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Force Appreciation, Perceived Function and Physical Performance in Surgically Stabilised Shoulders for Recurrent Anterior Instability

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Date

2023

Authors

Supervisor

McNair, Peter

Item type

Thesis

Degree name

Master of Health Science

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Publisher

Auckland University of Technology

Abstract

Objective To examine whether force appreciation at the affected shoulder after anterior stabilisation surgery is significantly different from the unaffected shoulder at 6-12 months from surgery. To investigate the relationship between force appreciation and perceived function and physical performance tests. Study Design A cross-sectional inter-limb comparison study with participants at 6-12 months after anterior stabilisation surgery. Background In New Zealand each year, 25% of individuals with shoulder dislocations require anterior stabilisation surgery to prevent recurrences and improve shoulder stability. However, the instability rate after surgery may range between 3% - 89%. It is thought that decreased neuromuscular control at the shoulder could be contributing to episodes of instability post-surgery. Proprioception influences neuromuscular control and force appreciation is a construct of this modality. It is unknown whether force appreciation differs between affected and unaffected shoulders in a post-surgery cohort. It is possible that decreased force appreciation at the affected shoulder could affect neuromuscular control and dynamic stability and may predispose to instability episodes. Method Twenty-five participants with an anterior stabilisation surgical procedure for recurrent anterior instability were recruited. Force appreciation at the affected and unaffected shoulder was examined with the shoulder at 90o abduction and external rotation. The dependent variables were force accuracy and force steadiness. Statistical comparisons (paired t-tests) were made between the affected and unaffected shoulders. Perceived function was examined using Western Ontario Shoulder Instability Index (WOSI), ROWE, Shoulder Instability-Return to Sport after Injury (SI-RSI) and Tampa Scale of Kinesophobia (TSK). Physical performance across shoulders was assessed using SARTS tests. Correlation coefficients were utilised to assess the relationship between force appreciation variables with perceived function and with one physical performance test (BABER). Results There was a significant (p < .05) difference in force steadiness for external rotators between the affected shoulder (mean: 5.5 SD = 2.3) and unaffected shoulder (mean: 4.6 SD = 1.4). The force steadiness for internal rotators was significantly (p < .05) greater at the affected shoulder (mean: 2.8 SD = .64) in comparison to the unaffected (mean: 3.1 SD = .76) shoulder. Concerning associations, the results showed that those individuals with higher LSIs for force accuracy in external rotators had higher perceived function (K- Tau = -.34), as measured by the WOSI. Similarly significant associations were observed for force accuracy (K-Tau = .32) and force steadiness (K-tau = .34) LSIs of the internal rotators with perceived function as measured by the ROWE. Conclusion The observed mean deficit of 0.9 % of target torque for force steadiness of external rotators across limbs was statistically significant, but its clinical relevance is questionable. Similarly, the deficit of 0.3 % of target torque for force steadiness of internal rotators was significant but negligible hence thought to be not clinically relevant. These results do not provide the impetus to change clinical practice, but they provide a starting point upon which further research that targets different measures related to force appreciation could be undertaken. Regarding associations, the findings highlight that improved force appreciation is associated with improved perceived function, but individually, the variables tested contribute to a small proportion of change in perceived function. It is likely that a larger study allowing multiple variables to be incorporated within a model would be a valuable next step.

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http://hdl.handle.net/10292/16386

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