Fear of movement and emotional distress as prognostic factors for disability in patients with shoulder pain: a prospective cohort study

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Determinants of Pain-Induced Disability in German Women with Endometriosis during the COVID-19 Pandemic

“…Pain and depression share common neurological pathways, leading to helplessness and fear of physical activity [ 85 ]. The detrimental impact of adverse mental health outcomes and pain-induced disability has been described in other chronic pain conditions [ 25 ], such as chronic neck pain [ 98 ] and chronic shoulder pain [ 99 , 100 ]. Psychological distress has been identified as a mediator of the relationship between pain and pain-induced disability in persons with back pain [ 101 , 102 ], which is also a symptom of endometriosis.…”

Exercise for rotator cuff tendinopathy: Proposed mechanisms of recovery

“…Psychosocial factors can partially explain the clinical outcomes of resisted exercise programs. 31,200,203,207 A 2019 systematic review 200 identified that baseline measures of treatment expectations and self-efficacy were predictive of patient-reported outcomes with rehabilitation for shoulder pain. Prospective studies 31,207 identified expectations of recovery, self-efficacy, kinesiophobia, and pain catastrophizing at baseline to be predictive of patient-reported outcomes with rehabilitation for musculoskeletal shoulder pain.…”

“…30,31,[200][201][202][203][204][205][206] Most recently, higher levels of emotional distress and kinesiophobia were associated with greater disability over one year in patients with shoulder pain. 207 These psychological factors may develop concurrently with pain, or precede the development of symptoms. A longitudinal study reported the development of shoulder pain concurrently with elevated levels of anxiety.…”

“…Investigations are limited that characterize whole-brain activity in those with RC tendinopathy and the effects of exercise on measures of central nervous system activity following exercise. The available evidence does suggest successful outcomes are related to fewer baseline psychological factors, 207 along with improved pain and sensorimotor processing. 214,215 Pain processing…”

“…31,200,203,207 A 2019 systematic review 200 identified that baseline measures of treatment expectations and self-efficacy were predictive of patient-reported outcomes with rehabilitation for shoulder pain. Prospective studies 31,207 identified expectations of recovery, self-efficacy, kinesiophobia, and pain catastrophizing at baseline to be predictive of patient-reported outcomes with rehabilitation for musculoskeletal shoulder pain. These studies are limited in that measures of psychological factors occurred only at baseline, and without considering the contributions of the central nervous system.…”