additional benefit of a stable base and improved mechanics for unimpeded shoulder mobility: Previous authors have speculated that optienizing scapular strength and motor control is necessary (9 improve funtion with patients who have seapular Avs" inesis and subacromial impingement. At this time there sno experimental evidence that has determined an optimal temporal sequence to strenathening OXF Cises for subacromial impingement. While most plac scapular emphasis at the beginning, some advocate that scapular exercises should be delayed until later in the rehabilitation program.’ ‘The present study eval ‘ates whether there is an optimal sequence for mus: ‘cular retraining efforts, Consequently, the purpose of this study is to determine if there is a difference in pain or function in patients with subacromial impinge ment who are given rotator cuff strengthening prior to of after initiating scapula stabilization exercises. ‘The hypothesis is that there will be no difference in outcome between groups ased on the sequence of therapy intervention and timing of the scapular based rehabilitation program. METHODS. Subjects This prospective randomized crossover trial was designed to evaluate the effectiveness of a rehabili: tation program beginning with axioscapular (scapu- lar stabilization) strengthening exercises compared to one beginning with scapulohumeral (rotator cuff) strengthening exercises. The investigation utilized patients who presented for shoulder rehabilitation at fn outpatient physical therapy’ clinic in a university medical center setting between 2012 and 2014, Forty subjects, 26 women and 14 men, aged 30-74 (mean 51.1 years) diagnosed with Neer Stage 1/1 subacro- ial impingement syndrome were referred for physical therapy by eight different primary care pl ians and four orthopedic surgeons for participation n the stud c initially enrolled but 10 did not complete the study protocol: four were subsequently diagnosed with a full-thickness rotator cul tears, two withdrew consent secondary to time constraints involved with the physical therapy visit ‘attendance, and four were lost to follow-up. Inclusion criteria to participate in the study were 1) 18-80 years of age 2) diagnosis of Neer Stage 1/ Volume Th, Number 1 | Rebruary 2016 | Pee 95 “Th rnarmanional fora Of SPOS Phayncat ThePY | Dipindai dengan CamScanner HI subactomial impingeme, complaint in the shoulder ay ence of at least two of the fo arc, weakness in external rotat, nent ign (Tawhine Kenney een pain and/or weakness with resign" rotation, external rotation, or tion. Radiological imaging an, ation supplemented the di investigator verified these in, subject upon entry i mt with a primary or upper am) ollowing findings: a pain pres- ful istance to inte japular plane eleva- Periodic MRI evalu. lagnosis. The primary \clusion criteria for each ‘0 the study. Exclusion criteria were 1) concurrent medical comorbidities includ. i ing pregnancy, diabetes, and y etes, and theumatoi 2) osteoarthritis greater than grade 2 ny ae na gren-Lawrence scale, lagna ang 3) current dia, ; : gnosis and/or previous history of glenohumeral instability or die: location, 4) full-thickness rotator cuff tear, 5) adh sive capsulitis, 6) fractures of the seapule, clavicle Greet poe der suger in past seat and) inabiey 0speak the English language at a level sufficient to obtain informed consent ‘Sample size was based on the primary outcome focus of change in self-reported function as measured by the American Shoulder and Elbow Scale (ASES) score by a true mean response difference of eight points to test the null hypothesis." Statistical power calculations were also based on a type | error prob ability level of alpha =0.05, type II error probability evel of beta=0.20, and an anticipated dropout rate of 20%. Based on literature review, the anticipated standard deviation (SD) was set at 12 points on the [ASES for the difference in response of matched pairs in a normally distributed population. Power caleu- lations resulted in an estimated sample size of 36 participants (18 per arm of the trial) to detect a true difference in mean response from the interventions This sample size is more than double the amount required for a crossover trial where both groups ar exposed to both forms of exercise and the randomiia- fier was to the exercise sequence as opposed (0 tne exercise treatment. The ze: is also similar to the number enrolled in anot trolled trial assessing a similar inte sample $ scr randomized con- srvention strates ensuring appropriate evaluation of inclusion and taxclusion erkeria, subjects were randomly allocated by the primary investigator via blind