Abstract
Objective
To determine whether higher level or improvements over time in pain self-efficacy (PSE) and expectations of intervention effectiveness lead to better outcomes and whether the intervention used to manage rotator cuff related shoulder pain (RCRSP) impacts PSE and expectations over time.
Design
Secondary analysis of data from a randomised controlled trial.
Participants
123 individuals (48 [15] years old; 51% female) with RCRSP.
Interventions
Participants randomised into one of three 12-weeks interventions (education; education and motor control exercises; education and strengthening exercises).
Main outcome measures
QuickDASH and Western Ontario Rotator Cuff Index (WORC) were administered at baseline and 12 weeks. Pain self-efficacy was assessed at 0 and 6 weeks. Patients’ expectations regarding intervention effectiveness were assessed before randomisation and after the first and the last intervention sessions. NparLD were used for the analyses. A time effect indicated a significant change in patients’ expectations or PSE over time, while a resolution effect indicated a significant difference in patients’ expectations or PSE between those whose symptoms resolved and those whose did not.
Results
Patients’ expectations (−3 to 3) increased over time (0.33/3 [0.19 to 0.77]). Overall expectations were higher for those who experienced symptom resolution based on the WORC (0.19/3 [0.05 to 0.33]). PSE increased over time (5.5/60 [3.6 to 7.4]). Overall PSE was higher for those who experienced symptom resolution based on the WORC (7.0 [3.9 to 10.1]) and the QuickDASH (4.9 [1.7 to 8.2]).
Conclusion
Clinicians should consider monitoring PSE and patients’ expectations as they are important indicators of outcome.
Contribution of the paper
- Irrespective of the intervention, we observed an improvement in patients’ pain self-efficacy and expectations of intervention effectiveness over time.
- Participants with a higher baseline expectations of intervention effectiveness, who received a combination of education and motor control exercises, reported better outcomes, measured by the WORC, than those receiving education alone or a combination of education and strengthening exercises.
- Clinicians should consider monitoring pain self-efficacy and patients’ expectations in individuals with RCRSP as they could be useful indicators of outcome and their clinical interventions could be tailored towards improving understanding of RCRSP and self-management.