title: A Multivariable Prediction Model for the Chronification of Non-traumatic Shoulder Pain: A Systematic Review.
abstract: BACKGROUND
  Shoulder pain is the third most common musculoskeletal complaint and many patients have an unfavorable outcome with long-term disability. Only 50% of all new episodes of shoulder pain show complete recovery within 6 months. Little is known about factors that contribute to chronicity of shoulder pain, although such information is needed for the management of patients with acute and sub-acute shoulder pain.
  
  
  OBJECTIVE
  To systematically review the literature for prognostic factors which are potential predictors for either recovery or chronification in patients with acute and sub-acute non-traumatic shoulder pain.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  This systematic review examined all studies involving the prognosis of shoulder pain patients.
  
  
  METHODS
  This systematic review was reported following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently scored the methodological quality of the selected studies. Due to heterogeneity of studies, a best-evidence synthesis of the available prognostic factors was provided.
  
  
  RESULTS
  Nine studies met our inclusion criteria and were included in this systematic review. There is strong evidence that high scores on the Shoulder Pain and Disability Index (SPADI), high scores on shoulder pain severity, and a long duration of complaints are factors that contribute to the chronification of shoulder pain. Moderate evidence was found supportive for other prognostic factors that enhance chronification, like being male, being over 55 years of age, having poor general health, having a gradual onset of complaints, a large amount of sick leave, the perception of high job demand, the perception of low social support, and the amount of visits to a health care professional. Also moderate evidence exists regarding factors that contributed to a reduced possibility of chronification: an active treatment policy and not taking medication on regular basis.
  
  
  CONCLUSIONS
  The large variability in definitions of shoulder pain, and patient selection bias. In addition, there is a paucity of strong longitudinal prospective studies.
  
  
  CONCLUSIONS
  This systematic review found evidence that high scores on the SPADI questionnaire, more shoulder pain, and a longer duration of complaints are associated with chronification of shoulder pain. In order to reduce chronification, clinicians can use the International Classification of Functioning based model presented here that could aid their decision-making.
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Pain in Motion Research Group, www.paininmotion.be.
authors.forename: Filip
authors.initials: F
authors.lastname: Struyf
authors.affiliation: Faculty of Health and Technique, University College Zuyd, Heerlen, the Netherlands.
authors.forename: Jacques
authors.initials: J
authors.lastname: Geraets
authors.forename: Suzie
authors.initials: S
authors.lastname: Noten
authors.affiliation: Pain in Motion Research Group (www.paininmotion.be); Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Mira
authors.initials: M
authors.lastname: Meeus
authors.affiliation: Pain in Motion Research Group (www.paininmotion.be); Department of Human Physiology and Physiotherapy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.
authors.forename: Jo
authors.initials: J
authors.lastname: Nijs
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020069:Shoulder Pain / Q000145:classification* / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D013997:Time Factors