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Impact of expectations on functional recovery in individuals with chronic shoulder pain.

ABSTRACT: Retrospective cohort.To examine general expectations for treatment by physical therapists and specific expectations for common interventions in patients with shoulder pain. A secondary objective was to assess the extent to which patients' general and specific expectations for treatment affect clinical outcomes.We performed a secondary analysis of data from a clinical trial of interventions for shoulder pain. Prior to beginning treatment for shoulder pain, 140 patients were asked their general expectations of benefit and their specific expectations for individual interventions. Next we examined how these expectations related to the patients' ratings of the success of treatment at one and six months after treatment.Patients had positive general expectations for treatment by a physical therapist. Specific manual therapy interventions of range of motion and strengthening had the highest proportion of patients who expected these interventions to significantly improve shoulder pain. Seventy-two patients (58%) reported themselves to be improved using the global rating of change (GROC) at one month and six months. In the full model predicting one-month GROC, only the expectation of moderate relief (p = 0.012) and body mass index (BMI) (p = 0.013) had significant effects. Overall, the Shoulder Pain and Disability Index (SPADI) significantly decreased over time (p = 0.004); however, a significant interaction did occur between time and BMI (p = 0.021).Patients expect common interventions used by physical therapists to be effective to manage shoulder pain. In conclusion, patients with shoulder pain had high general expectations for physical therapy.Prognosis, level 2b.

SUBMITTER: McDevitt AW

PROVIDER: S-EPMC6055964 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Impact of expectations on functional recovery in individuals with chronic shoulder pain.

McDevitt Amy W AW Mintken Paul E PE Cleland Joshua A JA Bishop Mark D MD

The Journal of manual & manipulative therapy 20180216 3

<h4>Study design</h4>Retrospective cohort.<h4>Objectives</h4>To examine general expectations for treatment by physical therapists and specific expectations for common interventions in patients with shoulder pain. A secondary objective was to assess the extent to which patients' general and specific expectations for treatment affect clinical outcomes.<h4>Methods</h4>We performed a secondary analysis of data from a clinical trial of interventions for shoulder pain. Prior to beginning treatment for ...[more]

PMID: 30042628

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Project description:Shoulder surgery is a primary intervention for shoulder pain, yet many individuals experience persistent postoperative pain. Previously, we found individuals categorized as having a high-risk phenotype (comprised of COMT variation and pain catastrophizing) had approximately double the chance of not reaching a 12-month pain recovery criterion. As a means to better understand the development of persistent postoperative shoulder pain, this study advanced our previous work by examining temporal ordering of postoperative shoulder recovery based on potential mediating factors, and expansion of outcomes to include movement-evoked pain and shoulder active range of motion. Before surgery, individuals were categorized as either high-risk (high pain catastrophizing, COMT-genotype linked to low enzyme activity [n = 41]) or low-risk (low pain catastrophizing, COMT-genotype linked to normal enzyme activity [n = 107]). We then compared potential mediating variables at 3, 6, and 12 months postoperatively 1) endogenous pain modulation defined by a conditioned pain modulation paradigm; and 2) and emotion factors such as anxiety, fear of movement, and depressive symptoms. At 3 months, the high-risk subgroup had higher fear and movement-evoked pain, and causal mediation analysis confirmed the direct effect of risk subgroup on 12-month movement evoked pain. However, baseline to 12-month change in depressive symptoms were found to mediate 53% of the total effect of risk subgroup on 12-month movement-evoked pain. This study introduces potential temporal components and relationships to the development of persistent postoperative shoulder pain, which future studies will confirm and assess for potential therapeutic targets. PERSPECTIVE: This study expands upon postoperative shoulder recovery measures to include movement-evoked pain and depressive symptoms, and provides preliminary indication of temporal ordering to postoperative shoulder recovery for a preidentified high-risk subgroup. Future studies will distinguish temporal components of shoulder surgery that may optimize treatment targets of postoperative recovery.

Dataset Information

Impact of expectations on functional recovery in individuals with chronic shoulder pain.

Publications

Impact of expectations on functional recovery in individuals with chronic shoulder pain.

Similar Datasets

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