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This research aims to explore the connections between avoidance behavior and disability following proximal humerus fractures while establishing a clinically relevant cutoff for the ADAP scale.

May 7, 2026

Avoidance behavior after proximal humerus fracture: implications for rehabilitation and a clinically relevant cutoff for the Avoidance of Daily Activities Photo Scale (ADAP Shoulder Scale)

Key Points

This research aims to explore the connections between avoidance behavior and disability following proximal humerus fractures while establishing a clinically relevant cutoff for the ADAP scale.
Cross-sectional design involving 105 adults with proximal humerus fractures.
Participants completed multiple questionnaires assessing avoidance, disability, kinesiophobia, and other psychosocial factors.
Multiple regression and ROC analyses were used to establish cutoff criteria for avoidance behavior.
A cutoff score of ≥61 on the ADAP Shoulder Scale indicates significant avoidance behavior.
The ADAP scale demonstrated strong discrimination ability for identifying disability (AUC = 0.86).
Lower pain-related self-efficacy was significantly correlated with increased avoidance behavior.

Abstract

PURPOSE: Avoidance behavior contributes to disability after proximal humerus fracture (PHF), yet its psychosocial determinants and clinical identification remain unclear. This study examined biopsychosocial correlates of avoidance and developed a clinically relevant cutoff for the Avoidance of Daily Activities Photo Scale (ADAP Shoulder Scale). MATERIALS AND METHODS: In this cross-sectional study, 105 adults with PHF completed measures of avoidance (ADAP Shoulder Scale), shoulder disability (SPADI), kinesiophobia (TSK-17), pain-related self-efficacy (PSEQ-10), resilience (Connor-Davidson Resilience Scale, CD-RISC-25), depressive symptoms (Patient Health Questionnaire, PHQ-9), and catastrophizing (PCS). Multiple regression and receiver operating characteristic (ROC) analyses were performed. RESULTS: = 0.049). The ADAP showed good discrimination of disability (AUC = 0.86). A cutoff score ≥61 may indicate relevant avoidance. CONCLUSIONS: Avoidance behavior, a significant contributor to disability after PHF, is strongly associated with lower pain-related self-efficacy. The ADAP cutoff may help clinicians identify patients with relevant avoidance, enabling early, targeted interventions to enhance confidence and engagement in rehabilitation.

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Avoidance behavior after proximal humerus fracture: implications for rehabilitation and a clinically relevant cutoff for the Avoidance of Daily Activities Photo Scale (ADAP Shoulder Scale)

Key Points

Abstract

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