draw w one of two groups after all baseline assessments were performed and informed consent was secured. The institutional review board at UT Southwestern Medi- cal Center in Dallas, TX approved the study. A flow chart of the trial is provided in Figure 1 All subjects received a comprehensive and standard- ized physical therapy treatment program over six visits during the first month that consisted of pathol- ogy education, postural advice, activity modification recommendations, manual therapy (no more than two units of less than 37 minutes per session) to the entire upper quarter including the cervicotho- racic spine area, and standard flexibility and range of motion exercises. Care providers were not blinded to the subject's group allocation. Subjects in one group (RC) were assigned four rota tor cuff intensive exercises for the first four weeks with the addition of four scapular stabilization exer- cises in the next four weeks. The four exercises included 1) external rotation with the arm in a rest- ing position supported by a towel roll; 2) 0-30" short arc military press; 3) internal rotation isolation with the forearm adjacent to the trunk; and 4) horizontal abduction at shoulder level. The short arc military press was progressed to a long arc scapular plane elevation mancuver as tolerated by cach patient. See Appendix 1 for detailed explanations. Subjects from group two began with a program of scapular stabilization intensive exercises (SS) for the first four weeks and added the aforementioned rotator exercises during the next four weeks. The four SS exercises included 1) supine shoulder protraction punch; 2) wide grip rows at shoulder level in stand ing; 3) shoulder extension/scapular depression and retraction from an overhead position in stand- ing; and 4) shoulder retraction with both shoulders ‘external rotation with the elbows at the side. These eight unique exercises were selected based ‘on reported high clectomyographical activity in target muscle groups as demonstrated in multiple studies." See Appendix 2 for detailed explana- tions, All therapeutic strengthening exercises were conducted using Theraband (The Hygenic Cor- ‘Akron, OH, USA) clastic resistance in poration; Procedures 7 : ‘This study was designed as a prospective ee ized control trial with crossover at four Wee mal of Sports Pysical TREY [ votone i, Number 1 | Febrary 2016 | Pege 96 The Ingernanvonat Jou Sexe Tipo Dipindai dengan CamScanner topes (sno) located —— ‘natyreti Intention to Tost 20) AC actomioclavicular SLAP - Superior labral anterior posterior Assesed to tigiaiy tent) Gow) ba alt Mtjeree nebouanar eto) otaton Cut pant eesti th ren Seopaer inna ttn apis 1 vw Trainin Haran = WE | wey Sa " tint ‘of secoantay to vitor | | srostonio Naliivehnvess Scapular Tine Me tan tater | Weivratocanatnne | cults tear tnea) | | Kiewnne we) rogram at ‘wees ‘wees Mata —aezn)—Notttaow (20 I pine 3 ost fellow: rope de ! w 1 thickness, wen rotor ett fates) tea (ne) —— | eed Intentionto Treat (n= 20) Figure 1 Study Mow Chae apoutle dosage of two to three sats oF ‘ould be completed. Detaled 6, «ont psnstto which a th 20 repetitions daily ¢ Instructions on exerelie techni or nubathution tndencies, and ariterta fir pre gression were provided for each exerchie. Tension adjustmonts were made by 1 subject within the each nap | Tecmo fn spots ta 1 exercises session (o ensure muscular fatigue during the third set of each exercise throughout the study. cir sixth visit at four wecks post- study enrollment, Both groups were performing all Volton 1, Number 1 | Rebraay 2006 | Tage 97 Dipindai dengan CamScanner vent standardized exercises dur oon week of the study. The fae ath through treatment protocol was the order in yf ePEMC Gees were iniiated during the first geen ME exe the independent variable under invegng es Thus, temporal Seauencing Of the resistive ¢ajot was the ces aimed a the axioscapular subiizery eee S OF scapu. teen of the oeived (seven from each group) a rnp stbieets Sabacromial injection during one of me eosteroia secessment periods. Each subject was inten? their weatment protocol but remained binned of over grOup aSSigMMeNts to minimine subj ee” “he assessor was blinded at baseline and all fal fessions regarding group assignment, seo Precise inter. sention protocols, and impairment measurements in fonumeral cuff muscles. Four assessment and treatment of all subjects was pro rided by one of four licensed physical therapists with one to two Years of experience that were comple an accredited orthopedic physical therapy reside, program. After enrollment, cach subject completed a questionnaire that provided demographic