Effect of an education and activation programme on functional limitations and patient-perceived recovery in acute and sub-acute shoulder complaints - a randomised clinical trial

Patient education for the management of subacromial pain syndrome: A scoping review

OBJECTIVE

To identify the extent of the literature on patient education for subacromial pain syndrome (SAPS).

METHODS

A scoping review was conducted in accordance with PRISMA-ScR standards. Nine databases were searched until November 2022 to identify articles describing patient education interventions for the management of SAPS. Interventions were extracted and described according to the Template for intervention description and replication (TIDieR) checklist and the core sets for shoulder-related health conditions of the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Sixty studies of various designs met the inclusion criteria, including thirty RCTs. Patient education was a primary intervention in seven of the included RCTs. In most of the educational interventions identified in the included studies, the descriptions did not adequately cover a majority of the TIDieR's checklist items. Patient education content was often mentioned and covered most, but not all, of the ICF core sets for shoulder disorders.

CONCLUSION

Available data in current literature on patient education interventions for SAPS is scarce and lacks description.

PRACTICE IMPLICATIONS

This study presents the content elements of patient education for the management of SAPS that are described in the literature and that clinicians could consider when treating individuals with SAPS.

A valid and reliable tool in assessing patient education: the Patient Education Implementation Scale

AIM

This study aimed to develop a valid and reliable tool for assessing the frequency of nurses' implementation of patient education in line with the stages of determining needs, assessment and planning, implementation, and evaluation and documentation.

BACKGROUND

Patient education is important in terms of the patient's completion of a reliable and effective treatment process. Patient education is one of the main responsibilities of a nurse. No valid and reliable study that assessed nurses' patient education process implementation was found in the literature.

METHODS

This instrument development study was conducted with 583 nurses working at university, private, and research and training hospitals located in the province of Istanbul in Turkey. The items of the Patient Education Implementation Scale were developed in line with the literature and expert opinions. The analyses involved descriptive statistics and psychometric analyses. The level of statistical significance was accepted as P < .05.

RESULTS

The content validity index was calculated as 0.96 for the 42-item Patient Education Implementation Scale, which explained 63.37% of the total variance. The scale items whose factor loads were 0.45 or higher were divided into four factors as (a) determining education needs, (b) assessment and planning, (c) implementation, and (d) evaluation and documentation. The Cronbach's alpha coefficients were 0.78-0.95 for the subdimensions and 0.97 for the general scale.

CONCLUSION

It was determined that the Patient Education Implementation Scale is a valid and reliable tool.

The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review

Objective:

To examine the predictive, moderating and mediating role of cognitive, emotional and behavioral factors on pain and disability following shoulder treatment.

Data sources:

Electronic databases (PubMed, Web of Science, Embase and PsycINFO) were searched until 14 January 2019.

Study selection:

Studies including persons with musculoskeletal shoulder pain that describe the predictive, moderating or mediating role of baseline cognitive, emotional or behavioral factors on pain or disability following treatment were selected.

Results:

A total of 23 articles, describing 21 studies and involving 3769 participants, were included. Three studies had a high risk of bias. There was no predictive role of baseline depression, anxiety, coping, somatization or distress on pain or disability across types of shoulder treatment. No predictive role of fear-avoidance beliefs was identified in patients receiving physiotherapy, which contrasted to the results found when surgical treatment was applied. Baseline catastrophizing was also not predictive for pain or disability in patients receiving physiotherapy. After conservative medical treatments, results on the predictive role of catastrophizing were inconclusive. Treatment expectations and baseline self-efficacy predicted pain and disability in patients receiving physiotherapy, which was not the case in patients receiving conservative medical treatment. Finally, there was a moderating role for optimism in the relationship between pain catastrophizing and disability in patients receiving physiotherapy.

Conclusion:

There is evidence that expectations of recovery and self-efficacy have a predictive role and optimism a moderating role on pain and/or disability following physiotherapy for musculoskeletal shoulder pain. After surgical treatment, fear-avoidance is a predictor of pain and disability.

Development of a Prognostic Model for Patients With Shoulder Complaints in Physical Therapist Practice

BACKGROUND

Health care providers need prognostic factors to distinguish between patients who are likely to recover and those who are not likely to recover.

OBJECTIVE

The aim of this study was to: (1) describe the clinical course of recovery and (2) identify prognostic factors of recovery in patients with shoulder pain at the 26-week follow-up.

DESIGN

A prospective cohort study was carried out in the Netherlands and included 389 patients who consulted a physical therapist for a new episode of shoulder pain.

METHOD

Participants were followed for 26 weeks. Potential predictors of recovery were selected from the literature and, with the addition of 2 new variables (ie, use of diagnostic ultrasound and working alliance), evaluated in the multivariable regression analysis. Multiple imputation was used to handle missing data, and bootstrap methods were used for internal validation.

RESULTS

The recovery rate was 60% for the total population and 65% for the working population after 26 weeks. Short duration of complaints, lower disability scores, having a paid job, better working alliance, and no feelings of anxiety or depression were associated with recovery. In the working population, only duration of complaints and disability remained in the final model. The area under the receiver operating characteristic curve (AUC) for the final model was 0.67 for the total population and 0.63 for the working population. After internal validation, the AUC was corrected to 0.66 and 0.63, respectively.

LIMITATIONS

External validation of the prognostic model should be done prior to its use in clinical practice.

CONCLUSION

The results of this study indicate that several factors can predict recovery.

Influence of fear-avoidance beliefs on disability in patients with subacromial shoulder pain in primary care: a secondary analysis

BACKGROUND

Little information exists about the role of fear-avoidance beliefs and catastrophizing in subacromial pain syndrome.

OBJECTIVE

The purpose of this study was to investigate the associations among pain, catastrophizing, fear, and disability and the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up.

