New Treatment Assessment Tool for Overhead Throwing AthletesIt's important to measure before and after results any time treatment is administered for orthopedic injuries. That's especially true with athletes who are eager to get back into the game. Orthopedic surgeons and physical therapists testing this patient group must make sure they are safe to return-to-sport at a competitive level. Avoiding reinjuries is one reason assessment of motion, strength, and function must be performed.
In this article, the very famous orthopedic surgeon, Frank Jobe, MD and his associates present a new tool for testing function in the arm for overhead throwing athletes. Up until now, surgeons and therapists have relied upon the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. But the DASH isn't specific to the shoulder or elbow -- it looks at the entire arm. So this new tool called the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC) might just fill the bill.
They started out getting input from a wide range of sports professionals about what should be on the survey. Sports medicine physicians, orthopedic surgeons, physical therapists, and athletic trainers contributed items for the tool. They put together 13 questions about pain, missed games/practices, flexibility, weakness, stability, change in throwing patterns, and throwing velocity (speed) and power. A few questions also addressed level of competition, history of injury, and effects of arm problems on relationships with others (e.g., coaches, team players, agents, team managers).
They tried to make sure the questions weren't just directed toward baseball pitchers. Even though that group makes up the majority of overhead throwing athletes who are injured, there are tennis players, volleyball players, swimmers, golfers, and others who could also benefit from this assessment tool.
Once the pilot survey was tested on a small number of athletes, they could tighten up the questions and narrow the survey down to 10-items. The second part of the study involved giving the revised questionnaire to a new batch of 282 healthy overhead throwing athletes at both the college level of competition and professional sports. A second (separate) group of athletes with shoulder injuries were also tested with the Kerlan-Jobe Orthopaedic Clinic (KJOC) questionnaire. These two groups of participants also filled out two other questionnaires. This is done in order to compare the results of the new survey with already established, valid tools.
On the basis of test results, the athletes could be placed into one of three groups called playing categories. The first group was labeled playing without pain. The second group was called playing with pain. And the third group was categorized as not playing due to pain. The KJOC test was used to further compare before and after results for each group.
Analysis of all the data showed that this assessment tool has the potential to help in research being done related to high-level overhead athletes as well as to improve patient care. Whereas the surgeon might say the case has been successful because motion and strength were restored, the patient who can't return to sports play remains unhappy and feels the treatment was a failure. An outcomes tool like the KJOC measures the patient's opinion of his or her results (response to treatment) based on function and psychologic health. The beauty of this approach is that it relies on the patient/athlete to be the best judge of his or her outcomes.
The KJOC will be tested further on many more athletes in order to confirm the results reported from this study. Reliability testing on a larger sample size is the next step. Follow-up of all athletes involved in these studies may also provide some additional useful information.
In summary, the new Kerlan-Jobe self-report questionnaire is designed to measure performance outcomes of the upper extremity (entire arm) after injury, treatment, and/or surgery. It has been pilot tested and retested on a larger group of overhead throwing athletes. It is easy to use, valid, efficient, and reliable in its measurements. Improved scores on the test are an indication of improvement in function and can be used with confidence to determine when the athlete is ready to start overhead shoulder motions in competitive sports again.
Frank G. Alberta, MD, et al. The Development and Validation of a Functional Assessment Tool for the Upper Extremity in the Overhead Athlete. In The American Journal of Sports Medicine. May 2010. Vol. 38. No. 5. Pp. 903-911.
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