Do psychological factors affect outcomes in musculoskeletal shoulder disorders? A systematic review

Abstract

Background Psychological factors may impact recovery in patients undergoing treatment for shoulder complaints. The aim of this review is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF) on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. MPF refers to factors that may change with intervention. Methods This is a systematic literature review. Five databases searched (MEDLINE, CINAHL, Cochrane Library, Embase and PsycInfo), for longitudinal studies investigating the influence of MPF on prognosis of patients with shoulder disorders, all diagnoses, undergoing clinical interventions (conservative or surgical). Level of evidence was determined using Scottish Intercollegiate Guidelines Network (SIGN) methodology. Moderate and high quality evidence was included. We extracted all MPF, categorized constructs into the following domains: beliefs (self-efficacy, expectation of recovery), coping (catastrophizing, avoidant coping), and affect (depression, anxiety). We evaluated constructs for its predictive value of at least one outcome. Outcomes were informed by this review. Evidence was classified into three categories: evidence for, inconclusive evidence, and evidence against. Results Of 1170 references, 40 distinct publications based on 35 datasets were included (intervention type: 20 surgical; 20 conservative). Overall, 22 studies (20 cohort studies and 2 RCTs) were classified as high quality and 18 studies (16 cohort studies, 2 RCTs) were classified as moderate quality. Outcomes reported included pain, disability/function, perceived recovery, physical and mental health, and work status. Based on the review, of the psychological constructs explored, these data would suggest that expectation of recovery, catastrophizing, avoidant coping, depression, and anxiety may predict outcome for patients managed surgically. In patients undergoing conservative intervention the evidence was either against (catastrophizing, depression, anxiety) or inconclusive (self-efficacy, expectation of recovery, avoidant coping) for the predictive value of psychological factors on outcome. Conclusions Five constructs were predictive of outcome for surgically managed patients. This suggests that implementing the biopsychosocial approach (i.e., preoperative screening, intervention by a trained clinician) may be advantageous for patients recommended for shoulder surgery,,. The same is not indicated for conservatively managed patients as no conclusive association of MPF with outcomes was noted. The importance of other MPF on outcome requires further investigation.

The relationship between shoulder pain and shoulder disability in women: The mediating role of sleep quality and psychological disorders

“…This result is supported by work from previous studies that reported shoulder pain as more frequent in people with psychological problems, especially among women, and that shoulder disability is associated with psychological problems. [ 3 , 8 , 25 , 26 ] Persistence of high-intensity shoulder pain may facilitate the disuse of the affected shoulder and lead to abnormal defensive behavior to avoid the shoulder pain, which can affect daily life activities including sleeping or driving a vehicle. Therefore, people with shoulder pain can perceive of pain as a threat or fear of life and experience symptoms of depression, anxiety, and stress.…”

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“…This supports increasing evidence that pre-existing psychosocial factors play an important role in influencing the patient-reported outcome following a range of both traumatic and non-traumatic conditions of the upper limb. [6][7][8][37][38][39][40] There is evidence in the trauma setting that treatment to address such psychosocial factors improves pain and disability after musculoskeletal injury, through better communication and behavioural therapy. [41][42][43][44][45] We defined affective disorders as recognized mood disorders, in accordance with ICD-10 codes, 46 as diagnosed by psychiatric evaluation and documented in the patient's records at the time of surgery.…”

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