infor mation such as sex, age, height and weight, side of involvement, date of onset, handedness, and whether or not they had recently received a corti- costeroid injection. In addition, they responded to a medical sereen that included a thorough review of their current and past medical status and history of upper quarter injury or disease. Outcome Assessment Dependent Variables The primary variables used to assess treatment out- comes included numerical pain ratings, sel-teport of fanction utilizing the American Shoulder and Elbow questionnaire, the patient's self-reported global pe: centage of function (GPF), and the patient's satisfac- tion using a global rating of change (GROC) scalé. Each outcome variable with the exception of the GROC was assessed at baseline, four weeks, eight weeks, and 16 weeks. The GROC and GPF were only evaluated during the follow-up assessments at four, Fight, and 16 weeks. For pain levels, each subject verbally responded ‘© a question regarding their current pa! level on an 11-point numeric pain rating scale (NPRS) anchors of and 10 where 0 represents no pain and 10 the worst possible pain imaginable. The pain The Internaniomal journal of Sports PHYS cal Therapy | Volume W level speci cally ev Pain s ally verity dui ncuve ‘aluated the subject's perceived Ing an active scapular plane cleva- euver in a standing position, The NPRS is a measure with f clinieal cal and nos levels ain face vatidity and a minimally * difference of 2.17 points for surgi Surgical patients when averaging pain best, worst, and current levels.” important The settreport sc der and € Assessment intende ion of the American Shoul- ow Surgeons Standardized Shoulder Form (ASES) is a region-specific scale Prien functional limitations and pain © shoulder. ‘The original ASES consists of two Portions, a medical professional assessment section anda patient self-report section. The self-report sec- tion, used in this study, is a short selfeeport survey tel consiing of questions regarding pain and the ensions of activities of daily living. The pain Score is calculated from the single pain question on a visual analog scale and the functional score from the sum of 10 questions addressing routine, every- “ay function. The pain score and function com- Posite score are weighted equally (50 points cach) and combined for a total score out of a possible 100 points with 100 representing a complete absence of pain and disability. ‘The test-retest reliability (ICC = 0.84) and internal consistency (Cronbach @, 0.86) values are acceptable, The standard error of the measure is 6.7 points on the ASES scale. Construct and discriminant validity have been demonstrated with comparison to the University of Pennsylvania Shoulder Score and the Short Form~36 quality of life scale, Adequate responsiveness is demonstrated by a standardized response mean of 1.5 and an effect size of 1.4, The minimal detectable change is 9.7 points smal clinically important difference of 6.4 points. This outcome measurement tool is consid- ered to be reliable, valid, and responsiv “The GPF was used to assess the patient's overall percep- tion of shoulder function. Patients rated their shoulder function based on the following question: “How would you rate your current level of shoulder function on a scale of 0-100% with 100% being your level of shoulder function before your injury The patient's global rat- ing of change (GROG) reflected the patient's satistac- tion with the overall treatment plan and progress. The scale for response is designed to quantify a patient's perception of improvement or deterioration over time ‘Number 1 | February 2016 | Page 98 Scand ty Tp Sesnee Dipindai dengan CamScanner using a 15-point ordinal scale range represents 2 “VCrY great deal wore Ghange in talus, and +7 rp setter’. This assessin valid, and from -7 ty +77 “ Orepeseny 0 has en set el change repre. statistical Analysis inlidataare presented as me, ans + SDunte : : ssothenwise sated: Significance testing of hance ics was performed utilizing unpaid (a ed tess and chi square tests. The NPRS, Asrs dependent variables were ee and GPF a repeated factor of “time* (at four levels, baseline, follow-up one (four weeks), followup we nen ks), and follow-up three (16 weeks); only three s for analysis of GROC anda non-repeated faerer of ttreatme evels: treatment beginning with RC exercises versus treatment beginning with $¢ exercises). Results of the analysis will be presented in the form of an F-statistic (the variance between group means) and the determined pwvalue (the probability of this variance solely due to chance). For practical purposes, interpretations will