Shoulder Pain and Function in Individuals With Implantable Cardiac Electronic Devices

The Shoulder Pain and Disability Index (SPADI) will be used for assessment. The pain subscale comprises 5 items, and participants are asked to rate their pain over the past week during various movements using a Visual Analog Scale between 0 to 10 points. The disability subscale includes 8 items, assessing the level of difficulty experienced during different activities over the past week, also rated on a VAS from 0 (no difficulty) to 10 (unable to perform). Higher scores indicate greater pain and functional limitation. When the entire questionnaire is evaluated, a total score of 0 represents maximum well-being, whereas 130 represents the worst possible condition.

A universal goniometer will be used to assess the range of motion of the shoulder. Active shoulder flexion, abduction, internal rotation, and external rotation will be measured in accordance with standard assessment principles. Each movement will be measured three times, and the average value will be recorded in degrees.

Unsupported Upper Limb Exercise Test (UULEX):Participants will be seated on a chair with their knees touching the wall where the UULEX lines are displayed. The UULEX consists of 8 horizontal levels, each 84 cm in width and 8 cm in height, with 15 cm between the centers of each level. The lowest line corresponds to the participant's knee level. Participants hold a plastic bar weighing 0.2 kg at shoulder width and move it from the hips toward the different levels of the UULEX lines. Each movement starts and ends at the hip joint. The first level is performed for 2 min, and each subsequent level is performed for 1 min. Using a metronome, participants lift the bar 30 times per min. Once participants reach their max height, the 0.2 kg bar is replaced with a 0.5 kg bar, and participants continue lifting to max height. Subsequently, the weight is increased by 0.5 kg per min at the specified level, up to max of 2 kg. Participants are instructed to continue the test until symptom limitation.

Pectoralis minor and pectoralis major muscle tightness tests will be performed during musculoskeletal examination using a tape.

Posture will be examined via the Corbin Postural Assessment Scale. The total points of the Corbin Postural Assessment Scale range from 0 to 28 points. A higher point represents worse posture.

Musculoskeletal pain will be assessed using the Nordic Musculoskeletal Questionnaire (NMQ). This questionnaire evaluates symptoms (pain, discomfort, numbness) over the past 12 months in nine anatomical regions: neck, shoulders, elbows, wrists/hands, upper back, lower back, hips/thighs, knees, and ankles/feet. Participants are asked whether these symptoms have interfered with their work (at home or outside) during the past 12 months and whether they have experienced pain in any of these nine regions at any time during the past seven days.

Upper extremity functional status will be evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. The QuickDASH is a shortened version of the full Disabilities of the Arm, Shoulder, and Hand questionnaire, consisting of 11 items. The scoring system is the same as the long version, using a 5-point Likert scale. According to this scale, upper extremity activity is rated as follows: 1 - no difficulty, 2 - mild difficulty, 3 - moderate difficulty, 4 - severe difficulty, and 5 - unable to perform. The total score ranges from 0 to 100, where 0 indicates no functional impairment and 100 indicates maximum functional limitation.

The Nottingham Extended Activities of Daily Living Scale (NEADLS) will be used to evaluate participants' daily living activities across four subdomains: mobility, kitchen, domestic, and leisure activities. Responses are scored as follows: 0 = unable to perform, 1 = able to perform with assistance, 2 = able to perform independently but with difficulty, and 3 = able to perform independently and easily. The total score ranges from 0 to 66, with higher scores indicating greater independence in daily living activities.

Body awareness will be evaluated using the Body Awareness Rating Questionnaire. This questionnaire was developed to assess individuals' difficulties in perceiving and describing their bodily sensations and functions. It evaluates body awareness across four parameters: function, sensations, mood, and awareness. Each item is scored on a 7-point Likert scale. Each parameter receives a score ranging from 6 to 42, with higher scores indicating greater body awareness. Participants will be asked to read each statement within every parameter and select the score that best represents their experience.