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Fear of movement and emotional distress as prognostic factors for disability in patients with shoulder pain: a prospective cohort study

Major, DH; Røe, Y; Småstuen, MC; Jæger, M; Grotle, M; Van Der Windt, D; Sandbakk, TB

Fear of movement and emotional distress as prognostic factors for disability in patients with shoulder pain: a prospective cohort study Thumbnail


Authors

DH Major

Y Røe

MC Småstuen

M Jæger

M Grotle

TB Sandbakk



Abstract

Background: Shoulder pain is a prevalent and often long-lasting musculoskeletal disorder. The overall prognosis of shoulder pain is highly variable with 40-50% of patients reporting persistent pain 6-12 months after consulting a clinician. The evidence for psychological prognostic factors for patients with shoulder pain is inconsistent. Therefore, the objective of this study was to investigate the association between fear of movement and emotional distress at presentation and self-reported disability over one year of follow-up.

Methods: This is a prospective cohort study of consecutive patients referred to secondary outpatient care due to shoulder pain. Consenting patients underwent a physical examination and completed a comprehensive questionnaire at baseline, three months-, and one-year follow-up. Associations between baseline fear of movement (0-10) or emotional distress (1-4), respectively, and patient reported disability measured using Quick Disability of the Arm and Shoulder (QuickDASH, 0-100) over one year were analyzed with linear mixed-effects models (LMM) for repeated measures (baseline, 3 months and 1 year), adjusting for established prognostic factors.

Results: A total of 138 patients were recruited between March 2015 and January 2018, with response rates of 84.7% (n = 117) and 79.7% (n = 1 00) at three months and one year, respectively. Adjusted associations revealed that for every point increase in baseline fear of movement, the QuickDASH score increased (worsened) by 1.10 points (95% CI 0.2-2.0) over the follow-up year. For every point increase in baseline emotional distress, the QuickDASH score increased by 19.9 points (95% CI 13.9-25.9) from baseline over the follow-up year.

Conclusion: Higher fear of movement and emotional distress scores at baseline were significantly associated with higher disability over one year in patients with shoulder pain referred to secondary care. Our study indicates that these psychological factors affect prognosis and should be considered by clinicians and researchers working with ipatients with shoulder pain.

Journal Article Type Article
Acceptance Date Feb 21, 2022
Publication Date Feb 26, 2022
Publicly Available Date Mar 28, 2024
Journal BMC Musculoskeletal Disorders
Print ISSN 1471-2474
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 23
Article Number 183
DOI https://doi.org/10.1186/s12891-022-05139-6
Publisher URL https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05139-6#article-info