title: Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study.
abstract: OBJECTIVE
  Shoulder pain is a major musculoskeletal problem. We aimed to identify which baseline patient and clinical characteristics are associated with a better outcome, 6 weeks and 6 months after starting a course of physiotherapy for shoulder pain.
  
  
  METHODS
  1030 patients aged ≥18 years referred to physiotherapy for the management of musculoskeletal shoulder pain were recruited and provided baseline data. 840 (82%) provided outcome data at 6 weeks and 811 (79%) at 6 months. 71 putative prognostic factors were collected at baseline. Outcomes were the Shoulder Pain and Disability Index (SPADI) and Quick Disability of the Arm, Shoulder and Hand Questionnaire. Multivariable linear regression was used to analyse prognostic factors associated with outcome.
  
  
  RESULTS
  Parameter estimates (β) are presented for the untransformed SPADI at 6 months, a negative value indicating less pain and disability. 4 factors were associated with better outcomes for both measures and time points: lower baseline disability (β=-0.32, 95% CI -0.23 to -0.40), patient expectation of 'complete recovery' compared to 'slight improvement' as 'a result of physiotherapy' (β=-12.43, 95% CI -8.20 to -16.67), higher pain self-efficacy (β=-0.36, 95% CI -0.50 to -0.22) and lower pain severity at rest (β=-1.89, 95% CI -1.26 to -2.51).
  
  
  CONCLUSIONS
  Psychological factors were consistently associated with patient-rated outcome, whereas clinical examination findings associated with a specific structural diagnosis were not. When assessing people with musculoskeletal shoulder pain and considering referral to physiotherapy services, psychosocial and medical information should be considered.
  
  
  BACKGROUND
  Protocol published at http://www.biomedcentral.com/1471-2474/14/192.
authors.affiliation: Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK.|Physiotherapy Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Chester
authors.affiliation: Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Jerosch-Herold
authors.affiliation: Department of Allied Health Professions, School of Health and Social Work, University of Hertfordshire, Hatfield, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Lewis
authors.affiliation: Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Shepstone
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000523:psychology / Q000628:therapy; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D020377:Self Efficacy; D020069:Shoulder Pain / Q000523:psychology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Assessment; Physiotherapy; Psychology; Shoulder