The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review

Abstract

Objective: To examine the predictive, moderating and mediating role of cognitive, emotional and behavioral factors on pain and disability following shoulder treatment. Data Sources: Electronic databases (Pubmed, Web of Science, Embase, PsycINFO) were searched until the 14 th of January 2019. Study selection: Studies including persons with musculoskeletal shoulder pain that describe the predictive, moderating or mediating role of baseline cognitive, emotional or behavioral factors on pain or disability following treatment were selected. Results: Twenty-three articles, describing 21 studies and involving 3769 participants, were included. Three studies had a high risk of bias. There was no predictive role of baseline depression, anxiety, coping, somatisation or distress on pain or disability across types of shoulder treatment. No predictive role of fear-avoidance beliefs was identified in patients receiving physiotherapy, which contrasted to the results found when surgical treatment was applied. Baseline catastrophizing was also not predictive for pain or disability in patients receiving physiotherapy. After conservative medical treatments, results on the predictive role of catastrophizing were inconclusive. Treatment expectations and baseline self-efficacy predicted pain and disability in patients receiving physiotherapy, which was not the case in patients receiving conservative medical treatment. Finally, there was a moderating role for optimism in the relationship between pain catastrophizing and disability in patients receiving physiotherapy. Conclusion: There is evidence that expectations of recovery and self-efficacy have a predictive role and optimism a moderating role on pain and/or disability following physiotherapy for musculoskeletal shoulder pain. After surgical treatment, fear-avoidance is a predictor of pain and disability.

Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis

“…A TSK baseline score of about 26 points was observed in non-recovered patients with shoulder pain over one year of follow-up [106]. Further, a very low level of evidence suggests that high levels of kinesiophobia seems to predict the persistency of disability overtime [27,36] and it is not clear whether kinesiophobia is a predictor for treatment outcome in shoulder pain [107].…”

Pain-related beliefs are associated with arm function in persons with frozen shoulder

“…Recently, several systematic reviews have shown an association between pain-related beliefs and disability in persons receiving either surgery, conservative medical or physiotherapy treatment for shoulder pain. [13][14][15] Pain self-efficacy was recognized as an important factor associated with arm function, assessed by the Shoulder Pain and Disability Index (SPADI) and Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH), in persons who received physiotherapy for their shoulder complaint. 16,17 This indicates that a person's perceived function may be related to the confidence he/she has in performing a task or activity despite pain.…”

Do Psychological Factors Affect Outcomes in Musculoskeletal Shoulder Disorders? A Systematic Review

“…This review aimed to explore the relationship between MPF and outcomes in patients with shoulder disorders and found that psychological factors may be barriers and facilitators to recovery for patients with shoulder pain managed surgically. Compared to previous reviews (8,(16)(17)(18)(19)(20) this review provides a more comprehensive examination of the topic in several ways. We included studies of both conservative and surgical intervention, short and long time from onset, and applied no language restrictions in our search.…”

“…Previous systematic reviews attempting to explore the impact of psychological factors on outcome in patients with shoulder conditions drew from a limited pool of studies, many of which are of low quality or lack important methodological details, such as time from onset (8,(16)(17)(18)(19)(20). Also, they focused on only surgical interventions or focused on psychological constructs, without de ning those that are modi able, and without distinguishing between surgical and conservative cases.…”