title: Between-session changes predict overall perception of improvement but not functional improvement in patients with shoulder impingement syndrome seen for physical therapy: an observational study.
abstract: Do between-session changes in global rating of change (GRoC) predict change in GRoC and self-report of function at discharge in patients with shoulder impingement that initially improve in early sessions of treatment (GRoC>5)? Is there a difference between individuals who initially respond to treatment (GRoC>5) compared to those that do not (GRoC<5) for self-report of function? This longitudinal, observational study had 55 patients seen for a formal physical therapy program after a medical diagnosis of shoulder impingement. Physical therapy used a standardized protocol. The American Shoulder and Elbow Surgeons Subjective Shoulder Scale (ASES) and self-report of improvement of condition using the GRoC were measured. We found no significant correlation between the first visits between-sessions changes of the GRoC and the change score of the ASES (r=0.13; p=0.39) in patients with shoulder impingement that initially improve in early sessions of treatment (GRoC>5). There was a moderate correlation between the first visits between-session changes of the GRoC and the final reported GRoC (r=0.48; p<0.01) for the patients who responded to treatment. There was no difference in ASES change scores between those who initially respond to treatment (N=10) and those who do not (N=34). ASES mean change scores were 21.5 for the responders and 14.3 for the non-responders. These findings suggest that a GRoC of 5 or greater is related to a perceived change in one's condition upon termination of formal physical therapy but is not related to actual improvement in one's self-report of function. This finding suggests that the construct of the GRoC may not be related to the constructs of the ASES, or between-session changes are not prognostic in patients with shoulder impingement and should not solely dictate treatment decision making.
authors.affiliation: Research Physical Therapist, Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA. CraigGarrison@TexasHealth.org
authors.forename: J Craig
authors.initials: JC
authors.lastname: Garrison
authors.forename: Ellen
authors.initials: E
authors.lastname: Shanley
authors.forename: Charles
authors.initials: C
authors.lastname: Thigpen
authors.forename: Eric
authors.initials: E
authors.lastname: Hegedus
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D010465:Perception; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D057566:Self Report; D012782:Shoulder / Q000503:physiopathology*; D019534:Shoulder Impingement Syndrome / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D013022:South Carolina; D013997:Time Factors; D016896:Treatment Outcome