CHANGES IN PAIN AND DISABILITY IN PATIENTS WITH SHOULDER PAIN AFTER THREE MONTHS OF DIGITALLY DELIVERED EXERCISE AND PATIENT EDUCATION
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SUBMITTER: WORNER T
PROVIDER: S-EPMC10658804 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:Background:The creation of pain as the fifth vital sign led to skyrocketing opioid prescriptions and a crisis with addiction and abuse among Americans. The purpose of this study was to evaluate the effectiveness of a patient engagement model including education and innovative opioid-free multimodal pain management to achieve an opioid-free recovery after shoulder arthroplasty (SA). Methods:Fifty patients undergoing SA were divided into 2 groups. In the opioid-free group (OFG), patients received additional preoperative education in combination with an innovative non-opioid multimodal pain management protocol and non-opioid alternatives. Patients were compared regarding pain levels and opioid consumption at 48 hours and at 2 weeks, as well as patient-reported outcome measures, using Student t tests. Results:No significant differences were found in age (average, 69.76 years) (P = .14), American Society of Anesthesiologists grade (average, 2.25) (P = .24), sex, body mass index (average, 29.5) (P = .34), or comorbidity burden. In the OFG, 24% of patients reported use of rescue opioids (<2 pills) within the first 48 hours after surgery with complete cessation by 2 weeks postoperatively. Comparatively, in the control group, 100% of patients reported using opioids in the first 48 hours after surgery and 80% reported still taking opioids at 2 weeks postoperatively. Patients in both groups showed significant improvements in outcome scores (P ? .05), with the OFG reporting significantly higher American Shoulder and Elbow Surgeons pain (P = .036) and Constant (P = .005) scores. Conclusions:Our findings support complete elimination of opioid use by 2 weeks after SA using a patient engagement model with non-opioid-based alternative pain management. The elimination of opioid pain management did not diminish outcomes or patient satisfaction after SA.
| S-EPMC7256883 | biostudies-literature
Project description:BackgroundShoulder complaints are common and the recommended first-line treatment is exercise therapy. However, it remains unknown if increased shoulder pain after an exercise session is a barrier for subsequent exercise dose, particularly in people with high fear-avoidance beliefs. Such knowledge could indicate ways to optimise shoulder rehabilitation. The aim was to examine whether increased shoulder pain across an exercise session was associated with a lower subsequent exercise dose, and if high fear-avoidance beliefs exaggerated this association.MethodsWe conducted a prospective cohort study using data from a randomised controlled trial in Central Denmark Region 2017-2019. Participants were employees (n = 79) with shoulder complaints and high occupational shoulder exposures. The intervention was a home-based or partly supervised exercise programme lasting 2-3 months. Linear mixed models were used to examine the associations between change in shoulder pain and exercise dose (number of repetitions, progression level (1-3), resistance level (1-3), and time until next exercise session [days]).ResultsAt baseline, the participants had a median pain intensity at rest of 2 on a numerical rating scale (0-10). For a 1-cm increase in pain on a visual analogue scale (0-10 cm) during an exercise session, the subsequent number of repetitions, progression level and resistance level were - 1.3 (95% confidence interval [CI] - 3.4 to 0.9), 0.0 (95% CI - 0.1 to 0.0) and - 0.0 (95% CI - 0.1 to 0.0), respectively. Likewise, the time until next exercise session was - 0.6 (95% CI - 2.4 to 1.3) days for a 1-cm increase. There were no interactions with fear-avoidance beliefs.ConclusionIncreased pain across an exercise session was not associated with subsequent exercise dose, regardless of fear-avoidance beliefs, among employees with shoulder complaints and high occupational shoulder exposures.Trial registrationThe trial was registered at Clinicaltrials.gov 19/05/2017 (ID: NCT03159910).