DESIGN

A cross-sectional and longitudinal analysis was conducted.

METHODS

Baseline demographic and clinical data, including fear-avoidance beliefs and catastrophizing, of 90 patients were assessed for this analysis. Disability was measured with the Shoulder Pain and Disability Index at baseline and at 3-month follow-up. First, bivariate and partial correlations were calculated among pain, fear-avoidance beliefs, catastrophizing, and disability, based on the fear-avoidance model. Second, the contribution of fear-avoidance beliefs to disability at baseline and at 3-month follow-up was examined with hierarchical regression analyses.

RESULTS

Correlations between clinical variables and disability were largely in line with the fear-avoidance model. Regression analyses identified a significant contribution of fear-avoidance beliefs to baseline disability but not to disability at 3 months.

LIMITATIONS

Patients with subacromial pain syndrome were studied; therefore, the results should be transferred with caution to other diagnoses. A modified version of the Fear-Avoidance Beliefs Questionnaire was used, which was not validated for this patient group.

CONCLUSIONS

Fear-avoidance beliefs contribute significantly to baseline disability but not to disability change scores after 3-month follow-up. Duration of complaints and baseline disability were the main factors influencing disability change scores. Although the results help to improve understanding of the role of fear-avoidance beliefs, further studies are needed to fully understand the influence of psychological and clinical factors on the development of disability in patients with subacromial shoulder pain.

Barriers and benefits associated with nurses information seeking related to patient education needs on clinical nursing units

The purpose of this study was to answer the following two questions: What are clinical nurses’ rationales for their approaches to finding patient educational materials on the web? What are perceived barriers and benefits associated with the use of web-based information resources for patient education in the context of nursing clinical practice?

Over 179 individual data units were analyzed to understand clinical nurses’ rationales for their approaches to find patient educational materials on the web. Rationales were defined as those underlying catalysts or activators leading to an information need. Analyses found that the primary reasons why clinical nurses conducted web-based information searches included direct patient requests ( 9 requests), colleague requests (6 requests), building patient materials collections (4), patients’ family requests (3), routine teaching (1), personal development (1), or staff development (1). From these data, four broad themes emerged: professional reasons, personal reasons, technology reasons, and organization reasons for selecting information resources. Content analysis identified 306 individual data units representing either ‘benefits’ (178 units) or ‘barriers’ (128) to the nurses’ use of web resources for on-unit patient care. Inter-rater reliability was assessed and found to be excellent (r = 0.943 to 0.961). The primary themes that emerged as barriers to the used of web-based resources included: 1) time requirements to perform a search, 2) nurses’ experience and knowledge about the resources or required technology, 3) specific characteristics of individuals electronic information resources, and 4) organizational procedures and policies. Three primary themes that represented the benefits of using web-based resources were also identified: 1) past experiences and knowledge of a specific resource or the required technologies, 2) availability and accessibility on the unit, and 3) specific characteristics of individual information tool. In many cases, nurses commented on specific characteristics or features of favorite information resources. Favorite sites included a variety or reputable health care organizations that displayed context in text, audio, and/or video. In addition such sites were described as easy-to read and provided content related to patient-focused information or specific content such as toll free telephone contact numbers.

Information searching is the interaction between and among information users and computer-based information systems. Information seeking is becoming an important part of the knowledge work of nurses. Information seeking and searching intersects with the field of human computer interaction (HCI), which focuses on all aspects of human, and computer interactions. Users of an information system are understood as “actors” in situations, with a set of skills and shared practices based on work experiences with others. Designing better tools and developing information searching strategies that support, extend, and transform practices, begins by asking: Who are the users? What are the tasks? What is the interplay between the technology and the organization of the task? This study contributes fundamental data and information about the rationales nurses use in information seeking tasks. In addition it provides empirical evidences regarding barriers and benefits of information seeking in the context of patient education needs in inpatient clinical settings.

Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial

Background

Shoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Physiotherapy is often the first choice of treatment although its effectiveness is still under debate. Systematic reviews in this field highlight the need for more high quality trials to investigate the effectiveness of physiotherapy interventions in patients with subacromial impingement syndrome.

Methods/Design

This randomized controlled trial will investigate the effectiveness of individualized physiotherapy in patients presenting with clinical signs and symptoms of subacromial impingement, involving 90 participants aged 18-75. Participants are recruited from outpatient physiotherapy clinics, general practitioners, and orthopaedic surgeons in Germany. Eligible participants will be randomly allocated to either individualized physiotherapy or to a standard exercise protocol using central randomization.

The control group will perform the standard exercise protocol aiming to restore muscular deficits in strength, mobility, and coordination of the rotator cuff and the shoulder girdle muscles to unload the subacromial space during active movements. Participants of the intervention group will perform the standard exercise protocol as a home program, and will additionally be treated with individualized physiotherapy based on clinical examination results, and guided by a decision tree. After the intervention phase both groups will continue their home program for another 7 weeks.

Outcome will be measured at 5 weeks and at 3 and 12 months after inclusion using the shoulder pain and disability index and patients' global impression of change, the generic patient-specific scale, the average weekly pain score, and patient satisfaction with treatment. Additionally, the fear avoidance beliefs questionnaire, the pain catastrophizing scale, and patients' expectancies of treatment effect are assessed. Participants' adherence to the protocol, use of additional treatments for the shoulder, direct and indirect costs, and sick leave due to shoulder complaints will be recorded in a shoulder log-book.

Discussion

To our knowledge this is the first trial comparing individualized physiotherapy based on a defined decision making process to a standardized exercise protocol. Using high-quality methodologies, this trial will add evidence to the limited body of knowledge about the effect of physiotherapy in patients with SIS.

Trial registration

Current Controlled Trials ISRCTN86900354