BackgroundPeople suffering from musculoskeletal shoulder pain are frequently referred to physiotherapy. Physiotherapy generally involves a multimodal approach to management that may include; exercise, manual therapy and techniques to reduce pain. At present it is not possible to predict which patients will respond positively to physiotherapy treatment. The purpose of this systematic review was to identify which prognostic factors are associated with the outcome of physiotherapy in the management of musculoskeletal shoulder pain.MethodsA comprehensive search was undertaken of Ovid Medline, EMBASE, CINAHL and AMED (from inception to January 2013). Prospective studies of participants with shoulder pain receiving physiotherapy which investigated the association between baseline prognostic factors and change in pain and function over time were included. Study selection, data extraction and appraisal of study quality were undertaken by two independent assessors. Quality criteria were selected from previously published guidelines to form a checklist of 24 items. The study protocol was prospectively registered onto the International Prospective Register of Systematic Reviews.ResultsA total of 5023 titles were retrieved and screened for eligibility, 154 articles were assessed as full text and 16 met the inclusion criteria: 11 cohort studies, 3 randomised controlled trials and 2 controlled trials. Results were presented for the 9 studies meeting 13 or more of the 24 quality criteria. Clinical and statistical heterogeneity resulted in qualitative synthesis rather than meta-analysis. Three studies demonstrated that high functional disability at baseline was associated with poor functional outcome (p ≤ 0.05). Four studies demonstrated a significant association (p ≤ 0.05) between longer duration of shoulder pain and poorer outcome. Three studies, demonstrated a significant association (p ≤ 0.05) between increasing age and poorer function; three studies demonstrated no association (p > 0.05).ConclusionAssociations between prognostic factors and outcome were often inconsistent between studies. This may be due to clinical heterogeneity or type II errors. Only two baseline prognostic factors demonstrated a consistent association with outcome in two or more studies; duration of shoulder pain and baseline function. Prior to developing a predictive model for the outcome of physiotherapy treatment for shoulder pain, a large adequately powered prospective cohort study is required in which a broad range of prognostic factors are incorporated.

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Background/Aims Physiotherapists generally have a positive view of research, but have identified a number of barriers to taking part, and have expressed challenges when attempting to integrate research findings into their practice. The aim of this study was to describe the self-reported impact of collecting data for a multicentre research study on physiotherapists' clinical practice. Methods Convenience sampling was used to select three of 11 NHS trusts involved in the original data collection. A questionnaire was emailed to the 28 of 34 physiotherapists working within these three Trusts who collected data and for whom contact details were available. Results A total of 21 (75%) physiotherapists completed the questionnaire. Out of the 21 physiotherapists, 15 stated they were aware of the study results; all of whom reported subsequent changes in their beliefs about prognostic factors for shoulder pain (subject of the original study) and some alteration in clinical practice. However, barriers to integrating further changes into practice were reported, including lack of time and a perception that patients would not engage with a more (bio)psychosocial approach. Overall, 85% of responders stated data collection had changed their understanding of the research process. Conclusions Clinicians' participation in the research process positively influenced practice. However, 29% were unaware of the results and only 33% of physiotherapists accessed the published article. There were perceived barriers to integrating results into practice.

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