Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study

Chester, Rachel; Jerosch‐Herold, Christina; Lewis, Jeremy; Shepstone, Lee

doi:10.1136/bjsports-2016-096084

Cited by 203 publications

(196 citation statements)

References 41 publications

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“…While these findings are consistent with those from the GLM analysis,13 the CART analysis selects variables based on prediction power rather than statistical significance or p values. Variables are included in order of importance; the most predictive variable is included first, the analysis then searches for the second most important variable among the rest and so on.…”

Section: Discussionsupporting

confidence: 79%

“…These variables included demographics, patient expectations and beliefs, lifestyle, general health, work, shoulder history and presentation and clinical examination findings 15. All factors statistically associated with outcome (p≤0.05) in at least one of the multivariable linear models from our previous analysis13 were included in the CART analysis. In addition, baseline factors measured, but not found to be statistically significant, were entered if reported as a significant prognostic factor for outcome in reviews of other musculoskeletal studies 19 20.…”

Section: Methodsmentioning

confidence: 99%

“…In a multicentre cohort study of 1030 patients with musculoskeletal shoulder pain attending physiotherapy, of mean duration 14 months (SD 28 months), 69% of patients reported complete recovery or being much improved by 6 months follow-up; 17% reported only slight improvement and 14% reported no change or a worsening of symptoms 12. A multivariable general linear model (GLM) was used to identify prognostic factors associated with patient-rated pain and disability 13. Several factors were consistently associated with a better outcome at 6 months.…”

Section: Introductionmentioning

confidence: 99%

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Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis

et al. 2019

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ObjectivesTo (i) identify predictors of outcome for the physiotherapy management of shoulder pain and (ii) enable clinicians to subgroup people into risk groups for persistent shoulder pain and disability.Methods1030 people aged ≥18 years, referred to physiotherapy for the management of musculoskeletal shoulder pain were recruited. 810 provided data at 6 months for 4 outcomes: Shoulder Pain and Disability Index (SPADI) (total score, pain subscale, disability subscale) and Quick Disability of the Arm, Shoulder and Hand (QuickDASH). 34 potential prognostic factors were used in this analysis.ResultsFour classification trees (prognostic pathways or decision trees) were created, one for each outcome. The most important predictor was baseline pain and/or disability: higher or lower baseline levels were associated with higher or lower levels at follow-up for all outcomes. One additional baseline factor split participants into four subgroups. For the SPADI trees, high pain self-efficacy reduced the likelihood of continued pain and disability. Notably, participants with low baseline pain but concomitant low pain self-efficacy had similar outcomes to patients with high baseline pain and high pain self-efficacy. Cut-off points for defining high and low pain self-efficacy differed according to baseline pain and disability. In the QuickDASH tree, the association between moderate baseline pain and disability with outcome was influenced by patient expectation: participants who expected to recover because of physiotherapy did better than those who expected no benefit.ConclusionsPatient expectation and pain self-efficacy are associated with clinical outcome. These clinical elements should be included at the first assessment and a low pain self-efficacy response considered as a target for treatment intervention.

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Section: Discussionsupporting

confidence: 79%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis

et al. 2019

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“…The validity of using specific anatomical diagnostic labels has been challenged extensively, particularly regarding non-acute shoulder pain 11–13. Clinical features of specific anatomical diagnoses, such as reduced external rotation or an external rotation lag, indicative of frozen shoulder and rotator cuff tear, respectively, are inconsistent predictors of outcome 14. Specific anatomical diagnostic labels provide limited clinical guidance in patient management or estimating prognosis 15.…”

Section: Introductionmentioning

confidence: 99%

Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis

et al. 2017

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BackgroundIt is unclear whether the presence of scapular dyskinesis increases the risk of developing shoulder pain in asymptomatic athletes.ObjectivesTo determine whether the presence of scapular dyskinesis in asymptomatic athletes increases the risk of developing shoulder pain by systematic review and meta-analysis.MethodsA systematic search was conducted in the Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database and SPORTDiscus. Prospective studies that assessed athletes for scapular dyskinesis and recorded incidents of shoulder pain were included. Study quality was assessed using the Downs and Black checklist. Meta-analysis was conducted to derive a pooled risk ratio (RR) for the development of shoulder pain in athletes with scapular dyskinesis compared with those without scapular dyskinesis.ResultsFive studies were included with a total of 419 athletes. Of the athletes with scapular dyskinesis, 35% (56/160) experienced shoulder pain during the follow-up, whereas 25% (65/259) of athletes without scapular dyskinesis experienced symptoms. The presence of scapular dyskinesis at baseline indicated a 43% increased risk of a shoulder pain event over a 9 to 24 months follow-up (RR=1.43, 95% CI 1.05 to 1.93).ConclusionsAthletes with scapular dyskinesis have 43% greater risk of developing shoulder pain than those without scapular dyskinesis.

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“…27 31 Currently, some evidence has shown how psychological factors could be associated with the prognosis of CSP. [32][33][34] Reilingh et al 32 investigated the course and prognosis of shoulder pain in the 6 first months after presentation to the GP. Predictors of a better outcome for CSP were lower scores on pain catastrophising and higher baseline pain intensity (explained variance 21%).…”

Section: Introductionmentioning

confidence: 99%

Influence of psychological factors on the prognosis of chronic shoulder pain: protocol for a prospective cohort study

et al. 2017

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IntroductionShoulder pain is a highly prevalent condition. Psychological factors could play an essential role in the prognosis of chronic shoulder pain (CSP). The aims of the study will be to analyse the level of association between psychological factors and pain-disability at baseline and prospectively to assess their prognostic role; to evaluate the association of pain catastrophising and kinesiophobia at baseline and prospectively in the relationship between pain intensity and disability, or between self-efficacy and disability in patients with CSP; to explore the association of self-efficacy at baseline and prospectively in the relationship between pain intensity and disability, in comparison with kinesiophobia and pain catastrophising.Methods and analysisThe study is a longitudinal, prospective cohort study with a 12-month follow-up. It will be conducted in 4 primary-care centres and one hospital of the province of Malaga, Spain. 307 participants aged between 18 and 70 years suffering from CSP (3 months or more) will be included. Primary outcomes will include pain, disability and self-efficacy, whereas kinesiophobia, pain-related fear, pain catastrophising, anxiety, depression, patient expectations of recovery, age, gender, duration/intensity of symptoms, educational level and other factors will be predictive measures. Follow-up: baseline, 3, 6 and 12 months.Ethics and disseminationThe local ethics committee (The Costa del Sol Ethics Committee, Malaga, 28042016) has approved this protocol. Dissemination will occur through presentations at National and International conferences and publications in international peer-reviewed journals.Trial registration numberNCT02738372; pre-results

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Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study

Cited by 203 publications

References 41 publications

Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis

Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis

Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis

Influence of psychological factors on the prognosis of chronic shoulder pain: protocol for a prospective cohort study

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