Predicting Response to Physiotherapy for Shoulder Pain
Predicting Response to Physiotherapy for Shoulder Pain
Shoulder pain has a lifetime prevalence of one in three and is the third most common musculoskeletal condition presenting in primary care. However just 50% of people referred to primary care with first episode shoulder pain show complete recovery within six months, rising to only sixty percent after one year.
Shoulder pain is one of the most common musculoskeletal disorders in the working population. In 2011–2012, for the first time in Great Britain, the prevalence of work related upper limb disorders exceeded those of low back pain.
The most effective treatment for musculoskeletal shoulder pain is not known. Reports indicate that up to one third of patients referred to physiotherapy musculsoskeletal outpatient services have shoulder pain. However clear indicators of who will and will not respond favourably to physiotherapy treatment is currently unavailable. When physiotherapy is unsuccessful, other interventions are often considered. However 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.
The exact cost of shoulder pain to healthcare and the economy is unclear. Studies in the Netherlands and Sweden have demonstrated that 12 to 22 percent of patients who visit primary care with shoulder pain incur between 74 and 91 percent of the total cost respectively; a relatively small percentage of patients incur a high percentage of the cost. This suggests that for some patients there may be a more effective and efficient management pathway for the resolution of shoulder pain. Between 47 and 84 percent of the total incurred cost is related to sickness absence. These same studies demonstrated that physiotherapy accounted for between 37 percent and 60 percent of the mean total healthcare cost. Those patients that used direct access to physiotherapy had lower healthcare and overall costs to the economy. This comparatively low cost, non-invasive resource is therefore an obvious choice as a first line treatment for shoulder pain. However, a greater knowledge of prognostic factors in terms of who is likely to respond to physiotherapy and who will not is vital for patients, healthcare professionals and commissioners and ensures effective and efficient use of limited resources. Referral to physiotherapy for patients who respond favourably will be of considerable benefit. However for those patients who do not respond favourably to physiotherapy, delayed referral along a more effective pathway may be costly. A review of previous research has suggested that a range of biopsychosocial factors are related to outcome following General Practitioner management of shoulder pain. The objective of this systematic review was to identify which prognostic factors are associated with the outcome from physiotherapy treatment for musculoskeletal shoulder pain. Primary outcomes of interest were functional recovery and pain over any time period.
Background
Shoulder pain has a lifetime prevalence of one in three and is the third most common musculoskeletal condition presenting in primary care. However just 50% of people referred to primary care with first episode shoulder pain show complete recovery within six months, rising to only sixty percent after one year.
Shoulder pain is one of the most common musculoskeletal disorders in the working population. In 2011–2012, for the first time in Great Britain, the prevalence of work related upper limb disorders exceeded those of low back pain.
The most effective treatment for musculoskeletal shoulder pain is not known. Reports indicate that up to one third of patients referred to physiotherapy musculsoskeletal outpatient services have shoulder pain. However clear indicators of who will and will not respond favourably to physiotherapy treatment is currently unavailable. When physiotherapy is unsuccessful, other interventions are often considered. However 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.
The exact cost of shoulder pain to healthcare and the economy is unclear. Studies in the Netherlands and Sweden have demonstrated that 12 to 22 percent of patients who visit primary care with shoulder pain incur between 74 and 91 percent of the total cost respectively; a relatively small percentage of patients incur a high percentage of the cost. This suggests that for some patients there may be a more effective and efficient management pathway for the resolution of shoulder pain. Between 47 and 84 percent of the total incurred cost is related to sickness absence. These same studies demonstrated that physiotherapy accounted for between 37 percent and 60 percent of the mean total healthcare cost. Those patients that used direct access to physiotherapy had lower healthcare and overall costs to the economy. This comparatively low cost, non-invasive resource is therefore an obvious choice as a first line treatment for shoulder pain. However, a greater knowledge of prognostic factors in terms of who is likely to respond to physiotherapy and who will not is vital for patients, healthcare professionals and commissioners and ensures effective and efficient use of limited resources. Referral to physiotherapy for patients who respond favourably will be of considerable benefit. However for those patients who do not respond favourably to physiotherapy, delayed referral along a more effective pathway may be costly. A review of previous research has suggested that a range of biopsychosocial factors are related to outcome following General Practitioner management of shoulder pain. The objective of this systematic review was to identify which prognostic factors are associated with the outcome from physiotherapy treatment for musculoskeletal shoulder pain. Primary outcomes of interest were functional recovery and pain over any time period.
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