***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective —To evaluate the responsiveness of the Shoulder Disability Question naire ( SDQ ) . Methods —The study was conducted within the framework of an observational study on shoulder disorders in primary care . After first presentation of their complaints to the general practitioner and after one and six months , participants completed the SDQ , a single question on functional status ( FSQ ) , and an ordinal 11 point scale for the severity of pain ( PSS ) . Responsiveness of the SDQ was evaluated compared with that of the FSQ and PSS , by calculating responsiveness ratios and by plotting receiver operating characteristic ( ROC ) curves . Recovery according to the patient was used as an external criterion for clinical ly relevant improvement ( complete recovery or much improved on a six point Likert scale was denoted as clinical ly relevant improvement ) . Results —A total of 349 consecutive patients with shoulder disorders were enrolled in the observational study . Response rates ranged between 96 % and 89 % . Responsiveness ratios were slightly higher for the PSS compared with the SDQ ( 2.53 versus 2.22 at one month , 2.24 versus 1.89 at six months ) . The area under the ROC curve was 0.84 for both the SDQ and the PSS , and 0.72 for the FSQ . Conclusion —The results of this study confirm the responsiveness of the SDQ , making it a useful instrument to assess functional disability in longitudinal studies OBJECTIVE To compare different assessment s following  shoulder surgery for impingement syndrome with or without rotator cuff tear or repair . METHODS A prospect i ve study of 93 patients was conducted . St and ard assessment s were performed before , at 6 months , and at 4 years following shoulder surgery using the patient-based Oxford Shoulder Score ( OSS ) , the Medical Outcomes Study Short Form-36 ( SF-36 ) question naire , and a surgeon-assessed Constant Shoulder Score . Patients were categorized according to the surgery received in relation to the presence of cuff tears : full repair , partial repair , cuff tear/no repair , no tear/no repair . RESULTS Most patients ( 57 % ) received subacromial decompression for impingement with no cuff tear . This group had the fewest pre- and postoperative symptoms . The category of patients who received only partial repair of a cuff tear had worse scores on all outcome assessment s compared with other groups . Patient-based measures were more stable over time than the Constant . CONCLUSION The shoulder-specific measures had greater sensitivity than the SF-36 in registering significant differences in outcomes between comparison groups at 6 months and 4 years Background : In a prospect i ve study , upper limb morbidity and perceived disability/activities of daily life ( ADLs ) were assessed before and 1 year after  sentinel lymph node biopsy ( SLNB ) or axillary lymph node dissection ( ALND ) . Methods : A total of 204 patients with stage I/II breast cancer ( mean age , 55.6 years ; SD , 11.6 years ) entered the study , and 189 patients ( 93 % ) could be evaluated after 1 year . Fifty-eight patients ( 31 % ) underwent only SLNB , and 131 ( 69 % ) underwent ALND . Assessment s performed before surgery ( t0 ) and 1 year after surgery ( t1 ) , included pain , shoulder range of motion , muscle strength , upper arm/forearm circumference , and perceived shoulder disability/ADL . Results : Considerable treatment-related upper limb morbidity was observed . Significant ( P < .05 ) changes between t0 and t1 were found in all assessment s except strength of elbow flexors . Patients in the ALND group showed significantly more changes in the range of motion in forward flexion , abduction , and abduction/external rotation ; grip strength and strength of shoulder abductors ; circumference of upper arm and forearm ; and perceived shoulder disability in ADLs compared with the SLNB group . Multivariate linear regression analysis showed that ALND could predict a decrease of range of motion in forward flexion , abduction , strength of shoulder abductors , grip strength , and shoulder-related ADLs and an increase in the circumference of the upper arm . Radiation of the axilla ( 19 patients ) predicts an additional decrease in shoulder range of motion . Conclusions : One year after treatment of breast cancer , there is significantly less upper limb morbidity after SLNB compared with ALND . ALND is a predictor for upper limb morbidity This study assessed pain , neurological symptoms , oedema of the ipsilateral arm , anxiety and depression occurring in women treated surgically for breast cancer , the impact of these symptoms on daily life and how they evolved during the 1 year follow-up . Ninety-three consecutive patients with non-metastasised breast cancer who were treated during 1993 - 94 were examined before surgery and after 1 , 6 and 12 months . They were asked about pain , neurological symptoms and oedema in the breast scar region and /or ipsilateral arm . Sensory testing was performed , and gripping force and the circumference of the arm were measured . Anxiety and depression were evaluated . One year after surgery , 80 % of the women had treatment-related symptoms in the breast scar region and virtually all patients had symptoms in the ipsilateral arm . The incidence of chronic post-treatment pain was higher after conservative surgery than after radical surgery ( breast area : 33 % vs 17 % , NS ; ipsilateral arm : 23 % vs 13 % , NS ) . Numbness occurred in 75 % and oedema of the ipsilateral arm in over 30 % of the patients after both radical and conservative surgery .  