The presentation and outcomes of shoulder pain in public hospital physiotherapy departments in NSW: an observational study

Roberts, David L.; Li, Frank

doi:10.3109/09593985.2013.871764

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…Nonetheless, hypothetico‐deductive reasoning, intuition, and the use of clinical guidelines do not enable consistent transparent decision‐making as evidenced by the increasing numbers of imaging requests and surgery, 3,8,13 despite the apparent effectiveness of conservative rehabilitation 14‐16 . Regardless of the clinical pathway, it is recognized that clinical outcomes can be variable, and decisions are inconsistent.…”

Section: Difficulties Associated With Musculoskeletal Decision‐makingmentioning

confidence: 99%

“…Nonetheless, hypothetico-deductive reasoning, intuition, and the use of clinical guidelines do not enable consistent transparent decision-making as evidenced by the increasing numbers of imaging requests and surgery, 3,8,13 despite the apparent effectiveness of conservative rehabilitation. [14][15][16] Regardless of the clinical pathway, it is recognized that clinical outcomes can be variable, and decisions are inconsistent. For example, a recent study found little difference between operative and non-operative treatment groups for fullthickness tears of the rotator cuff, using the quality-of-life index score.…”

Section: Difficulties Associated With Musculoskeletal Decision-makingmentioning

confidence: 99%

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Clinical decision‐making for shoulder surgery referral: An art or a science?

Taylor

Baxter

Tumilty

2020

Evaluation Clinical Practice

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Rationale Decision‐making in musculoskeletal health care is complex, with discrepancy among clinical providers and variation in the per cent of referrals for specialist care. To date, there is an increased focus on specialist referrals, risking overuse of expensive testing and contributing to unnecessary treatment. Aims and Objectives This report will considerer the difficulties of primary care musculoskeletal decision‐making using shoulder injuries as an example, presenting a solution based on multi‐criteria decision‐making analysis with online software. The associated issues involved in clinical decision‐making are complex. Contributing to the components of complexity are; the multifaceted aetiology of shoulders, the experience and knowledge of providers, and the burden of patient demands. Notwithstanding, funding considerations, resource allocation availability and other associated issues around clinical decision‐making. Considering the many facets and complexities of clinical decision‐making, this is an area where multi‐criteria decision‐making analysis (MCDM) may be appropriate. The MCDM analysis approach is increasingly being used in health care and can assist in the organizing and weighting of identified key clinical factors. MCDM could be applied to the challenges of musculoskeletal care with the potential to decrease decision‐making variability. Furthermore, the significance of each key clinical factor that musculoskeletal decision‐making is based on are to date unclear. Conclusion Therefore, this preliminary report offers a start towards clarifying key factors and an approach for implementing improved shoulder clinical care decision‐making which could then be adapted and applied to other body sites.

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Section: Difficulties Associated With Musculoskeletal Decision‐makingmentioning

confidence: 99%

Section: Difficulties Associated With Musculoskeletal Decision-makingmentioning

confidence: 99%

Clinical decision‐making for shoulder surgery referral: An art or a science?

Taylor

Baxter

Tumilty

2020

Evaluation Clinical Practice

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“…[ 7 , 15 , 16 ] Given this fact, physical therapists routinely evaluate older adults following referral from primary care providers, or by patients’ self-referral, and provide initial management for shoulder dysfunction. [ 17 , 18 ] Physical therapists typically diagnosis RC tear based on clinical examination alone, since most physical therapists do not order imaging studies for their patients. [ 19 , 20 ] Thus, in contrast to patients receiving care from orthopedic surgeons, there is a current gap in knowledge about levels of FI and progression of FI over time in the population of patients receiving initial management for RC tear by physical therapists.…”

Section: Introductionmentioning

confidence: 99%

Supraspinatus fatty infiltration on MRI among older adults receiving physical therapy as initial management for clinically suspected rotator cuff tear: A pilot study

