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Title: Prognostic indicators of successful rehabilitation outcome in patients with subacromial impingement syndrome/rotator cuff tendinopathy
Author: Smith, Michael Justin
ISNI:       0000 0004 7426 6442
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2018
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Background As one of the most common types of shoulder pain, subacromial impingement/rotator cuff tendinopathy (SIS/RCTendinopathy) is frequently treated with physiotherapy. However there is uncertainty as to which patients do and do not improve with this approach. Aim To identify baseline factors that predict outcome in SIS/RCTendinopathy patients following treatment with physiotherapy. Method Patients with a clinical diagnosis of SIS/RCTendinopathy referred for physiotherapy were recruited. Baseline potential prognostic factors (demographics, clinical history, patient reported measures, clinical measures and structural pathology) were recorded immediately prior to the first physiotherapy appointment. Treatment was pragmatic as determined by the treating clinician. Outcome was determined by the change in a patient reported outcome measure (Oxford Shoulder Score, OSS) from baseline. Time points for analysis were at discharge and three months post-discharge. Findings Seventy-six patients fulfilling the inclusion and exclusion criteria were recruited and outcome data were available from 73 subjects at discharge and 62 subjects at three months post discharge. The number of candidate variables were trimmed using a sequential decision process comprising methodological, conceptual and statistical methods. Multivariate regression analysis comprising forward selection and backward elimination was applied. Baseline function (measured by the total SPADI; higher SPADI = greater pain and disability) and (younger) age predicted 15.7% of the outcome (greater improvement in function) from baseline to discharge. Total SPADI (higher SPADI = greater pain and disability) predicted 9.6% of the outcome (greater improvement in function) from baseline to three months post-discharge. Conclusion The study findings provide evidence of a limited ability to predict outcome. Potential reasons for this include the multifactorial nature of the condition and the high degree of heterogeneity in the treatment of the cohort. The limited sample size and lack of consideration of variable types such as patient or clinician expectation are also noteworthy limitations of the study. Nonetheless, the regression findings indicate the value of considering baseline function and age for informing the likely change in patient reported pain and disability across the period of treatment and up to three months post discharge.
Supervisor: Not available Sponsor: Arthritis Research UK
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: R Medicine (General)