The Influence of a Cognitive Behavioral Approach on Changing Patient Expectations in Shoulder Pain

Duke University55 enrolled

Overview

Background: Despite similar treatment outcomes for surgery or conservative care, the number of surgeries for the care of rotator cuff (RTC) related shoulder pain has increased. With the increase in surgery, there is an increased risk of harms, increased costs, and high re-tear rates. Patient expectations are beliefs or attitudes that include pre-treatment thoughts and beliefs regarding the need for specific treatment methods and the timing and intensity of these methods. Brief interventions designed to alter and enhance treatment expectations for conservative care and have been shown to improve patient expectations, but to date, no studies have explored whether such interventions can influence patient decisions to pursue surgical care. The investigators propose a comprehensive intervention that involves Patient Engagement Education, and Restructuring of Cognitions (PEERC) that is designed to change expectations, will reduce the likelihood that patients will choose to have shoulder surgery and improve functional outcomes. The cognitive behavioral therapy (CBT) approaches that form the core of our PEERC protocol are patient-centered and are designed to empower the patient in their own recovery process. Purpose/Aims: To examine the effect of the PEERC protocol on the decision to have surgery (primary), and improve global well-being, pain catastrophizing, pain, functional outcomes, and follow up expectations (secondary).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Rotator Cuff Impingement Syndrome

Interventions

Patient Engagement Education and Restructuring of CognitionsBEHAVIORAL

This protocol, informed by principles of CBT, involves three components: 1) engagement, 2) education and 3) cognitive restructuring and behavioral activation. A health coach who is responsible for engaging patients, educating them about pain modulatory mechanisms, and reinforcing cognitive and behavioral coping skills, will deliver the PEERC protocol.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18 to 70 * A rotator cuff related shoulder pain diagnosis * A mobile or land-line telephone * Ability to read and write English for completion of the self-report forms. Exclusion Criteria: * The investigators will exclude patients who have received or are scheduled for a surgical intervention for their shoulder condition * Demonstrate any evidence of cervicogenic pain and/or radiculopathy from cervical origin * Who demonstrate symptoms consistent with thoracic outlet syndrome * The investigators will also exclude individuals who are undergoing treatment for a serious psychological disorder (e.g., severe depression, psychosis).

Outcomes

Primary Outcomes

Pursuance of Surgical Intervention

The subject will be questioned if, after physical therapy, he or she will pursue surgery to address continued shoulder pain.

Time frame: 6 Months

Secondary Outcomes

Change in Pain

Numeric Pain Scale- The NRS for pain is scaled from 0 to 10 (11 point scale) and is based on pain intensity. Overall pain intensity will be queried where 0/10 represents no pain and 10/10 represents the worst pain possible.

Time frame: Baseline, 6 weeks, Discharge (estimated 3 months)

Change in GRoC - Global rate of change

The Global Rating of Change (GRoC) asks patients to report their global rating of change (GROC) relative to physical function, using a 7-point ordinal scale (where -7 much worse and +7 much better).

Time frame: 6 weeks, Discharge (estimated 3 months)

Change in SPADI - Shoulder Pain and Disability Index

The SPADI contains 13 items that assess two domains; a 5-item subscale that measures pain and an 8-item subscale that measures disability

Time frame: Baseline, 6 weeks, Discharge (estimated 3 months)

Change in MODEMS

The MODEMS patient expectation scale has been used by a number of studies and has shown validity in predicting outcomes in conservative and surgical interventions. As we previously stated, the instrument is a Likert-based scoring tool with a mean score of 5 out of 5 (indicating high expectations of positive outcomes) and a mean score of 1 out of 5 (indicating very poor expectations of positive outcomes)30

Time frame: Baseline, 3 weeks, 6 weeks, Discharge (estimated 3 months)

Change in TEGNER

The Tegner Activity Scale measures the patient's perspective of function and activity as a numerical value between 0 (complete disability) to 10 (elite athletics)

Time frame: Baseline, Discharge (estimated 3 months)

OSPRO 10 - Optimal Screening for Prediction of Referral and Outcome

Optimal Screening for Prediction of Referral and Outcome-10. The OSPRO is a review-of-systems screening tool that includes constructs associated with comorbidities, negative mood, quality of life, pain, and function

Time frame: Baseline

Pain Catastrophizing Scale

The Pain Catastrophizing Scale (PCS) assesses the extent of catastrophic thinking according to 3 components: rumination, magnification, and helplessness. It is a 13-item scale

Time frame: Baseline

SANE - Single Assessment Numeric Evaluation

The Single Assessment Numeric Evaluation (SANE) is a patient reported outcome measure utilized to rate the patient's perceived level of function

Time frame: 6 months

Overall Satisfaction with Care

Patients will be asked to rate their satisfaction of care as "excellent" "good" "fair" or "poor"