G. Sole1, N. Swain2, M. Perry3, C. Wassinger4
1University of Otago, Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy, Dunedin, New Zealand, 2University of Otago, Department of Psychological Medicine, Dunedin, New Zealand, 3University of Otago - Wellington, Centre for Health, Activity and Rehabilitation Research; School of Physiotherapy, Wellington, New Zealand, 4East Tennessee State University, Department of Physical Therapy, Johnston City, United States

Background: Rehabilitation for patients with rotator cuff related shoulder pain (RCRSP) generally includes exercise prescription and manual therapy. The role of patient education and self-management is also an integral part of rehabilitation. Such education has, in the past, focused mainly on advice related to shoulder patho-anatomy and biomechanics. Patient beliefs about their pain can influence their behavior: fear of pain may lead to fear avoidance, whereas, self-efficacy and high expectations for recovery can enhance outcomes. Considering multiple factors influencing the experience of shoulder pain, patient education may need to include pain biology, influence of lifestyle and well-being, and general physical activity.  We developed a series of resources to be used by physiotherapists during rehabilitation sessions in conversations with their patients, and online video links for patients to watch from home.

Purpose: (1) To explore the feasibility to conduct a trial integrating holistic patient education with pragmatic, individualized physiotherapy for patients with RCRSP; (2) examine changes in patient-reported outcomes at discharge and at 3-months follow-up.

Methods: 29 patients (60.0±10.5 yrs) with persistent RCRSP (median duration 22 months) received maximally 8 pragmatic individual physiotherapy sessions over 3 months. Sessions included explicit education about shoulder pathoanatomy and age-related changes, pain biology, goal-setting, shoulder-specific exercise, general physical activity and lifestyle, and pain self-management. Education resources were provided. The Shoulder Pain and Disability Index (SPADI), Pain Self Efficacy Questionnaire (PSEQ), and Patient Acceptable Symptom State (PASS) were completed at baseline, discharge, and 3-month follow-up.  

Results: One patient withdrew after 4 treatment sessions, and 28 completed the sessions until formal discharge (96% treatment retention rate). 27 patients completed the 3-month follow-up (93% follow-up retention rate). At Baseline, the mean (SD) SPADI-Total was 35.3 (17.7)/100 and the PSEQ was 49.1 (8.7)/60.  SPADI-Total decreased by a mean of 19.6 points (95%CI 12.7-26.5) and 21.5 points (95%CI 14.7-28.2) from baseline to discharge and from baseline to 3-month follow-up, respectively. The PSEQ improved by 8.5 scores (median; range -2 to 28) from baseline to 3-month follow-up.  Baseline PASS showed that 86% of patients were ‘very’ or ‘somewhat’ dissatisfied with their condition, compared to 20% at discharge and 15% at 3-month follow-up. Audit of patient documentation indicated that the patient resources had been included into physiotherapy sessions, besides providing manual therapy, taping and exercise prescription.

Conclusion(s): The trial was feasible for patient recruitment, retention and integration of patient resources into physiotherapy management. Meaningful improvements were evident for SPADI at discharge and at follow-up.  High self-efficacy scores were evident at discharge and maintained at 3-month follow-up. Most patients (85%) were satisfied with their current state.

Implications: An explicit patient education approach integrating pain biology, lifestyle and well-being with usual physiotherapy may be useful to improve self-management and self-efficacy for patients with persistent RCRSP. This trial provided directions for future research exploring formalised patient education integrated into physiotherapy. Such investigation will determine whether a focus on patient education and self-management for RCRSP can decrease dependence on medication, direct and indirect health care costs, and improve quality of life.  

Funding, acknowledgements: Jack Thomson Arthritis Grant, Otago Medical Research Foundation, New Zealand.

Keywords: Patient education, Shoulder pain, Self-management

Topic: Musculoskeletal: upper limb

Did this work require ethics approval? Yes
Institution: Health and Disability Ethics Committee (New Zealand)
Committee: Health and Disability Ethics Committee
Ethics number: 18/CEN/145

All authors, affiliations and abstracts have been published as submitted.

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