Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK.
BMC Musculoskelet Disord. 2022 Feb 26;23(1):183. doi: 10.1186/s12891-022-05139-6.
Shoulder pain is a prevalent and often long-lasting musculoskeletal disorder. The overall prognosis of shoulder pain is highly variable with 40-50% of patients reporting persistent pain 6-12 months after consulting a clinician. The evidence for psychological prognostic factors for patients with shoulder pain is inconsistent. Therefore, the objective of this study was to investigate the association between fear of movement and emotional distress at presentation and self-reported disability over one year of follow-up.
This is a prospective cohort study of consecutive patients referred to secondary outpatient care due to shoulder pain. Consenting patients underwent a physical examination and completed a comprehensive questionnaire at baseline, three months-, and one-year follow-up. Associations between baseline fear of movement (0-10) or emotional distress (1-4), respectively, and patient reported disability measured using Quick Disability of the Arm and Shoulder (QuickDASH, 0-100) over one year were analyzed with linear mixed-effects models (LMM) for repeated measures (baseline, 3 months and 1 year), adjusting for established prognostic factors.
A total of 138 patients were recruited between March 2015 and January 2018, with response rates of 84.7% (n = 117) and 79.7% (n = 100) at three months and one year, respectively. Adjusted associations revealed that for every point increase in baseline fear of movement, the QuickDASH score increased (worsened) by 1.10 points (95% CI 0.2-2.0) over the follow-up year. For every point increase in baseline emotional distress, the QuickDASH score increased by 19.9 points (95% CI 13.9-25.9) from baseline over the follow-up year.
Higher fear of movement and emotional distress scores at baseline were significantly associated with higher disability over one year in patients with shoulder pain referred to secondary care. Our study indicates that these psychological factors affect prognosis and should be considered by clinicians and researchers working with patients with shoulder pain.
肩部疼痛是一种普遍且常持续存在的肌肉骨骼疾病。肩部疼痛的总体预后差异很大，40-50%的患者在向临床医生就诊后 6-12 个月仍报告持续性疼痛。肩部疼痛患者的心理预后因素的证据并不一致。因此，本研究的目的是调查在向二级门诊就诊的肩部疼痛患者中，就诊时的运动恐惧和情绪困扰与一年随访时的自我报告残疾之间的关系。
这是一项连续肩部疼痛患者的前瞻性队列研究。同意参加的患者在基线、3 个月和 1 年随访时接受了体格检查和全面的问卷调查。使用线性混合效应模型（LMM）对重复测量（基线、3 个月和 1 年）进行分析，以评估基线时的运动恐惧（0-10）或情绪困扰（1-4）分别与一年随访时患者报告的残疾（使用手臂和肩部快速残疾量表，QuickDASH，0-100）之间的关联，调整了既定的预后因素。
2015 年 3 月至 2018 年 1 月共招募了 138 名患者，3 个月和 1 年的应答率分别为 84.7%（n=117）和 79.7%（n=100）。调整后的关联表明，与运动恐惧的基线分数每增加 1 分，QuickDASH 分数在随访年内增加（恶化）1.10 分（95%CI0.2-2.0）。与基线相比，情绪困扰的基线分数每增加 1 分，QuickDASH 分数在随访年内增加 19.9 分（95%CI13.9-25.9）。
在向二级护理转诊的肩部疼痛患者中，较高的运动恐惧和情绪困扰基线分数与一年后的残疾程度显著相关。我们的研究表明，这些心理因素会影响预后，应得到临床医生和研究人员的重视。
