Chester Rachel, Jerosch-Herold Christina, Lewis Jeremy, Shepstone Lee
Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK.
Physiotherapy Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK.
Br J Sports Med. 2018 Feb;52(4):269-275. doi: 10.1136/bjsports-2016-096084. Epub 2016 Jul 21.
BACKGROUND/AIM: Shoulder pain is a major musculoskeletal problem. We aimed to identify which baseline patient and clinical characteristics are associated with a better outcome, 6 weeks and 6 months after starting a course of physiotherapy for shoulder pain.
1030 patients aged ≥18 years referred to physiotherapy for the management of musculoskeletal shoulder pain were recruited and provided baseline data. 840 (82%) provided outcome data at 6 weeks and 811 (79%) at 6 months. 71 putative prognostic factors were collected at baseline. Outcomes were the Shoulder Pain and Disability Index (SPADI) and Quick Disability of the Arm, Shoulder and Hand Questionnaire. Multivariable linear regression was used to analyse prognostic factors associated with outcome.
Parameter estimates (β) are presented for the untransformed SPADI at 6 months, a negative value indicating less pain and disability. 4 factors were associated with better outcomes for both measures and time points: lower baseline disability (β=-0.32, 95% CI -0.23 to -0.40), patient expectation of 'complete recovery' compared to 'slight improvement' as 'a result of physiotherapy' (β=-12.43, 95% CI -8.20 to -16.67), higher pain self-efficacy (β=-0.36, 95% CI -0.50 to -0.22) and lower pain severity at rest (β=-1.89, 95% CI -1.26 to -2.51).
Psychological factors were consistently associated with patient-rated outcome, whereas clinical examination findings associated with a specific structural diagnosis were not. When assessing people with musculoskeletal shoulder pain and considering referral to physiotherapy services, psychosocial and medical information should be considered.
Protocol published at http://www.biomedcentral.com/1471-2474/14/192.
背景/目的：肩部疼痛是主要的肌肉骨骼问题。我们旨在确定在开始针对肩部疼痛的物理治疗疗程6周和6个月后，哪些基线患者特征和临床特征与更好的治疗结果相关。
招募了1030名年龄≥18岁因肌肉骨骼性肩部疼痛而接受物理治疗的患者，并收集了他们的基线数据。840名（82%）患者在6周时提供了治疗结果数据，811名（79%）患者在6个月时提供了治疗结果数据。在基线时收集了71个可能的预后因素。治疗结果采用肩部疼痛和功能障碍指数（SPADI）以及手臂、肩部和手部快速功能障碍问卷进行评估。采用多变量线性回归分析与治疗结果相关的预后因素。
给出了6个月时未转换的SPADI的参数估计值（β），负值表示疼痛和功能障碍较轻。对于两种测量方法和两个时间点，有4个因素与更好的治疗结果相关：较低的基线功能障碍（β=-0.32，95%置信区间-0.23至-0.40）、与“略有改善”相比，患者对“完全康复”（“由于物理治疗”）的期望（β=-12.43，95%置信区间-8.20至-16.67）、较高的疼痛自我效能感（β=-0.36，95%置信区间-0.50至-0.22）以及较低的静息时疼痛严重程度（β=-1.89，95%置信区间-1.26至-2.51）。
心理因素始终与患者自评的治疗结果相关，而与特定结构诊断相关的临床检查结果则不然。在评估肌肉骨骼性肩部疼痛患者并考虑转介至物理治疗服务时，应考虑心理社会和医学信息。
