Patient Attitude Tied to Physical Therapy Outcomes
In patients with shoulder pain, self-efficacy, patient expectation linked to pain and disability outcomes
WEDNESDAY, Jan. 30, 2019 (HealthDay News) -- Patient expectation and pain self-efficacy are associated with clinical outcomes among patients undergoing physical therapy for shoulder pain, according to a study published online Jan. 24 in the British Journal of Sports Medicine.
Rachel Chester, Ph.D., from the University of East Anglia in Norwich, England, and colleagues evaluated 34 predictors of four outcomes among 1,030 adult patients aged ≥18 years referred to physical therapy for the management of musculoskeletal shoulder pain. At six months, data were available for 810 patients.
The researchers found that the most important predictor was baseline pain and/or disability, with higher or lower baseline levels, respectively, associated with higher or lower levels at follow-up for all outcomes. For the Shoulder Pain and Disability Index outcome, high pain self-efficacy reduced the likelihood of continued pain and disability. Patients with low baseline pain but low pain self-efficacy had similar outcomes to patients with high baseline pain and high pain self-efficacy. There were different cut-off points for defining high and low pain self-efficacy based on baseline pain and disability. For the Quick Disability of the Arm, Shoulder and Hand outcome, the association between moderate baseline pain/disability and outcome was influenced by patient expectation, with participants who expected to recover with physical therapy doing better than those who expected no benefit.
"We recommend that pain self-efficacy and patient expectation of outcome as a result of physiotherapy treatment should be formally assessed and discussed at the first physiotherapy appointment," the authors write.