be based off of the pvalue. Post-hoc pairwise comparisons were performed to identify the individual differences within factors. In order to maintain the probability of a Type I error at 5% (set a priori, a stringent Bonferroni correction was used. Alldata were analysed using SAS 9.4 for Windows (SAS 9.4, Cary, NC, USA) with normality and equal variance assumptions ensured prior to the analysis. In cases where the assumptions of sphericity were violated (Mauchly’s test), a Greenhouse-Geisser correction was Used to interpret the results of the ANOVA. Intention ‘treat imputation was used for missing data, primar- ily at the follow-up two time interval; this provided a conservative estimate of the main effect size. Results ‘This study was completed with 40 patients that met the inclusion criteria for SAIS. There were no signifi Cant differences between groups in regards to base- line characteristics of age, sex, size, and chronicity of injury. Also of note is that both groups had a very similar prevalence of shoulder girdle weakness at baseline (Table 1). A summary of the outcome variables rable 2, at all follow. No uninte Feported by any of the subjects. up intervals is presented in were ‘ded effects or adverse events ASES Functional Outcome Score The interaction bet fen treatment and time on ASES outcome score w. a8 not statistically significant With FG.114) 0.60 and p= 0.47. There was no sta- taal significant difference in the main treat: Ment effect when initiating one group of exercise before the other with F(L.38) = 0.32 and p=05 Notably, the score hetween groups never exceeded the minimally clinically important difference. The ‘main etfect of time showed a statistically significant difference on ASES outcome score between time Points with F(3,114) = 11.52 and p<.0001. Ana lyzing pairwise comparisons, the improvement of functional scores at follow-up 1 (75.8 + 17.6), follow- up 2 (80.1 + 14.4), and follow-up 3 (70.4 + 20.1) were Statistically different from baseline (64.2418.3) but not from one another. There was no difference in mean score between treatment groups at basc- line with p=0.91 (RC: 63.8+15.5 vs. SS: 64.5¢21.1, Figure 2), Numerical Pain Score The interaction between treatment and time on reported pain scores was not statistically significant with FG.114)=1.35 and p= 0.25. There was not a difference in the main treatment effect of exercise sequencing with F(1,38) = 1.09 and p=0.30. Nota- bly, the pain score between groups never exceeded the minimally clinically important difference at each time interval. The main effect of time showed a statistically significant difference on pain scores berween time points with F@,I4) = 11.69 and P<.0001. Pairwise multiple comparison analyses showed that the improvement of scores at follow-up one (2.72.8), follow-up two (2.32.7), and follow: up three (2.1 £2.5) were statistically different from. baseline (4.32.6) but not from one another. There was no difference of mean score beeen treatment groups at baseline with p=0.30 (Re 3.9429, Figure 3) SATE21 vs, SS: Global Rating of Change Score (GROC) The interaction between treatment and time on reported GROG scores was statistically significant ‘The Incernationa jnurnal of Sports Physical Therary [ volume 1, Number 1 | Rebrary 2006 | Rages Dipindai dengan CamScanner 4) = 3.67 and p= 0.03. He thor simple effects saument $10 upone mean ditt two mean die mean difference 1.15, P= parison of the ment group, there was reported scores across tin {(allow-up 1: 4 the other hand, there was a slat increase of the reported one compared to follow-up 6° up one: 3.643.2; follow up one compared to follow-uP significant different with P< 36432; followup three: 5.92 within the RC treatment grOUP ii Characteristic $082.1 (30-72) Side of involvement is dominant extemity 55% ‘Sex (%o female 18/20(75%) RCGroup Pp value 49.4106 - Gi) Oe 60% 11/20 (55%) exdy Mass Index [ean Hoy Mass Index [mean 4 SD) rangey] 28.54.7(17-49) 290275 G04) Mean weeks since injury (mean + SD) an02340 Haseltine Muscular Strength (% of subjects testing < 4/5) Shoulder Flexion Shoulder Abduction Shoulder External Rotation st Supraspinatus Empty Can julder Internal Rotation Sertatus Anterior Middle Traperius raining: RC= Rotator cull exercise owever, with fur ne with P analysis there was no diften “ateach follow-up period (follow ce = “1.15, px 0.21; follow-up cea 0.1, p= 0.00; follow-up three ‘0.11). In regards to com ime within the RC treate jactor of re no statistical dit me with all p values > 0.91 022.7; follows mai 4; follow-up 2 n the SS treatment jstically ROC score from follow-up

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