The relationship of pain intensity, physical impairment, and pain-related fear to function in patients with shoulder pathology.
METHODS
Cross-sectional.


OBJECTIVE
This study examined the baseline relationship of pain intensity, physical impairment, and pain-related fear to shoulder function.


BACKGROUND
There is no consensus regarding the influence psychological variable have on function and recovery in individuals with shoulder pathologies. While pain-related fear has been shown to predict disability for patients with low-back and cervical pain, this relationship has not been consistently reported for patients with shoulder pain.


METHODS
One hundred forty-two subjects (78 male, 64 female; mean age, 41.4 years) with nonoperative unilateral shoulder disorders were identified from a clinical database of impairment and outcome measures.Demographic information, duration of symptoms, mechanism of injury, pain intensity, pain-related fear, and range-of-motion (ROM) measures were collected. Self-report of function was measured with the Shoulder Pain and Disability Index (SPADI). Hierarchical regression analysis determined the proportions of explained variance in function.


RESULTS
Demographic variables (duration of symptoms, sex, age, and mechanism of injury) collectively contributed approximately 9% (P=.003) of the variance in function scores. Average pain intensity and flexion ROM contributed an additional 22% (P<.001) of the variance, and Tampa Scale of Kinesiophobia (TSK-11) scores contributed an additional 3% (P<.001). In the final parsimonious model, presence of symptoms longer than 3 months (beta=.23, P=.003), pain intensity (beta=.25, P=.002), shoulder flexion ROM index (beta=-.35, P=.001), and kinesiophobia (beta=.17, P=.026) explained 33% of the variance in SPADI function score (P<.001).


CONCLUSIONS
Presence of symptoms longer than 3 months, average pain intensity, flexion ROM index (strongest contributor in multivariate model), and fear-of-pain scores all contributed to baseline shoulder function. The immediate clinical relevance of these findings is unclear but they do provide direction for prospective studies.
Shands Rehabilitation, UF, Gainesville, FL 32607, USA. lentzt@shands.ufl.edu
Trevor A
TA
Lentz
Josh A
JA
Barabas
Tim
T
Day
Mark D
MD
Bishop
Steven Z
SZ
George
D000328:Adult; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D015995:Prevalence; D011379:Prognosis; D016059:Range of Motion, Articular / Q000502:physiology; D019534:Shoulder Impingement Syndrome / Q000150:complications* / Q000453:epidemiology / Q000534:rehabilitation; D020069:Shoulder Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*