title: Clinician and Patient-reported Outcomes Are Associated With Psychological Factors in Patients With Chronic Shoulder Pain.
abstract: BACKGROUND
  Validated clinician outcome scores are considered less associated with psychosocial factors than patient-reported outcome measurements (PROMs). This belief may lead to misconceptions if both instruments are related to similar factors.
  
  
  OBJECTIVE
  We asked: In patients with chronic shoulder pain, what biopsychosocial factors are associated (1) with PROMs, and (2) with clinician-rated outcome measurements?
  
  
  METHODS
  All new patients between the ages of 18 and 65 with chronic shoulder pain from a unilateral shoulder injury admitted to a Swiss rehabilitation teaching hospital between May 2012 and January 2015 were screened for potential contributing biopsychosocial factors. During the study period, 314 patients were screened, and after applying prespecified criteria, 158 patients were evaluated. The median symptom duration was 9 months (interquartile range, 5.5-15 months), and 72% of the patients (114 patients) had rotator cuff tears, most of which were work injuries (59%, 93 patients) and were followed for a mean of 31.6 days (SD, 7.5 days). Exclusion criteria were concomitant injuries in another location, major or minor upper limb neuropathy, and inability to understand the validated available versions of PROMs. The PROMs were the DASH, the Brief Pain Inventory, and the Patient Global Impression of Change, before and after treatment (physiotherapy, cognitive therapy and vocational training). The Constant-Murley score was used as a clinician-rated outcome measurement. Statistical models were used to estimate associations between biopsychosocial factors and outcomes.
  
  
  RESULTS
  Greater disability on the DASH was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale combined coefficient, 0.64; 95% CI, 0.25-1.03; p = 0.002) and social factors (language, professional qualification combined coefficient, -6.15; 95% CI, -11.09 to -1.22; p = 0.015). Greater pain on the Brief Pain Inventory was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale combined coefficient, 0.076; 95% CI, 0.021-0.13; p = 0.006). Poorer impression of change was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia coefficient, 0.93; 95% CI, 0.87-0.99; p = 0.026) and social factors (education, language, and professional qualification coefficient, 6.67; 95% CI, 2.77-16.10; p < 0.001). Worse clinician-rated outcome was associated only with psychological factors (Hospital Anxiety and Depression Scale (depression only), Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia combined coefficient, -0.35; 95% CI, -0.58 to -0.12; p = 0.003).
  
  
  CONCLUSIONS
  Depressive symptoms and catastrophizing appear to be key factors influencing PROMs and clinician-rated outcomes. This study suggests revisiting the Constant-Murley score.
  
  
  METHODS
  Level III, prognostic study.
authors.affiliation: Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Wolfensberger
authors.affiliation: Institute for Research in Rehabilitation, Clinique Romande de Réadaptation SuvaCare, Sion, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vuistiner
authors.affiliation: Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation SuvaCare, Sion, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Konzelmann
authors.affiliation: Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation SuvaCare, Sion, Switzerland.
authors.forename: Chantal
authors.initials: C
authors.lastname: Plomb-Holmes
authors.affiliation: Institute for Research in Rehabilitation, Clinique Romande de Réadaptation SuvaCare, Sion, Switzerland.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Léger
authors.affiliation: Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Avenue Pierre Decker, 1011, Lausanne, Switzerland. Francois.Luthi@crr-suva.ch.
authors.forename: François
authors.initials: F
authors.lastname: Luthi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058443:Catastrophization / Q000523:psychology; D059350:Chronic Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D000071066:Patient Reported Outcome Measures; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000070599:Shoulder Injuries / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D020069:Shoulder Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult