Predicting response to physiotherapy treatment for musculoskeletal shoulder pain: protocol for a longitudinal cohort study

BMC Musculoskeletal Disorders

Christina Jerosch-Herold²  Jeremy S Lewis³  Lee Shepstone⁴  Rachel Chester¹ 

[1] Physiotherapy Department, Norfolk and Norwich University Hospital, Norwich, Norfolk NR4 7UY, UK;School of Allied Health Professions, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK;Musculoskeletal Department, Health at the Stowe, Central London Community Healthcare, 260 Harrow Road, Greater London W2 5ES, UK;Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK

关键词: Prognosis;    Predict;    Musculoskeletal;    Shoulder pain;    Shoulder;    Physical therapy;   

Others  :  1130486
DOI  :  10.1186/1471-2474-14-192

 received in 2013-04-09, accepted in 2013-05-22,  发布年份 2013

【 摘 要 】

Background

Shoulder pain affects all ages, with a lifetime prevalence of one in three. The most effective treatment is not known. Physiotherapy is often recommended as the first choice of treatment. At present, it is not possible to identify, from the initial physiotherapy assessment, which factors predict the outcome of physiotherapy for patients with shoulder pain. The primary objective of this study is to identify which patient characteristics and baseline measures, typically assessed at the first physiotherapy appointment, are related to the functional outcome of shoulder pain 6 weeks and 6 months after starting physiotherapy treatment.

Methods/Design

Participants with musculoskeletal shoulder pain of any duration will be recruited from participating physiotherapy departments. For this longitudinal cohort study, the participants care pathway, including physiotherapy treatment will be therapist determined.

Potential prognostic variables will be collected from participants during their first physiotherapy appointment and will include demographic details, lifestyle, psychosocial factors, shoulder symptoms, general health, clinical examination, activity limitations and participation restrictions.

Outcome measures (Shoulder Pain and Disability Index, Quick Disability of the Arm, Shoulder and Hand, and Global Impression of Change) will be collected by postal self-report questionnaires 6 weeks and 6 months after commencing physiotherapy.

Details of attendance and treatment will be collected by the treating physiotherapist. Participants will be asked to complete an exercise dairy.

An initial exploratory analysis will assess the relationship between potential prognostic factors at baseline and outcome using univariate statistical tests. Those factors significant at the 5% level will be further considered as prognostic factors using a general linear model.

It is estimated that 780 subjects will provide more than 90% power to detect an effect size of less than 0.25 adjusted for other variables which have a co-efficient of determination (R-squared) with the outcome of up to 0.5. Assuming a 22% loss to follow up at 6 months, 1000 participants will initially be recruited.

Discussion

This study may offer service users and providers with guidance to help identify whether or not physiotherapy is likely to be of benefit. Clinicians may have some direction as to what key factors indicate a patient’s likely response to physiotherapy.

【 授权许可】

   
2013 Chester et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]van der Heijden GJ: Shoulder disorders: a state-of-the-art review. Baillieres Best Prac Res Clin Rheumat 1999, 12:287-309.
• [2]Health and Safety Executive: Musculoskeletal Disorders. 2012. http://www.hse.gov.uk/statistics/causdis/musculoskeletal/index.htm webcite
• [3]Roquelaure Y, Ha C, Leclerc A, Touranchet A, Sauteron M, Melchior M, Imbernon E, Goldberg M: Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. Amer Coll Rheumat 2006, 55:765-778.
• [4]Kuijpers T, Tulder MW, van der Heijden GJ, Bouter LM, van der Windt DA: Costs of shoulder pain in primary care consulters: a prospective cohort study in The Netherlands. BMC Musculoskelet Disord 2006, 7:83-90. BioMed Central Full Text
• [5]Virta L, Jorangerm P, Brox JI, Eriksson R: Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden. BMC Musculoskelet Disord 2012, 13:17-27. BioMed Central Full Text
• [6]Festin J, Alexanderson K: Changes in sick-leave diagnoses over eleven years in a cohort of young adults initially sick-listed due to low back, neck, or shoulder diagnoses. J Rehabil Med 2009, 41:423-428.
• [7]Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, Simmons A, Williams G: Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998, 57:649-655.
• [8]Van der Windt DAWN, Koes BW, Boeke AJ, Deville W, De Jong BA, Bouter LM: Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract 1996, 46:518-523.
• [9]Green S, Buchbinder R, Hetrick SE: Physiotherapy interventions for shoulder pain. Cochrane Database of Systematic Reviews 2003, (2):CD004258.
• [10]May S: An outcome audit for musculoskeletal patients in primary care. Physiother Theory Pract 2003, 19:189-198.
• [11]Kuijpers T, Van der Windt DAWN, van der Heijden GJ, Bouter LM: Systematic review of prognostic cohort studies on shoulder disorders. Pain 2004, 109:420-431.
• [12]Simmen BR, Chairmany LM, Bachmann G: Development of a predictive model for estimating the probability of treatment success one year after total shoulder replacement. Osteoarthritis Cartilage 2008, 16:631-634.
• [13]Kuijpers T, van der Windt DAWN, Van der Heijden GJ, Bouter LM: Clinical prediction rules for the prognosis of shoulder pain in General Practice. Pain 2006, 109:276-285.
• [14]van der Windt DAWM, Kuijpers T, Jellema P, van der Heijden GJMG, Bouter LM: Do psychological factors predict outcome in both low-back pain and shoulder pain? Ann Rheum Dis 2007, 66:313-319.
• [15]Lentz TA, Barabas JA, Day T, Bishop MD, George SZ: The relationship of pain intensity, physical impairment, and pain-related fear to function in patients with shoulder pathology. J Orthop Sports Phys Ther 2009, 39:270-277.
• [16]Black C: Working for a healthier tomorrow. Department for Work and Pensions 2008. http://www.dwp.gov.uk/docs/hwwb-working-for-a-healthier-tomorrow.pdf webcite
• [17]Department of Health: NHS 2010–2015: From good to great. Preventative, people centred, productive. 2009. http://www.official-documents.gov.uk/document/cm77/7775/7775.pdf webcite
• [18]MacDermid JC, Budinman-Mak E, Songsiridej N, Lertratanakul Y: Development of a shoulder pain and disability index. Arthritis Care Res 1991, 4:143-149.
• [19]Beaton DE, Wright JG, Katz JN: Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005, 87A:1038-1046.
• [20]Hanchard N, Cummins J, Jeffries C: Evidence-based clinical guidelines of the diagnosis, assessment, and physiotherapy management of shoulder impingement syndrome. London: Chartered Society of Physiotherapy; 2004.
• [21]Hanchard N, Goodchild L, Thompson J, O’Brien T, Richardson C, Davison D, Watson H, Wragg M, Mtopo S, Scott M: Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder v.1.2, ‘standard’ physiotherapy. London: Chartered Society of Physiotherapy; 2011.
• [22]Hanratty CE, McVeigh JG, Kerr DP, Basford JR, Finch MB, Pendleton A, Sim J: The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Semin Arthritis Rheum 2012, 42:297-316.
• [23]Littlewood C, May S, Walters S: A review of systematic reviews of the effectiveness of conservative interventions for rotator cuff tendinopathy. Shoulder and Elbow 2013. In Press
• [24]Kromer TO, Tautenhahn UG, de Bie RA, Staal JB, Bastiaenen CH: Effects of physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature. J Rehabil Med 2009, 41:870-880.
• [25]Trampas A, Kitsios T: Exercise and manual Therapy for the treatment of impngement syndrome of the shoulder: a systematic review. Phys Ther Rev 2006, 11:125-142.
• [26]International Classification of Functioning Disability and Health[http://www.who.int/classifications/icf/en/ webcite]
• [27]MacDermid JC, Solomon P, Prkachin K: The shoulder pain and disability index demonstrates factor, construct and longitudinal validity. BMC Musculoskelet Disord 2006, 7:12-22. BioMed Central Full Text
• [28]Roy J-S, MacDermid JC, Woodhouse LJ: Measuring shoulder function: a systematic review of four questionnaires. Arthritis Rheum (Arthritis Care & Research) 2009, 61:623-632.
• [29]Staples MP, Forbesa A, Green S, Buchbinder R: Shoulder-specific disability measures showed acceptable construct validity and responsiveness. J Clin Epidemiol 2010, 63:163-170.
• [30]Christie A, Hagen KB, Mowinckel P, Dagfinrud H: Methodological properties of six shoulder disability measures in patients with rheumatic diseases referred for shoulder surgery. J Shoulder Elbow Surg 2009, 18:89-95.
• [31]Polson K, Reid D, McNair PJ, Larmer P: Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire. Man Ther 2010, 15:404-407.
• [32]Mintken PE, Glynn P, Cleland JA: 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.
• [33]Gummesson C, Ward M, Atroshi I: 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, 7:44-50. BioMed Central Full Text
• [34]Lipsitz S, Parzen M: Sample size calculations for non randomized studies. J Royal Stat Soc (Series D) 1995, 44:81-90.
• [35]Nicholas MK: The pain self-efficacy questionnaire: taking pain into account. Eur J Pain 2007, 11:153.
• [36]Godin G: COMMENTARY: the godin-shephard leisure-time physical activity questionnaire. Health & Fitness Journal of Canada 2011, 4:18-22.
• [37]Godin G, Shephard RJ: A simple method to assess exercise behavior in the community. Can J Appl Sports Sciences 1985, 10:141-146.
• [38]Godin G, Shephard RJ: Godin leisure-time exercise questionnaire. Med Sci Sport Exer 1997, 26:S36-S38.
• [39]Data Protection Act. 1998. http://www.legislation.gov.uk/ukpga/1998/29/contents webcite
• [40]Department of Health: The NHS Quality, innovation, productivity and prevention challenge: an introduction for clinicians. 2010. http://webarchive.nationalarchives.gov.uk/20130107105354/; webcitehttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113806 webcite