Abstract
Study Design
Retrospective cohort.
Introduction
Rehabilitation interventions are commonly prescribed for patients with shoulder pain,
but it is unclear what factors may help clinicians' prognosis for final outcomes.
Purpose of the Study
The purpose of this study is to determine what factors are the best predictors of
improved patient-reported outcomes at discharge in patients with shoulder pain.
Methods
Retrospective chart review of 128 patients presenting with shoulder pain to an outpatient
physical therapy clinic. Chart review captured data regarding patient demographics,
treatment interventions, patient history, and patient-reported outcome scores. The
primary dependent variable was the overall change score of the QuickDASH (initial
to discharge). Thirty-eight predictor variables were entered into a forward stepwise
multivariate linear regression model to determine which variables and to what degree
contributed to the dependent variable.
Results
The linear regression model identified 5 predictor variables that yielded an R = 0.74
and adjusted R2 = 0.538 (P < .001). The 5 predictor variables identified in order of explained variance are
QuickDASH change at the fifth visit, a total number of visits, initial QuickDASH score,
scapular retraction exercise, and age.
Discussion
Early change scores, equal to minimal detectable change scores on patient-reported
outcomes appear to be strong indicators that patients with shoulder pain are on a
positive trajectory to benefit from rehabilitation.
Conclusion
Using patient-reported outcomes throughout care, not just at the start and end of
care, will provide therapist feedback regarding patient's progress and indicate treatment
effectiveness.
Levels of Evidence
4.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence and incidence of shoulder pain in the general population; a systematic review.Scand J Rheumatol. 2004; 33: 73-81
- Prevalence of shoulder pain in the community: the influence of case definition.Ann Rheum Dis. 1997; 56: 308-312
- The clinical course of shoulder pain: prospective cohort study in primary care. Primary Care Rheumatology Society Shoulder Study Group.BMJ. 1996; 313: 601-602
- Shoulder disorders in general practice: incidence, patient characteristics, and management.Ann Rheum Dis. 1995; 54: 959-964
- The long-term course of shoulder complaints: a prospective study in general practice.Rheumatology (Oxford). 1999; 38: 160-163
- Systematic review of prognostic cohort studies on shoulder disorders.Pain. 2004; 109: 420-431
- Prognostic factors for musculoskeletal pain in primary care: a systematic review.Br J Gen Pract. 2007; 57: 655-661
- Prognostic indicators for non-recovery of non-traumatic complaints at arm, neck and shoulder in general practice–6 months follow-up.Rheumatology (Oxford). 2007; 46: 169-176
- The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis.Semin Arthritis Rheum. 2012; 42: 297-316
- Prognostic factors in patients with rotator tendinosis (stage II impingement syndrome) of the shoulder.Scand J Prim Health Care. 1996; 14: 100-105
- Evidence-based treatment methods for the management of shoulder impingement syndrome among Dutch-speaking physiotherapists: an online, web-based survey.J Manipulative Physiol Ther. 2012; 35: 720-726
- The Nordic back pain subpopulation program: can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in nonpersistent low back pain?.J Manipulative Physiol Ther. 2005; 28: 153-158
- Prognostic factors for short-term improvement in acute and persistent musculoskeletal pain consulters in primary care.Chiropr Man Therap. 2011; 19: 27
- The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH.BMC Musculoskelet Disord. 2006; 7: 44
- Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain.J Shoulder Elbow Surg. 2009; 18: 920-926
- Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy.Spine. 2003; 28: 52-62
- Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests.Br J Sports Med. 2008; 42 (discussion 92): 80-92
- Shoulder pain and mobility deficits: adhesive capsulitis.J Orthop Sports Phys Ther. 2013; 43: A1-A31
- The painful shoulder: can consultants agree?.Br J Rheumatol. 1996; 35: 1172-1174
- Subacromial impingement syndrome.J Bone Joint Surg Am. 1997; 79: 1854-1868
- Communication breakdown: clinicians disagree on subacromial impingement.Med Biol Eng Comput. 2014; 52: 221-231
- Reliability of shoulder range of motion comparing a goniometer to a digital level.Physiother Theory Pract. 2010; 26: 327-333
- Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: a case series.J Orthop Sports Phys Ther. 2010; 40: 474-493
- Physical therapy in a value-based healthcare world.J Orthop Sports Phys Ther. 2012; 42: 1-2
- What is value in health care?.N Engl J Med. 2010; 363: 2477-2481
- Federal Register.Centers for Medicare and Medicaid Services: Department of Health and Human Services. 2012; 77: 68891-69380
- Predicting response to physiotherapy treatment for musculoskeletal shoulder pain: a systematic review.BMC Musculoskelet Disord. 2013; 14: 203
- The concept of clinically meaningful difference in health-related quality-of-life research. How meaningful is it?.Pharmacoeconomics. 2000; 18: 419-423
- Shoulder disorders: a state-of-the-art review.Baillieres Best Pract Res Clin Rheumatol. 1999; 13: 287-309
- Prognosis in soft tissue disorders of the shoulder: predicting both change in disability and level of disability after treatment.Phys Ther. 2006; 86: 1013-1032
- The hand in neck manoeuvre as a toll to analyze pain-generating mechanisms in the subacromial impingement syndrome.Clin Orthop Relat Res. 1994; 26: 59-64
- Effects of scapular dyskinesis and scapular assistance test on subacromial space during static arm elevation.J Shoulder Elbow Surg. 2012; 21: 631-640
- Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: effect of a 6-week training program on muscle recruitment and functional outcome.Am J Sports Med. 2012; 40: 1906-1915
- Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program.Phys Ther. 2004; 84: 832-848
- Physical therapists' perceptions and use of exercise in the management of subacromial shoulder impingement syndrome: Focus Group Study.Phys Ther. 2016; 96: 1354-1363
- Users' guides to the medical literature III how to use an article about a diagnostic test are the results of the study valid?.J Am Med Assoc. 1994; 271: 389-391
- Evidence based medicine: what it is and what it isn't.BMJ. 1996; 312: 71-72
- Incorporating outcome measures into evidence-based practice.in: Law M. MacDermid J. Evidence-Based Rehabilitation. 2nd ed. Slack, Thorofare2008: 63-94
- An introduction to evidence-based practice for hand therapists.J Hand Ther. 2004; 17: 105-117
- Shoulder impingement revisited: evolution of diagnostic understanding in orthopedic surgery and physical therapy.Med Biol Eng Comput. 2014; 52: 211-219
JHT Read for Credit
Quiz: #488
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.The study design is
- a.RCTs
- b.prospective cohort
- c.retrospective cohort
- d.case series
- a.
- #2.The primary purpose of the study was to identify the best__________________ for patients with shoulder pain
- a.predictors of outcomes
- b.practices
- c.evaluation techniques
- d.exrercises
- a.
- #3.The primary dependent variable was the
- a.McClure graded outcome measure (MGOM)
- b.Mayo Clinic outcome scale (MCOS)
- c.Rockwood and Matsen method (RAMM)
- d.Quick-DASH change score
- a.
- #4.In reviewing published studies, the authors found ________ which they characterized as “high quality”
- a.10
- b.20
- c.6
- d.3
- a.
- #5.The authors recommend doing patient rated outcome measures initially and at the conclusion of therapy, but not midway through the course of treatment
- a.true
- b.false
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: May 30, 2017
Accepted:
April 26,
2017
Received in revised form:
April 26,
2017
Received:
March 30,
2017
Identification
Copyright
© 2017 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
