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Prognosis in Soft Tissue Disorders of the Shoulder: Predicting Both Change in Disability and Level of Disability After Treatment

CA Kennedy, BScPT, MSc, is Research Associate, Institute for Work and Health, Toronto, Ontario, Canada; Research Associate, Martin Family Arthritis Care and Research Centre, Mobility Program Clinical Research Unit, St Michael’s Hospital, Toronto; and Clinical Lecturer, Department of Physical Therapy, University of Toronto
M Manno, MSc, is Biostatistician, Cancer Care Ontario, Toronto; Analyst, Institute for Work and Health; and Lecturer, Department of Public Health Sciences, University of Toronto
S Hogg-Johnson, PhD, is Senior Biostatistician, Institute for Work and Health, and Assistant Professor, Graduate Department of Community Health, University of Toronto
T Haines, MD, DOHS, is Associate Professor, Department of Clinical Epidemiology and Biostatistics and Program in Occupational Health and Environmental Medicine, McMaster University, Hamilton, Ontario, Canada
L Hurley is Project Coordinator, SCRIPT Project, Sponsored by The University Health Network, Toronto. At the time of the study, she was Manager, Quality Management Program, College of Physiotherapists of Ontario, Toronto
D McKenzie is Director of Clinical Services, Work Able Centres Inc, Toronto. At the time of the study, she was Research Coordinator, Institute for Work and Health
DE Beaton, BScOT, PhD, is Scientist, Institute for Work and Health; Scientist and Director, Mobility Program Clinical Research Unit, Martin Family Arthritis Care and Research Centre; Assistant Professor, Department of Occupational Therapy, Graduate Departments of Rehabilitation Science and Health Policy, Management, and Evaluation, University of Toronto.
Dr Hogg-Johnson, Dr Haines, Ms McKenzie, and Dr Beaton provided concept/idea/research design. Ms Kennedy, Dr Haines, and Dr Beaton provided writing. Ms Kennedy, Ms Hurley, Ms McKenzie, and Dr Beaton provided data collection and project management. Ms Kennedy, Mr Manno, Dr Hogg-Johnson, Dr Haines, and Dr Beaton provided data analysis. Ms Hurley and Dr Beaton provided fund procurement, facilities/equipment, and institutional liaisons. Ms Hurley provided subjects. Ms McKenzie provided clerical/secretarial support. Dr Hogg-Johnson, Dr Haines, and Ms McKenzie provided consultation (including review of manuscript before submission)

(dbeaton{at}iwh.on.ca) Address all correspondence to Dr Beaton at Institute for Work and Health, 481 University Ave, Ste 800, Toronto, Ontario, Canada M5G 2E9

Background and Purpose. Clinicians often are faced with questions about prognosis and outcome of shoulder disorders. The purpose of this study was to identify predictors of both change in disability and level of disability following physical therapy treatment. Subjects. The subjects were consecutive patients (n=361) who were receiving physical therapy for soft tissue shoulder disorders. Methods. Clinical response to physical therapy, which was measured using the Disabilities of the Arm, Shoulder, and Hand (DASH) measure, was assessed over 12 weeks. The 28 independent baseline predictors included demographics, disorder-related and disability measures, medication use, clinical findings, and expectations for recovery. Multiple linear regression techniques were used. Results. Predictors of greater disability at discharge were: higher initial disability, therapist prediction of restricted activities at discharge, workers’ compensation claim, older age, and being female. Predictors of greater improvement in disability were: shoulder surgery, higher pain intensity, shorter duration of symptoms, younger age, and poorer general physical health (measured using the 36-Item Short-Form Health Survey [SF-36]). Discussion and Conclusions. Prognostic factors differ depending on the format of the outcome. Only age was significant in both models. [Kennedy CA, Manno M, Hogg-Johnson S, et al. Prognosis in soft tissue disorders of the shoulder: predicting both change in disability and level of disability after treatment. Phys Ther. 2006;86:1013–1032.]

Key Words: Linear models • Prognosis • Shoulder • Shoulder pain • Soft tissue injuries

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