Phantom sensations in the breast were reported by 25 % of the patients . No difference in psychic morbidity was detected after the two types of surgery . Both the anxiety and depression scores were highest before surgery , decreasing with time , and were significantly correlated with preoperative stressful events A self-administered question naire was design ed to assess the severity of symptoms related to and the functional status of the shoulder . It includes domains of global assessment , pain , daily activities , recreational and athletic activities , work , satisfaction , and areas for improvement . Each domain is grade d separately and is weighted to arrive at the total score . The over-all scale and each domain were prospect ively tested for validity , reliability , and responsiveness to clinical change . One hundred patients who were seen for evaluation of the shoulder were enrolled in the study . The validity of the scale was demonstrated by moderate-to-high correlation of the domains and individual questions of the Shoulder Rating Question naire with those of the Arthritis Impact Measurement Scales 2 . Validity was supported further by significant correlation of the scores in each domain with the level of satisfaction in that domain and by significantly lower scores in domains that patients selected as areas important for improvement . The over-all scale and each domain were internally consistent ( Cronbach alpha , 0.71 to 0.90 ) . Reproducibility was evaluated by repeated administration of the question naire after a mean of three days to forty patients whose condition was clinical ly stable . Reproducibility of the over-all question naire and individual domains was excellent ( Spearman-Brown index , 0.94 to 0.98 ) . Individual questions were reproducible , with a weighted kappa value of more than 0.7 for each . Responsiveness was evaluated by comparison of the preoperative and postoperative scores of thirty patients who had a satisfactory result one year after an operation on the shoulder . The over-all Shoulder Rating Question naire and each domain were responsive to clinical change as demonstrated by favorable st and ardized response means ( range , 1.1 to 1.9 ) and indices of responsiveness ( range , 1.1 to 2.0 ) . Similar analysis performed for individual diagnostic groups supported the validity , reliability , and responsiveness of the question naire in each group . The self-administered shoulder question naire was found to be valid , reliable , and responsive to clinical change . These qualities should make it a useful instrument for the prospect i ve assessment of the outcome of treatment of disorders related to the shoulder BACKGROUND AND PURPOSE Shoulder scales are often used to evaluate treatment efficacy , yet little is known about the psychometric properties of these scales . Only one scale has undergone psychometric scrutiny : the Shoulder Pain and Disability Index ( SPADI ) . This study compared 2 shoulder measures -the University of California-Los Angeles ( UCLA ) Shoulder Scale and the Simple Shoulder Test (SST)-with the SPADI . SUBJECTS One hundred ninety-two patients with shoulder disorders were recruited from one physician 's office to complete the self-report sections of the 3 scales . METHODS Cronbach alpha values and st and ard errors of measurement ( SEM ) were calculated for each of the multi-item subscales . Validity was examined through calculation of correlation coefficients among the 3 scales . Factor analysis was completed to assess the underlying constructs of the SPADI and the SST . RESULTS Cronbach alpha values ranged from.85 to.95 . The SEM values for the multi-item scales ranged from 4.75 to 11.65 . Evidence for validity to reflect function was indicated by the correlation between the SST and the SPADI disability subscale . The factor analysis of the SPADI revealed loading on 1 factor , whereas the SST loaded on 2 factors . CONCLUSION AND DISCUSSION All scales demonstrated good internal consistency , suggesting that all items for each scale measure the same construct . However , the SEMs for all scales were high . Factor loading was inconsistent , suggesting that patients may not distinguish between pain and function OBJECTIVE We aim ed to investigate the effects of low-level laser therapy ( LLLT ) in managing postmastectomy lymphedema . BACKGROUND DATA Postmastectomy lymphedema ( PML ) is a common