Martinez-Calderon Javier, Meeus Mira, Struyf Filip, Miguel Morales-Asencio Jose, Gijon-Nogueron Gabriel, Luque-Suarez Alejandro
Department of Physiotherapy, University of Malaga, Malaga, Spain.
Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.
BMJ Open. 2018 Apr 13;8(4):e020703. doi: 10.1136/bmjopen-2017-020703.
Chronic shoulder pain is a very complex syndrome, and the mechanisms involved in its perpetuation remain unclear. Psychological factors appear to play a role in the perpetuation of symptoms in people with shoulder chronicity. The purpose of this systematic review is to examine the role of psychological factors in the perpetuation of symptoms (pain intensity and disability) in people with chronic shoulder pain.
A systematic search was performed on PubMed, AMED, CINAHL, PubPsych and EMBASE from inception to July 2017. Longitudinal studies with quantitative designs analysing the role of psychological factors on pain intensity, disability or both were included. The methodological quality of the included studies was evaluated with an adapted version of the Newcastle Ottawa Scale. The level of evidence per outcome was examined using the Grading of Recommendations Assessment, Development and Evaluation approach.
A total of 27 articles were included with a sample of 11 176 people with chronic shoulder pain. The risk of bias ranges from 7/21 to 13/21 across the studies. The quality of the evidence was very low. High levels of self-efficacy, resilience and expectations of recovery were significantly associated with low levels of pain intensity and disability. Inversely, high levels of emotional distress, depressive symptoms, anxiety, preoperative concerns, fear-avoidance beliefs, somatisation and pain catastrophising were significantly associated with high levels of pain intensity and disability.
Our results suggest that psychological factors may influence the perpetuation of pain intensity and disability, with very low evidence. A meta-analysis was not carried out due to the heterogeneity of the included studies so results should be interpreted with caution.
CRD42016036366.
慢性肩部疼痛是一种非常复杂的综合征，其持续存在的机制尚不清楚。心理因素似乎在肩部慢性疼痛患者症状的持续存在中起作用。本系统评价的目的是研究心理因素在慢性肩部疼痛患者症状（疼痛强度和功能障碍）持续存在中的作用。
对PubMed、AMED、CINAHL、PubPsych和EMBASE从创刊至2017年7月进行系统检索。纳入采用定量设计的纵向研究，分析心理因素对疼痛强度、功能障碍或两者的作用。采用纽卡斯尔渥太华量表的改编版评估纳入研究的方法学质量。使用推荐分级评估、制定和评价方法检查每个结局的证据水平。
共纳入27篇文章，样本为11176例慢性肩部疼痛患者。各研究的偏倚风险范围为7/21至13/21。证据质量非常低。高水平的自我效能感、心理弹性和康复期望与低水平的疼痛强度和功能障碍显著相关。相反，高水平的情绪困扰、抑郁症状、焦虑、术前担忧、恐惧回避信念、躯体化和疼痛灾难化与高水平的疼痛强度和功能障碍显著相关。
我们的结果表明，心理因素可能影响疼痛强度和功能障碍的持续存在，但证据非常少。由于纳入研究的异质性未进行荟萃分析，因此结果应谨慎解释。
PROSPERO试验注册号：CRD42016036366。
