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

Abstract

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.

Self‐efficacy in patients with chronic musculoskeletal conditions discharged from physical therapy service: A cross‐sectional study

“…In this study, most participants were discharged after completing rehabilitation program for shoulder and low back pain. A recent study showed the negative effects of low self-efficacy and considered the variables, disability and shoulder pain, as poor prognostic factors of subacromial pain (Chester, Khondoker, Shepstone, Lewis, & Jerosch-Herold, 2019). Our results showed the association between low selfefficacy and higher pain intensity at discharge.…”

A cross-sectional study on associations of physical symptoms, health self-efficacy and suicidal ideation among Chinese hospitalized cancer patients following diagnosis.

“…An increased risk of SI was shown in those patients with low health self-efficacy and pain. Previous studies have suggested that higher level of self-efficacy could reduce the likelihood of continued pain and disability [50], Therefore, patients with higher health self-efficacy experience their illness as less distressing, which in turn related to a lower degree of pain and function limitation. This is in line with prior studies showing an association of higher health self-efficacy of cancer patients with lower psychological distress levels and higher quality of life [34,35].…”

Shoulder pain: physiotherapy patients who believe in their ability to move show better recovery

“…The results, published in the British Journal of Sports Medicine ,1 showed that only three of the 34 baseline factors considered were predictive of outcome. These were the patients’ baseline pain or disability, their pain self efficacy (defined as patients’ belief in their ability to complete tasks and to reach a desired outcome despite their shoulder pain), and their expectation of change due to physiotherapy treatment.…”

“…The new study,1 which was funded by the National Institute for Health Research, aimed to identify the factors most likely to predict outcomes in patients being treated for musculoskeletal shoulder pain where surgery was not indicated.…”