| S-EPMC9336042 | biostudies-literature
Project description:Shoulder pain is a common complaint in primary health care and has an unfavourable outcome in many patients. The objectives were to identify predictors for pain and disability (SPADI) and work status in patients with subacromial shoulder pain.Secondary analyses of data from a randomized clinical controlled trial were performed. Outcome measures were the absolute values of the combined Shoulder Pain and Disability Index (SPADI) and work status 1 year after treatment with supervised exercises (SE) or radial extracorporeal shockwave therapy (rESWT). Predictors of outcome were investigated using multiple linear regression (SPADI) and logistic regression (work status).104 patients were included. Low education (? 12 years), previous shoulder pain, and a high baseline SPADI score predicted poor results with these variables explaining 29.9% of the variance in SPADI score at 1 year. Low education and poor self-reported health status predicted a work status of "not working": Odds Ratio, OR = 4.3(95% CI (1.3 to 14.9)), p = 0.02 for education, and OR = 1.06 (95% CI (1.0 to 1.1)), p = 0.001 for self-reported health status, respectively. Adjustments for age, gender, and treatment group were performed, but did not change the results.Education was the most consistent predictor of pain and disability, and work status at 1 year follow-up. Also, baseline SPADI score, previous shoulder pain and self-reported health status predicted outcome.Clinical trials NCT00653081.
| S-EPMC2957391 | biostudies-literature
Project description:Background:Central sensitisation, in addition to high levels of fear-avoidance and pain catastrophisation may exist in a subgroup of patients with shoulder pain. Pain neuroscience education (PNE) has been shown to positively influence sensitivity of the nervous system, as well as reduce fear and catastrophisation prior to lumbar and total knee surgery. To date, no study has examined the application of PNE prior to shoulder surgery. Objectives:This study examined the response to preoperative PNE in patients preparing for shoulder surgery. Method:An exploratory pre-post case series was conducted. Twelve patients scheduled for surgery completed various pre-education measurements including shoulder pain, fear-avoidance, pain catastrophisation, beliefs and expectations regarding surgery, active shoulder flexion and pressure pain thresholds for the involved and uninvolved shoulder and the dominant-sided knee. Patients underwent a standard 30-min, one-on-one PNE session with a physiotherapist prior to surgery. Results:Following education, all measures improved with some failing to reach significance: self-reported pain (p = 0.125), pain catastrophisation (p = 0.250) and pain pressure threshold of the uninvolved shoulder (p = 0.68) and knee (p = 0.097). Fear-avoidance (p = 0.013), active shoulder flexion (p = 0.013) and pain pressure threshold for the involved shoulder (p = 0.004) significantly improved. Conclusion:A small patient group improved beyond minimal detectable change and/or minimal clinical important difference after education. No significant shifts of the preoperative beliefs occurred after education. Clinical implications:Preoperative PNE may be beneficial to a subgroup of patients scheduled for shoulder surgery.
| S-EPMC7479411 | biostudies-literature
Project description:Background: Younger patients are more likely than older patients to experience shoulder instability and to rely on online educational resources. Although the Internet has increased patient access to medical information, this may not translate to increased health literacy. Purpose: We sought to analyze the quality and readability of online information on shoulder instability. Methods: We conducted a Google search using 6 terms related to shoulder instability. We collected the first 20 non-sponsored results for each term. Readability was evaluated using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Gunning Fox Index (GFI) instruments. Quality was assessed using a Quality Grading Sheet (QGS) and the validated DISCERN instrument. Results: A total of 64 of 120 patient educational materials (PEMs) met the inclusion criteria. The mean FKGL, FRE, and GFI scores were 9.45 ± 0.552, 50.51 ± 3.4, and 11.5 ± 0.6, respectively. The mean DISCERN score and QGS rating were 33.09 ± 2.02 and 10.52 ± 1.28, respectively. While 49 (76.6%) articles discussed operative treatment for persistent shoulder instability, only 4 (6.3%) mentioned risks associated with surgery. Non-institutional sources had higher DISCERN scores than those from medical institutions. Conclusions: This review of online shoulder instability-related PEMs suggests that many do not meet current recommendations, with an average quality rating of "poor" and a mean ninth-grade reading level. Surgeons should be aware of the relative paucity of information on the risks and outcomes associated with operative treatment of shoulder instability contained in these PEMs.
