Objectives To (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.
Methods 1030 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.
Results Four 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.
Conclusions Patient 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.
- longitudinal study
- observational study
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Contributors RC conceived the study. RC, LS, JSL and CJ-H contributed to the design of the study. RC directed the study and managed data acquisition. RC had full access to all of the data in the study and takes responsibility for the integrity of the data. MK undertook and LS provided expert advice on the statistical analyses. RC and MK drafted the manuscript. LS, JSL and CJ-H provided additional important intellectual and substantial scientific input throughout the study and on all redrafts of the report.
Funding RC was funded by the National Institute for Health Research (NIHR CAT CDRF 10–008). CJ-H was funded by the NIHR (NIHR- SRF-2012-05-119). The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report or decision to submit the article for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.
Disclaimer The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report or decision to submit the article for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.
Competing interests RC had support from a National Institute of Health Clinical Doctoral Research Fellowship for the submitted work.
Ethics approval This study was obtained from the National Research Ethics Service, East of England, Norfolk, UK in July 2011 (reference 11/EE/0212).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
Patient consent for publication Not required.
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