Several studies have shown that in chronic pain conditions, factors such as lack of positivity and resilience, pain catastrophizing, stress, anxiety and depression can contribute to the persistence and maintenance of pain. Thus, the present project will identify psychosocial risk factors that predict the persistence of shoulder pain. Individuals with shoulder pain (n=112) will be recruited. At baseline, the participants will fill a series of questionnaires evaluating different biopsychosocial constructs (resilience, perceived stress, anxiety, depression, pain, disability, pain catastrophizing, self-efficacy, social support, physical activity). After baseline evaluation, the participants will take part in an educational program aimed at promoting self-management of shoulder pain. At the end of the project (6 months), participants will only fill questionnaires evaluating pain and disability. Based on the scores on these questionnaires, the participants will be classified as having persistent shoulder pain or as recovered. Thereafter, statistical analyses will be performed to identify significant predictors for persistent shoulder pain. The primary hypothesis of the study is that low levels of resilience, self-efficacy, social support and physical activity, and high levels of stress, pain, disability, catastrophizing, anxiety and depression will negatively influence the pain response resulting in increased pain ratings and persistent symptoms over time.
A prospective cohort study will be conducted. One hundred and twelve individuals with rotator cuff related shoulder pain (RCRSP) will be evaluated twice: baseline and 6-month after baseline. At baseline, participants will complete a questionnaire on sociodemographic and symptomatology. Then, the participants will be asked to fill questionnaires covering a biopsychosocial spectrum: Brief Resilience Scale (BRS), Perceived Stress Scale (PSS-10), Numeric Pain Rating Scale (NPRS), abbreviated version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH), Patient-Health Questionnaire - 9 (PHQ-9), General Anxiety Disorder - 7 (GAD-7), Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ), Multidimensional Scale of Perceived Social Support (MSPSS) and short version of the International Physical Activity Questionnaire (IPAQ). After the baseline evaluation, participants will take part in an educational program aimed at promoting self-management of shoulder pain. The program will include two one-on-one sessions (approximately 30-45 minutes) within 2 weeks with a physiotherapist. The main reasons to propose an education intervention is that it is usual to receive a rehabilitation intervention when a person presents shoulder pain. It was therefore difficult to expect that the participants would not seek treatment during the study period and therefore that the investigators could only have considered the effect of time (natural evolution of the injury). Finally, at 6-months, participants will only be asked to fill NPRS and QuickDASH. Based on the scores on these questionnaires, the participants will be classified as having persistent shoulder pain or as recovered.The follow-up evaluation will be performed online (6-month follow-up) using RedCap. For the statistical analysis, participants will be dichotomized into 2 subgroups according to whether their symptoms have resolved or not at 6-month, aiming to determine the baseline variables that predict the persistence of pain 6 months after baseline. All variables found to be significant on univariate analyses will be considered potential predictors. Thereafter, logistic regression analyses will be performed to identify significant predictors for persistent rotator cuff related shoulder pain.
Study Type
OBSERVATIONAL
Enrollment
112
After the baseline evaluation, all participants will take part in an education intervention, aiming at promoting self-management of shoulder pain, that will include two one-on-one sessions (approximately 30-45 minutes) within 2 weeks with a physiotherapist (1st session right after the baseline evaluation, 2nd session two weeks later). Participants will receive written information regarding shoulder (anatomy and function) and basic pain science and will be directed to watch a series of six educational videos on shoulder pain and function, persistent pain, physical activity, stress, sleep and eating habits. It should be noted that the objective of this study is not to assess the effectiveness of the intervention; the purpose of offering an intervention to participants is to control the intervention that will be received by them.
Dayana P Rosa
Québec, Quebec, Canada
QuickDASH at 6 months
Shoulder pain and function will be evaluated using the abbreviated version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) questionnaire. The questionnaire consists of 11 items covering 6 domains (daily activities, symptoms, social function, work function, sleep, and confidence) that are scored on a numeric rating scale between 1 (no difficulty) and 5 (unable). Participants will be dichotomized into 2 subgroups according to whether their symptoms have resolved or not at 6-month. To do this, the investigators will use the NPRS and QuickDASH scores from the 6-month follow-up. If patients present a score between 0 (no disability) and 11 (minimal clinically important difference - MCID) on the QuickDASH, their symptoms will be considered resolved. Conversely, if their score is greater than 11 on the QuickDASH , their symptoms will be considered unresolved.
