IntroductionChronic shoulder pain is a very complex syndrome, and the mechanisms involved in its perpetuation remain unclear. Psychological factors appear to play a role in the perpetuation of symptoms in people with shoulder chronicity. The purpose of this systematic review is to examine the role of psychological factors in the perpetuation of symptoms (pain intensity and disability) in people with chronic shoulder pain.Methods and analysisA systematic search was performed on PubMed, AMED, CINAHL, PubPsych and EMBASE from inception to July 2017. Longitudinal studies with quantitative designs analysing the role of psychological factors on pain intensity, disability or both were included. The methodological quality of the included studies was evaluated with an adapted version of the Newcastle Ottawa Scale. The level of evidence per outcome was examined using the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsA total of 27 articles were included with a sample of 11 176 people with chronic shoulder pain. The risk of bias ranges from 7/21 to 13/21 across the studies. The quality of the evidence was very low. High levels of self-efficacy, resilience and expectations of recovery were significantly associated with low levels of pain intensity and disability. Inversely, high levels of emotional distress, depressive symptoms, anxiety, preoperative concerns, fear-avoidance beliefs, somatisation and pain catastrophising were significantly associated with high levels of pain intensity and disability.DiscussionOur results suggest that psychological factors may influence the perpetuation of pain intensity and disability, with very low evidence. A meta-analysis was not carried out due to the heterogeneity of the included studies so results should be interpreted with caution.PROSPERO trial registration numberCRD42016036366.

Objectives: Pain catastrophizing (PC) is the most consistent psychosocial factor predicting of adjustment to chronic pain and may contribute to the development and long-term maintenance of chronic pain. The aim of this review was systematically review and critically appraise the concurrent and longitudinal associations between PC and both pain intensity and disability in individuals with chronic musculoskeletal pain (CMP). Materials and Methods: An electronic search of PubMed, Scopus, AMED, CINAHL, PsycINFO, and PubPsych databases, as well as gray literature, was undertaken from inception until September 2018. Cross-sectional and longitudinal studies reporting on the associations between measures of PC, pain intensity, and disability were selected for review. Results: A total of 85 observational studies (92% cross-sectional) were included, with a total sample of 13,628 participants with CMP. Very low-quality evidence (based on the GRADE criteria) indicated that higher levels of PC were often, but not always, significantly associated with and prospectively predicted both chronic pain intensity and disability. Heterogeneity was large after conducting multiple meta-analyses. Discussion: Despite the very low quality of the available evidence, the general consistency of the findings highlights the potential role that PC may play in delaying recovery from CMP. Research that uses higher quality study designs and procedures would allow for more definitive conclusions regarding the impact of PC on pain and function.

The main aim of this article is to explore the experiences and life situations of people living with intestinal stomas. Previous studies indicated the need to investigate the concerns of ostomy patients and how these concerns can affect their quality of life and their approaches to the comprehensive conceptualization of the bodily changes. A qualitative systematic review and metasynthesis design was carried out by using the main scientific databases. Original articles from 2002 to 2015 were selected based on their qualitative methodology. Methodological quality was evaluated using the Critical Appraisal Skills Program. The findings were synthesized using the metasynthesis procedure of Sandelowski. The final number of articles included was 95 and 1,982 participants. Regarding the metasummary, the data generated 191 thematic statements that were organized into eight categories. The findings support an explanatory model of the experience of people with ostomy based on three aspects: Acceptance, Adaptation, and Autonomy.

Many potentially valuable interventions in case management, such as information provision, self-care education and coordination between services and providers, are still not provided.