complication of breast cancer treatment that causes various symptoms , functional impairment , or even psychosocial morbidity . A prospect i ve , single-blinded , controlled clinical trial was conducted to examine the effectiveness of LLLT on managing PML . METHODS Twenty-one women suffering from unilateral PML were r and omly allocated to receive either 12 sessions of LLLT in 4 wk ( the laser group ) or no laser irradiation ( the control group ) . Volumetry and tonometry were used to monitor arm volume and tissue resistance ; the Disabilities of Arm , Shoulder , and H and ( DASH ) question naire was used for measuring subjective symptoms . Outcome measures were assessed before and after the treatment period and at the 4 wk follow-up . RESULTS Reduction in arm volume and increase in tissue softening was found in the laser group only . At the follow-up session , significant between-group differences ( all p < 0.05 ) were found in arm volume and tissue resistance at the anterior torso and forearm region . The laser group had a 16 % reduction in the arm volume at the end of the treatment period , that dropped to 28 % in the follow-up . Moreover , the laser group demonstrated a cumulative increase from 15 % to 33 % in the tonometry readings over the forearm and anterior torso . The DASH score of the laser group showed progressive improvement over time . CONCLUSION LLLT was effective in the management of PML , and the effects were maintained to the 4 wk follow-up The aim of this prospect i ve study was to investigate the effects of early onset rehabilitation program on shoulder mobility , functional status , lymphedema , and the incidence of postoperative complications in patients who had modified radical mastectomy . Fifty-seven women were r and omly assigned to either treatment group or home exercise program groups , which were consisted of 27 and 30 patients , respectively . After removal of the drains , the patients were instructed to 15 sessions of individual rehabilitation program and continued with home-based physical activity program . The home exercise program groups only received a form including the exercises , which could be performed by themselves after removal of the drains . Range of motion of the shoulder joint and upper extremity circumferential difference were measured . Functional status was assessed by functional index score . Each patient was assessed preoperatively and then postoperatively at fifth day and first , third , and sixth months . The improvement in measurements of flexion , abduction , and adduction movements of the shoulder joint and the functional question naire scores were significantly better in treatment group . There was no statistically significant difference in the development of lymphedema and postoperative complications in both groups . Early onset rehabilitation program after modified radical mastectomy provides improvement in shoulder mobility and functional capacity without causing adverse effect in postoperative period ABSTRACT The primary objective of this pilot study was to explore the feasibility of implementing two exercise programs for female patients who are breast cancer survivors and residents of the metropolitan area of San Juan , Puerto Rico . Potential benefits and complications of participating in a gym‐exercise program or a home‐exercise program , as opposed to st and ard care , were identified . Participants were r and omly assigned to 1 of 3 groups : a gym‐exercise group , a home‐exercise group , or a non‐exercise group . Interventions consisted of exercise programs with both aerobic and strengthening components , offered for a 26‐week period . Outcome measures consisted of functional evaluation , shoulder range of motion , 12‐minute walk test , h and grip strength , body mass index , and quality of life . The results of this study showed that it is feasible for Puerto Rican women to participate in a moderate intensity exercise program without developing complications . Participation in the exercise programs studied here minimized the side effects after cancer treatment , such as reduced physical functional ability and restricted shoulder mobility . Improvements were found in the measures of shoulder range of motion , upper extremity related physical function , and distance walked PURPOSE To determine the prevalence of and contributing factors for chronic arm morbidity including lymphedema in breast cancer patients after treatment and to assess the impact of arm morbidity on quality of life ( QOL ) . PATIENTS AND METHODS A four- question screening question naire was developed and mailed to a r and om sample of 744 breast cancer patients treated curatively in two cancer centers from 1993 to 1997 . Patients were without recurrence and 
    Output:
    
Based on the current evidence , we recommend administering the DASH to assess patient-reported upper extremity function in breast cancer survivors because the DASH has the most consistently large effects sizes for construct validity and responsiveness .