Impaired health-related quality of life, psychological distress, and productivity loss in younger people with persistent shoulder pain: a cross-sectional analysis

Abstract

Purpose

To investigate wellbeing and work impacts in younger people with persistent shoulder pain.

Materials and methods

People aged 20–55 years with shoulder pain of >6 weeks’ duration (excluding those with recent fracture or dislocation) were recruited from orthopaedic clinics at three major public hospitals. Health-related quality of life (HRQoL) and psychological distress were evaluated using the Assessment of Quality of Life (AQoL) and K10 instruments and compared to population norms. Shoulder-related absenteeism and presenteeism were quantified using the Work Productivity and Activity Impairment (WPAI) Questionnaire.

Results

Of the 81 participants (54% male), 69% had shoulder pain for over 12 months. Substantial HRQoL impairment was evident (mean reduction from population norms 0.33 AQoL units, 95% CI −0.38 to −0.27; minimal important difference 0.06 AQoL units). High or very high psychological distress was three times more prevalent among participants than the general population (relative risk 3.67, 95% CI 2.94 to 4.59). One-quarter of participants had ceased paid employment due to shoulder pain and 77% reported shoulder-related impairment at work.

Conclusions

The broader impacts of painful shoulder conditions on younger people extend well beyond pain and upper limb functional limitations. In particular, the work-related impacts should form a routine part of patient assessment and rehabilitation.

Implications for rehabilitation

• Persistent shoulder pain in younger people (aged 20–55 years) is associated with substantially reduced health-related quality of life and greater psychological distress, compared to population norms, as well as work participation and productivity impacts.

• As rotator cuff conditions, shoulder capsule pathology, and glenohumeral instability are relatively common, our data suggest that persistent shoulder pain is likely to have a high community impact among people of working age.

• Information resources that people with painful shoulder conditions can share with their families, employers, and colleagues may assist others to better understand the broader impacts of these conditions.

• Work-related challenges associated with shoulder pain should be considered within routine clinical care, and may require referral to an occupational health clinician or vocational rehabilitation service.

Keywords:

• Osteoarthritis
• quality of life
• rotator cuff injuries
• shoulder pain
• work impairment

Acknowledgements

The authors wish to thank the study participants for their contribution to this research. We are also grateful to Sally Beattie (Barwon Centre for Orthopaedic Research and Education) and Cylie Williams (Peninsula Health and Monash University) for their support and assistance.

Disclosure statement

Professor Page’s institution received educational support from De Puy-Synthes and research investigator support from Integra Health outside the submitted work. A/Prof Brennan-Olsen has received speaker fees from Amgen Australia and Pfizer Australia, and funding from Sanofi, outside the submitted work. A/Prof Bucknill receives consulting fees from Corin Ltd, MatOrtho, and Gyder Surgical, not related to the submitted work.

Additional information

Funding

This study was supported by a grant from the Victorian Orthopaedic Research Trust, with additional support from a targeted donation via the Barwon Centre for Orthopaedic Research and Education. A/Prof Ackerman is supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. A/Prof Sharon Brennan-Olsen is supported by a National Health and Medical Research Council of Australia Career Development Fellowship (#1107510). The study sponsors had no role in the study design, collection, analysis, and interpretation of data, in the writing of the manuscript, or in the decision to submit the manuscript for publication.