Davis

Almardawi

Awan

et al. 2022

JCIS

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Objectives: Rotator cuff (RC) tear is common among adults ≥60 years, with supraspinatus tear most common. Intramuscular fatty infiltration (FI) on imaging is predictive of long-term outcomes following RC tear. Physical therapists routinely diagnose RC tear only by clinical examination since most do not order imaging studies. Thus, there is limited knowledge about FI in older populations receiving physical therapy (PT) for initial management of RC tear. The primary objective of our pilot study is to determine longitudinal differences in supraspinatus FI over time among older adults receiving PT (PT cohort) for initial management of RC tear relative to older adult volunteers (control cohort), and with secondary objective to evaluate longitudinal self-reported shoulder function over time. Material and Methods: This was a prospective longitudinal cohort study. Forty adults, 60–85 years, were enrolled at baseline; one follow-up visit at ≥6 months. Shoulder magnetic resonance imaging and clinical screening for Charlson comorbidity index (CCI), body mass index (BMI), and American Shoulder and Elbow Surgeon (ASES) score were completed at baseline and follow-up visits. Supraspinatus FI was evaluated by 6-point Dixon fat fraction and Goutallier grade. PT (n = 15) and control (n = 25) cohorts were stratified by supraspinatus status: Intact (no tear), partial-thickness tear (PTT), and full-thickness tear (FTT). Comparisons within cohort were performed by Kruskal–Wallis test and between cohorts by Mann–Whitney U-test. Interobserver reliability was performed for Dixon fat fraction and Goutallier grade. Results: PT cohort at baseline showed no difference for age, BMI, CCI, and ASES score; supraspinatus FI was highest for FTT by Goutallier grade (no tear, 0.5 ± 0.5; PTT, 1.1 ± 0.2; and FTT, 1.5 ± 0.5; P = 0.033) and by Dixon fat fraction (no tear, 4.6% ± 1.4%; PTT, 6.1% ± 1.9%; and FTT, 6.7% ± 2.5%; P = 0.430). Control cohort at baseline showed no difference for age, BMI, CCI, and ASES score; supraspinatus FI was highest for supraspinatus FTT by Dixon fat fraction (no tear, 5.8% ± 1.2%; PTT, 7.1% ± 6.3%; and FTT, 21.4% ± 10.4%; P = 0.034) and by Goutallier grade (no tear, 0.8 ± 0.5; PTT, 1.0 ± 0.6; and FTT, 2.4 ± 1.7; P = 0.141). No difference between similar PT and control cohort subgroups at baseline except no tear groups for ASES score (PT cohort, 58.9 ± 8.2; control cohort, 84.0 ± 21.9; P = 0.049). No differences were identified for Δ-Dixon fat fraction and Δ-Goutallier grade over time in the PT and control cohorts. PT cohort no tear subgroup showed significant improvement (P = 0.042) for Δ-ASES score over time relative to PTT and FTT subgroups; no difference for Δ-ASES score over time in the control cohort. Conclusion: Full-thickness RC tear showed higher levels of FI relative to PTT or no tear at baseline. Our pilot study’s trend suggested that older adults receiving PT for initial management of RC tear have full-thickness RC tear for shorter duration based on relative lower levels of FI at baseline as compared to older adult volunteers with full-thickness RC tear. Our pilot study also found that older adults in the PT cohort with no tear had superior shoulder functional recovery by ASES score over time relative to full-thickness and PTTs.

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Manual therapy and exercise for rotator cuff disease

Page

Green

McBain³

et al. 2016

Cochrane Database of Systematic Reviews

136

149

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Despite identifying 60 eligible trials, only one trial compared a combination of manual therapy and exercise reflective of common current practice to placebo. We judged it to be of high quality and found no clinically important differences between groups in any outcome. Effects of manual therapy and exercise may be similar to those of glucocorticoid injection and arthroscopic subacromial decompression, but this is based on low quality evidence. Adverse events associated with manual therapy and exercise are relatively more frequent than placebo but mild in nature. Novel combinations of manual therapy and exercise should be compared with a realistic placebo in future trials. Further trials of manual therapy alone or exercise alone for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.

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The presentation and outcomes of shoulder pain in public hospital physiotherapy departments in NSW: an observational study

Abstract: Physiotherapy in NSW Public Health settings manages a wide variety of shoulder conditions with benefits observed across all patient presentations and diagnoses.

Cited by 5 publications

References 28 publications

Clinical decision‐making for shoulder surgery referral: An art or a science?

Clinical decision‐making for shoulder surgery referral: An art or a science?

Supraspinatus fatty infiltration on MRI among older adults receiving physical therapy as initial management for clinically suspected rotator cuff tear: A pilot study

Manual therapy and exercise for rotator cuff disease

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