Abstract
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.
Highlights
People suffering from musculoskeletal shoulder pain are frequently referred to physiotherapy
To be included in this review study participants had to have received physiotherapy for the management of musculoskeletal shoulder pain
Predictive factors found to have a significant association with any of these outcomes in two or more of the studies will be summarised in the section following
Summary
People suffering from musculoskeletal shoulder pain are frequently referred to physiotherapy. At present it is not possible to predict which patients will respond positively to physiotherapy treatment. Shoulder pain has a lifetime prevalence of one in three [1] and is the third most common musculoskeletal condition presenting in primary care [2]. Reports indicate that up to one third of patients referred to physiotherapy musculsoskeletal outpatient services have shoulder pain [6]. For some patients, the time spent in an unsuccessful course of physiotherapy may delay referral along another, possibly more appropriate pathway. This increases the likelihood of chronic pain and reduces the effectiveness of future interventions [5]
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