Journal Club Bottom Line
Question & Methods: Can abduction and external rotation (AbER) immobilization after primary anterior shoulder dislocation reduce rates of recurrence compared to conventional immobilization in adduction and internal rotation (AdIR). A randomized trial.
Findings: After 24 months, the AdIR group recurrence rate was 33.3%; the AbER group 3.9% (P<0.001)
Limitations: Small sample size and single centre.
Interpretation: A positive study showing significant reduction in dislocation recurrence with AbER immobilization. Inconsistent results in similar trials prevent concluding that external rotation is clearly superior but certainly warrants further investigation.
By: Dr Joshua Karram
Clinicians and researchers often seek to measure “quality of life” in an objective manner. One example of such “Global” health measurement instrument is the SF12-Health Questionnaire. The Western Ontario Shoulder Instability Index is a 21-item, 4-domain “disease-specific” quality of life measure. A lot of work goes into the development of these quality measures, including: 1) clearly defining the population; 2) defining the disease (via literature review, interviews with clinicians and patients), its severity, and treatment options; 3) reducing the number of identified items; 4) pilot testing; and 5) examination of validity, reliability, responsiveness, etc. It is also customary to re-validate these tools when translated into a new language, or when considering their use with a different population.