Trajectory of patient-rated outcomes and association with patient acceptable symptom state in patients with musculoskeletal shoulder pain

ABSTRACT

Objective

Characterize trajectory and predictors of patient acceptable symptom state (PASS) defined recovery at 6 months.

Methods

Individuals with musculoskeletal shoulder pain (n = 140) completed patient-reported disability and PASS at baseline, 1 and 6 months. The PASS was categorized into 3 trajectory groups; 1.) Early Recovery (answered yes to PASS at 1 and 6-months), 2.) Delayed Recovery (PASS-yes only at 6-months), and 3.) Unrecovered. Mixed models characterized the trajectory between PASS-groups using SPADI and QDASH disability change scores. Logistic regression identified predictors of Early Recovery versus Delayed+Unrecovered groups.

Results

PASS-defined recovery rates by group were Early Recovery (58%), Delayed Recovery (22%), and Unrecovered (20%). A group main effect indicated lower disability over time in the Early Recovery versus Unrecovered (QDASH mean difference = 11(2.4); p = 0.001; SPADI mean difference = 12(3); p < 0.001). The odds of an Early Recovery slightly increased with greater change scores on the SPADI (odds ratio = 1.06, 95%CI:1.02,1.11; p = 0.004) and QDASH (odds ratio = 1.08, 95%CI:1.03,1.13; p = 0.003) over the first month of treatment.

Conclusion

Recovery trajectories of patients indicate differing responses to treatment despite overall improvements over the first month of treatment. Incorporating both patient-reported disability (SPADI, QDASH) and acceptable satisfaction (PASS) may aid in determining recovery trajectory, but more evidence is needed to be clinically useful.

KEYWORDS:

• Outcomes
• prediction
• impingement
• pain

Acknowledgements

We would like to thank all of the clinicians who participated in data collection and treatment of the individuals in this clinical trial including XXXXX, XXXXX, XXXXX, XXXXX, XXXXXX and XXXXXX. We would also like to acknowledge the University of XXXXXX Physical Therapy Program students who volunteered their time in assisting with this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authorship statement

All authors have read and approved the final version of this manuscript. MJF and LAM contributed to study design, data analysis and interpretation, drafting the manuscript, and incorporating revisions. PEM and AWM contributed to study design, data acquisition and interpretation, and critical review.

Additional information

Funding

This study was funded by the Academy of Orthopaedic Physical Therapy (AOPT) of the APTAThis trial was registered with www.clinicaltrials.gov (NCT01571674)This study was approved by Institutional Review Boards at all 6 collection sites