| S-EPMC11572692 | biostudies-literature
Project description:BackgroundExamine the ability of a dynamic scapular recognition exercise to improve scapular upward rotation and decrease shoulder pain and disability in patients with adhesive capsulitis of the shoulder.MethodsA test-retest randomized controlled study design was used. A total of sixty-six patients with unilateral adhesive capsulitis were equally divided into two groups. The study group received a dynamic scapular recognition exercise using a wireless biofeedback system, while the control group received placebo treatment in the form of active range-of-motion (ROM) exercises of the sound upper limb. A digital inclinometer was used to measure the scapular upward rotation and ROM of the shoulder joint, and the Shoulder Pain and Disability Index (SPADI) was used to measure the shoulder pain and disability.ResultsStudy results showed that after two weeks, there were statistically significant differences between the study and control groups in scapular upward rotation and shoulder flexion and abduction (P < .05) and nonsignificant differences in shoulder external rotation and SPADI (P > .05). After two and six months, there were statistically significant differences between study and control groups in scapular upward rotation; shoulder flexion, abduction and external rotation; and SPADI scores (P < .05).ConclusionThis study showed that a dynamic scapular recognition exercise significantly improves scapular upward rotation and the ROM of shoulder flexion and abduction after two weeks. At two and six months, this exercise improves scapular upward rotation; ROM of shoulder flexion, abduction, and external rotation; and SPADI scores. These improvements persisted for six months after the performance of this exercise.
| S-EPMC7480516 | biostudies-literature
Project description:BackgroundThe Shoulder Pain and Disability Index (SPADI) is a self-report measure developed to evaluate patients with shoulder pathology. While some validation has been conducted, broader analyses are indicated. This study determined aspects of cross-sectional and longitudinal validity of the SPADI.MethodsCommunity volunteers (n = 129) who self-identified as having shoulder pain were enrolled. Patients were examined by a physical therapist using a standardized assessment process to insure that their pain was musculoskeletal in nature. This included examination of pain reported during active and passive shoulder motion as reported on a visual analogue pain scale. Patients completed the SPADI, the Coping Strategies Questionnaire (CSQ) and the Sickness Impact Profile (SIP) at a baseline assessment and again 3 and 6 months later. Factor analysis with varimax rotation was used to assess subscale structure. Expectations regarding convergent and divergent subscales of CSQ and SIP were determined a priori and analysed using Pearson correlations. Constructed hypotheses that patients with a specific diagnosis or on pain medication would demonstrate higher SPADI scores were tested. Correlations between the observed changes recorded across different instruments were used to assess longitudinal validity.ResultsThe internal consistencies of the SPADI subscales were high (alpha > 0.92). Factor analysis with varimax rotation indicated that the majority of items fell into 2 factors that represent pain and disability. Two difficult functional items tended to align with pain items. Higher pain and disability was correlated to passive or negative coping strategies, i.e., praying/hoping, catastrophizing on the CSQ. The correlations between subscales of the SPADI and SIP were low with divergent subscales and low to moderate with convergent subscales. Correlations, r > 0.60, were observed between the SPADI and pain reported on a VAS pain scale during active and passive movement. The two constructed validity hypotheses (on diagnosis and use of pain medications) were both supported (p < 0.01). The SPADI demonstrated significant changes over time, but these were poorly correlated to the SIP or CSQ suggesting that these scales measure different parameters.ConclusionThe SPADI is a valid measure to assess pain and disability in community-based patients reporting shoulder pain due to musculoskeletal pathology.
| S-EPMC1382226 | biostudies-literature
Project description:IntroductionPrevious systematic reviews have identified the multiple factors impacting on the prognosis of shoulder pain. However, the typical clinical course of subacromial shoulder pain remains unclear. The aim of this systematic review is to assess the clinical course of pain and disability in patients with subacromial shoulder pain.Method and analysisWe will systematically search electronic databases (Medline, Embase and AMED (via Ovid), Web of Science, Cochrane Library and Scopus) from the date of inception to 28 February 2018 for randomised controlled trials (RCTs) and observational studies with patients with subacromial shoulder pain. We will follow patient groups measured with pain and disabilities with no intervention or usual care treatment. Two reviewers will extract the data, and assess the risk of bias within included studies. We will use the Cochrane Risk of Bias tool for RCTs, and a methodological quality assessment tool for observational studies. We will perform meta-analyses for changes in pain and disability scores for each group (usual care and no intervention) at different time categories (up to 6 weeks, 6-12 weeks, 12-26 weeks or more). If there are 10 or more studies, we will perform a meta-regression for each planned analysis. The outcomes of the included studies will be described individually if the above statistical methods are not possible. Findings from this review will be of interest to clinicians and researchers, and will describe the expected clinical course of subacromial shoulder pain. This study may indicate the potential differences between the clinical courses of pain and disability over time.Ethics and disseminationThis review will not gather original data, hence ethical approval is not required. The results of this systematic review will be published in a peer-reviewed journal and presented at a scientific conference.Prospero registration numberCRD42016052518.
