Does A Group Supervised Shoulder Impingement Class Improve Shoulder Pain, Disability and Generic Health Outcomes? A Summative Service Evaluation

• Main Author: Darren Abramson (Author)
• Format: Book
• Published: Journal of Novel Physiotherapy and Physical Rehabilitation - Peertechz Publications, 2018-06-15.
• Subjects: Thesis
• Online Access: Connect to this object online.

Summary

<p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif">Background: </span></strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif">Patients with shoulder impingement syndrome (SIS) suffer pain and disability and<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">present enormous health and fi nancial challenges to the NHS. There is limited evidence for many of the<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">commonly used physiotherapy treatment interventions. Research suggests deprivation, age, gender<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">and attendance are possible predictors of poor treatment outcome in common MSK conditions. The<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">present author set up and ran a physiotherapy led group based SIS class to improve generic health<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">outcomes and reduce shoulder pain and disability.<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif">Method: </span></strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif">236 SIS patients were referred over a 22 month period. 154 completed the once weekly<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">six week course. 82 failed to complete the class. Generic health outcomes were measured with the<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">Euroqol EQ-5D-5L with condition specifi c outcome measured using the Shoulder Pain and Disability<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">Index (SPADI). Covariates possibly predictive of poor treatment outcome were analysed using linear<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">regression and included Townsend Deprivation Score (TDS), age and gender. Class completers and<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">non-completers were compared to determine any association with TDS, age and gender.<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif">Results: </span></strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif">Statistically signifi cant improvements in generic health (t -7.77, df 153, p < 0.001) and<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">shoulder pain and disability (t -9.36, df 153, p < 0.001) were found post intervention. No association for<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">the predictive utility of TDS, age and gender on EQ-5D-5L and SPADI outcome was found. Statistically<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">signifi cant differences between class completers and non-completers for TDS t (181.17)=-3.62, p <<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">0.001) and age (t (134.72)=2.41, p = 0.017) were found. Younger patients and those from more deprived<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">areas attended fewer classes. No association was found between gender and non- attendance. TDS,<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">age and gender have no association with class non-completion type be it never attended or attended<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">then did not attend (DNA).<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif">Conclusion: </span></strong><span style="font-size:9.0pt;font-family:"Arial",sans-serif">Physiotherapists play a key role in managing the third most common MSK pathology.<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">This evaluation suggests positive outcomes for those completing a group based SIS class on both<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">health and shoulder pain and disability. SIS patients meeting inclusion criteria should be routinely fed<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"><span style="font-size: 9.0pt;font-family:"Arial",sans-serif">into group based classes.
Younger patients and those from more deprived areas may benefi t from a<o:p></o:p></span></p><p class="MsoNormal" style="margin-bottom:0cm;margin-bottom:.0001pt;line-height: normal;mso-layout-grid-align:none;text-autospace:none"> <span style="font-size:9.0pt;line-height:107%;font-family:"Arial",sans-serif; mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;mso-ansi-language: EN-IN;mso-fareast-language:EN-US;mso-bidi-language:AR-SA">more individualised management approach.</span><br></p>

DOI

10.17352/2455-5487.000057