Predicting change in symptoms and function in patients with persistent shoulder pain: a prognostic model development study

Abstract

Background Persistent shoulder pain causes considerable disruption of the individual’s life and imposes high costs on healthcare and society. Well-informed treatment and referral pathways are crucial as unsuccessful interventions and longer duration of symptoms minimizes the likelihood of success in future interventions. Although physiotherapy is generally recommended as first line treatment, no prognostic model or clinical prediction rules exists to help guide the treatment of patients with persistent shoulder pain undergoing physiotherapy. Thus, the objective of this study was to develop a prognostic model to inform clinical decision making and predict change in symptoms and function in patients with persistent shoulder pain. Methods This was a prospective cohort study of 243 patients with persistent shoulder pain referred to outpatient physiotherapy rehabilitation centres. Data was collected at baseline and six-month follow-up. The outcome was change in shoulder symptoms and function as measured by the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) from baseline to 6 months follow up. Potential predictors were included in a multivariable linear regression model which was pruned using modified stepwise backwards elimination. Results The final model consisted of seven predictors; baseline QuickDASH score, employment status, educational level, movement impairment classification, self-rated ability to cope with the pain, health-related quality of life and pain catastrophizing. Together these variables explained 33% of the variance in QuickDASH-change scores with a model root mean squared error of 17 points. Conclusion The final prediction model explained 33% of the variance in QuickDASH change-scores at 6 months. The root mean squared error (model SD) was relatively large meaning that the prediction of individual change scores was quite imprecise. Thus, the clinical utility of the prediction model is limited in its current form. Further work needs be done in order to improve the performance and precision of the model before external validity can be examined along with the potential impact of the model in clinical practice. Two of the included predictors were novel and could be examined in future studies; movement impairment classification based on diagnosis and health-related quality of life.

Predicting outcomes across treatment settings in patients with shoulder pain referred to physiotherapy: a secondary analysis of two comparable prospective cohort studies

“…As defined by the framework of Kent et al ,10 this study was an exploratory prognostic study of individual patient data obtained from two cohort studies of patients referred to physiotherapy treatment in primary11 and secondary care12 in Denmark.…”

“…They were notified by email when follow-up questionnaires at 2, 4 and 6 months were available. Data collection was administered by an online clinical database (Trial Partner) 12. Only patients with a primary diagnosis of the shoulder ICD-10 classification DM750-759 or DM254-256 were included, excluding all surgically treated patients.…”

Are clinical outcomes associated with baseline sensory profiles in people with musculoskeletal shoulder pain? Protocol for a prospective longitudinal observational study

“…A range of factors have shown some prognostic value in patients presenting with shoulder pain in primary care; however, there is currently limited evidence to support the use of any proposed prognostic models (Karel et al., 2017; Kuijpers et al., 2006; Struyf et al., 2016; Vergouw et al., 2011). Notably, there is a lack of prospective research investigating the factors that may contribute to outcomes in patients with persistent symptoms and longer care trajectories (i.e., patients referred to tertiary care centres) (Rønnow et al., 2021).…”

Correction to: Predicting change in symptoms and function in patients with persistent shoulder pain: a prognostic model development study

“…Following the publication of the original article [ 1 ] the authors noticed that the statement “all authors contributed equally” appeared in the published article. This statement is directly opposite of the author contribution statement in the article.…”

“…This statement is directly opposite of the author contribution statement in the article. The original article [ 1 ] has been updated.…”