| S-EPMC5942400 | biostudies-literature
Project description:PurposeThe purpose of this study was to compare the effects of two different resistance exercise protocols on self-reported disability, fear avoidance beliefs, pain catastrophizing, and back pain symptoms in obese, older adults with low back pain (LBP).MethodsObese adults (n = 49, 60-85 yr) with chronic LBP were randomized into a total body resistance exercise intervention (TOTRX), lumbar extensor exercise intervention (LEXT), or a control group (CON). Main outcomes included perceived disability (Oswestry Disability Index, Roland Morris Disability Questionnaire). Psychosocial measures included the Fear Avoidance Beliefs survey, Tampa Scale of Kinesiophobia, and Pain Catastrophizing Scale. LBP severity was measured during three functional tasks: walking, stair climbing, and chair rise using an 11-point numerical pain rating scale.ResultsThe TOTRX group had greater reductions in self-reported disability scores due to back pain (Oswestry Disability Index, Roland Morris Disability Questionnaire) compared with those in the LEXT (P < 0.05). The Pain Catastrophizing Scale scores decreased in the TOTRX group compared with that in the CON group by month 4 (64.3% vs 4.8%, P < 0.05). Pain severity during chair rise activity and walking was decreased in both the LEXT and TOTRX groups relative to the CON group.ConclusionsGreater reductions in perceived disability due to LBP can be achieved with TOTRX compared with those achieved with LEXT. Pain catastrophizing and pain severity decreased most with TOTRX. The positive change in psychological outlook may assist obese, older adults with chronic back pain in reconsidering the harmfulness of the pain and facilitate regular participation in other exercise programs.
| S-EPMC4137474 | biostudies-literature
Project description:BackgroundPatellofemoral pain (PFP) is a common knee disorder that causes persistent pain, lower self-reported function and quality of life. People with PFP also present with altered psychological factors, which are associated with higher levels of pain and dysfunction. Mindfulness-based interventions (MBI) generally consist of meditative practices developed to provide a holistic approach to chronic conditions. However, the effects of MBI on clinical and psychological outcomes for people with PFP remains understudied.MethodsThis assessor-blinded, parallel, two-arm randomized clinical trial aims to investigate the effects of adding an 8-week online MBI program to exercise therapy and patient education on clinical and psychological factors for people with PFP. We also aim to investigate whether psychological factors mediate changes in pain and function. Sixty-two participants with PFP will be recruited and randomized into one of two treatment groups (Mindfulness or Control group). Both groups will receive an 8-week intervention involving exercise therapy and education delivered through an online platform. The Mindfulness group will additionally receive a MBI component including formal and informal practices. Outcomes will be assessed online at baseline, intervention endpoint (follow-up 1) and 12 months after intervention completion (follow-up 2). Comparisons between groups will be performed at all time points with linear mixed models. A mediation analysis will be performed using a 3-variable framework.DiscussionExercise therapy and patient education are considered the "best management" options for PFP. However, unsatisfactory long-term prognosis remains an issue. It is known that people with PFP present with altered psychological factors, which should be considered during the evaluation and treatment of people with PFP. Adding a MBI to the current best treatment for PFP may improve short and long-term effects by addressing the underlying psychological factors.Trial registrationRegistro Brasileiro de Ensaios Clínicos (ReBEC) RBR-4yhbqwk, registered in April 6, 2021.
| S-EPMC10173555 | biostudies-literature