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Table Slide Shoulder Flexion test for early assessment following proximal humeral fracture: development and
Brit Jorun Fossan Liseth1,2, Rolf Moe-Nilssen1, Randi M Hole3
1Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Background:
Proximal humeral fractures are common in older people, often resulting in pain and reduced shoulder range of motion, which impacts daily activities. Although early exercises are recommended to improve function, reliable methods for assessing shoulder range of motion in the early post-fracture phase are lacking. This study aimed to develop a method for measuring shoulder flexion early after non-surgically treated proximal humeral fractures and to assess its test-retest reliability.
Methods:
The novel Table Slide Shoulder Flexion test was piloted on 17 individuals, among them physiotherapists providing feedback. Within-day test-retest reliability was assessed by a single tester using an electronic goniometer. Shoulder flexion was measured in 37 patients (mean age 62 years, 86% women) with non-surgically treated proximal humeral fractures, 1-9 weeks post-injury. The goniometer was placed both in high-thoracic and mid-thoracic positions for reliability comparisons. Intraclass correlation coefficients (ICC) and Minimal Detectable Change (MDC) were calculated.
Results:
The method was deemed unsuitable for two patients, and one dropped out. In the remaining 34, ICC (2,1) reached 0.932 for the high-thoracic goniometer position and 0.926 for the mid-thoracic position when performing two table slides, with both values increasing further when three repetitions were performed. High-thoracic measurements slightly outperformed mid-thoracic measurements, achieving a MDC of 19° at the third repetition, compared to 20° for the third mid-thoracic repetition. Measured high-thoracic shoulder flexion ranged from 58-178°.
Conclusion:
The novel Table Slide Shoulder Flexion test is a reliable tool for measuring shoulder flexion in the early phase after proximal humeral fractures. It may be useful for tracking individual changes over time and as an outcome measure in group comparisons research. Further studies are needed to investigate its intertester reliability, responsiveness, and validity.
