J. Chepeha1, A. Silveira1, D. Sheps2, L. Beaupre1
1University of Alberta, Department of Physical Therapy, Edmonton, Canada, 2University of Alberta, Department of Surgery, Division of Orthopaedics, Edmonton, Canada
Background: Shoulder pain/dysfunction are common patient complaints in primary care, but best practice for managing shoulder pathology is unclear.
Purpose: To determine: (1) Does a decision rule, as part of a standardized rehabilitation program, detect patients who require surgical consult? (2) Are there patient characteristics associated with failure of rehabilitation?
Methods: 143 participants with shoulder pathology requiring treatment for the first time were enrolled in a standardized rehabilitation program. The program was considered unsuccessful if participants showed no progression within 6-12weeks (<15% change on Western Ontario Rotator Cuff [WORC] score). These participants underwent expedited surgical consult. Outcomes of interest were 1) proportion of patients with successful versus failed rehabilitation and 2) patient characteristics associated with failed rehabilitation. Analyses utilized independent t-tests and Chi-square tests.
Results: Of 143 participants, 32 (22%) required surgical consult with 16 (11%) proceeding to surgery. The remainder were successfully managed with rehabilitation management (78%). Characteristics associated with failed rehabilitation included: full-thickness rotator cuff tears (p<0.05), increased medication use (p<0.03), increased age (p<0.05), claiming short-term disability (p<0.03), decreased flexion, abduction and external rotation range of motion (ROM) (p<0.05) and decreased external rotation strength (p<0.05).
Conclusion(s): Initial rehabilitation using a decision rule is effective at detecting those who require surgical consult for generalized shoulder pathology; most patients recovered with rehabilitation. Degree of rotator cuff tear, decreased ROM and strength may be helpful in guiding treatment decisions.
Implications: Initial rehabilitation using a decision rule for success may direct patients with shoulder problems to appropriate care in a timely way.
Funding, acknowledgements: This study was funded through the Workers' Compensation Board of Alberta, Canada
Keywords: Shoulder, Decision Rule, Rehabilitation
Topic: Musculoskeletal: upper limb
Did this work require ethics approval? Yes
Institution: University of Alberta, Health Research Ethics Board (HREB)
Committee: HREB - Biomedical Panel
Ethics number: Pro00052670
All authors, affiliations and abstracts have been published as submitted.