Time frame: 6 months
NPRS at 6 months
The NPRS will quantify the average pain over the last 7 days. This scale score ranges from 0 (no pain) to 10 (worst pain), and the scale is considered valid and with good reliability to assess individuals with shoulder pain. Participants will be dichotomized into 2 subgroups according to whether their symptoms have resolved or not at 6-month. To do this, the investigators will use the NPRS and QuickDASH scores from the 6-month follow-up. If patients present a score between 0 (no disability) and 2 (minimal clinically important difference - MCID) on the NPRS, their symptoms will be considered resolved. Conversely, if their score is greater than 2 on the NPRS, their symptoms will be considered unresolved
Time frame: 6 months
QuickDASH at Baseline
Shoulder pain and function will be evaluated using the abbreviated version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) questionnaire. The questionnaire consists of 11 items covering 6 domains (daily activities, symptoms, social function, work function, sleep, and confidence) that are scored on a numeric rating scale between 1 (no difficulty) and 5 (unable).
Time frame: Baseline
NPRS at Baseline
The NPRS will quantify the average pain over the last 7 days. This scale score ranges from 0 (no pain) to 10 (worst pain), and the scale is considered valid and with good reliability to assess individuals with shoulder pain.
Time frame: Baseline
Resilience at Baseline
The validated French version of Brief Resilience Scale (BRS) will be used to classify the groups into low or high resilience levels. The BRS aims to measure the individual's ability to recover from a trauma or stress situations. It is composed of 6 items, which negatively or positively assess the stressful situation. Each question presents 5 response options ranging from 1= "strongly disagree" to 5= "strongly agree". Higher scores represent high levels of resilience. Internal consistency of the scale showed Cronbach's alpha of 0.84.
Time frame: Baseline
Perceived Stress at Baseline
The Perceived Stress Scale - 10 (PSS-10) translated and adapted to French will be applied to measure the individuals' perceived stress.66 The scale quantifies the extent of how individuals consider stressful situations experienced in the last month. It uses a 10-item scale with a 5-point Likert scale of response (0=never; to 4=always) and higher scores indicate greater perceived stress. The Cronbach alpha for the instrument is 0.83.66
Time frame: Baseline
Pain Catastrophizing at Baseline
The Pain Catastrophizing Scale (PCS) translated and validated to French will be used to identify catastrophic thoughts about pain. The PCS is a 13-item scale aiming to quantify pain catastrophizing characterized by magnification, rumination, and helplessness of pain beliefs. Its score ranges from 0 to 52: 0 - best score and 52=worst score, where 52 means higher individual catastrophizing. High internal reliability has been reported in patients with chronic pain with adequate validity and test-retest reliability.
Time frame: Baseline
Depressive symptoms at Baseline
The French version of Patient Health Questionnaire-9, a shorter version of the complete PHQ, will be used to self-report depressive symptoms. Each of the nine items can be scored from 0 (not at all) to 3 (nearly every day), and the total scale score ranges from 0-27, where higher scores mean more severity of symptoms. A Cronbach's alpha of 0.86 was demonstrated for the instrument.
Time frame: Baseline
Level of Anxiety at Baseline
The French version of the General Anxiety Disorder (GAD-7) will be utilized to evaluate generalized anxiety. Each of the seven items are scored from 0 (not at all) to 3 (nearly every day). The total GAD-7 scale score ranges from 0-21 and higher scores means higher anxiety levels. The scale presents satisfactory internal consistency (Cronbach's alpha=0.89).
Time frame: Baseline
Sel-Efficacy at Baseline
The Pain Self-Efficacy Questionnaire (PSEQ) consists of 10 items utilized to measure patient's confidence in performing daily activities despite of pain. Each item is rated on a scale ranging from 0 ("not at all confident") to 6 ("completely confident"), and the total score can range from 0 to 60, with higher scores indicating better self-efficacy. The questionnaire has shown excellent validity, reliability, and responsiveness in individuals with musculoskeletal disorders.
Time frame: Baseline
Social Support at Baseline
The French version of the Multidimensional Scale of Perceived Social Support (MSPSS) will be used to evaluate individual perceived satisfaction with social support received from family, friends and significant others. It is a 12 Likert-type items questionnaire with 7 response options (from 1, 'completely disagree', to 7 'strongly agree'). Higher scores represent higher satisfaction with social support received. The scale presented satisfactory internal consistency with a Cronbach's alpha value of 0.92.
Time frame: Baseline
Physical Activity Level at Baseline
The French short version of the International Physical Activity Questionnaire (IPAQ) will be used to assesses the frequency, duration, and intensity of physical activity. This short version includes 7 items and provides total activity scores expressed in metabolic equivalent (MET) minutes. A test-retest reliability of 0.81 (95% Confidence Interval 0.79 to 0.82) were previously determined.
Time frame: Baseline
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