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Table 1 Characteristics of existingproposals of assessment strategies

From: Towards an integrated clinical framework for patient with shoulder pain

Existing proposals of assessment strategies

SSMP

Star-shoulder

Klintberg’s clinical algorithm

The SSMP is a series of clinical procedures aimed to reduce the patient’s symptoms. A procedure able to eliminate/reduce the symptoms is adopted as a treatment technique. If following the application of the SSMP, symptoms have not completely disappeared an exercise program is required; the SSMP is typically embedded within a graduated shoulder exercise program.

Lewis suggests to apply the different techniques of the SSMP after the conduction of a preliminary assessment (composed by detailed history, screening for potential red-flag, functional/disability questionnaires administration, evaluation of impairments and if necessary orthopaedic tests and imaging).

The authors created a model providing a sub-classification of patients on the basis of patho-anatomical features, tissue irritability and individual impairments. Three steps are proposed: 1) screening, 2) patho-anatomical diagnosis (e.g. sub-acromial syndrome, frozen shoulder, glenohumeral instability) and 3) a rehabilitative step, based on the level of irritability.

The algorithm encompasses the functional assessment of a range of motion (ROM) and the evaluation of presence/absence of abnormal scapulohumeral

motion pattern in order to identify patients with limited passive ROM or with reduced muscle performance that can be treated with specific exercises or manual therapy. The algorithm helps clinicians to choose the adequate therapeutic approach. Moreover, it allows flexibility during the assessment process. Algorithm-based re-assessment of the patients allows monitoring whether the proposed exercises are correctly targeted towards the prevalent impairment or is necessary to test other clinical adjunctive problems.