PREDICTING IMPROVEMENT IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME / ROTATOR CUFF TENDINOPATHY FOLLOWING PHYSIOTHERAPY

摘要

Purpose of the study: To identify which baseline variables predict improvement in function and pain following physiotherapy for Subacromial Impingement Syndrome / Rotator Cuff Tendinopathy (SIS/ RCT). Methods: Baseline data was collected on 76 patients with a clinical diagnosis of SIS/RCT immediately prior to commencing physiotherapy. Candidate variables were demographics, clinical history, patient reported measures of pain, psychological symptoms and function (via the Shoulder Pain and Disability Index; SPADI), point-of-care diagnostic ultrasound and clinical measures of shoulder strength, range of movement and scapular control. Change in function and pain was determined by the Oxford Shoulder Score (OSS) performed at baseline, upon discharge following pragmatic treatment (model 1) and 3 months post discharge (model 2). Multivariate stepwise regression was performed for each model using a process of forward selection and backward elimination. Results: Age and the total SPADI score were the only variables retained in model 1 and collectively accounted for 15.7% of the variance in OSS change (p = 0.004). The values of -0.268 and 0.367 reflected that greater age was associated with less improvement in OSS whilst a higher total SPADI (greater pain and disability) was associated with a greater improvement in OSS. Only total SPADI was retained in model 2, accounting for 9.6% of the variance in OSS change (p = 0.017) where a higher total SPADI was again associated with a greater improvement in OSS. Conclusion: The study findings provide evidence of a limited ability to predict outcome in SIS/RCT patients in this prospective cohort study which combined the novel elements of pragmatic treatment, follow up determined by actual treatment duration and point-of-care ultrasound as a potential predictor. Neither clinical nor diagnostic measures were identified as having a predictive role. Nonetheless, knowledge of age and baseline function provides a basis for patient triage and patient-clinician discussion around likely outcome.