Predicting the outcome of physiotherapy in adults with painful partial-thickness rotator cuff tears

Hdl Handle:
http://hdl.handle.net/10149/621790
Title:
Predicting the outcome of physiotherapy in adults with painful partial-thickness rotator cuff tears
Authors:
Braun, C. (Cordula)
Advisors:
Hanchard, N. C. A. (Nigel); Handoll, H. H. G. (Helen); Batterham, A. M. (Alan)
Citation:
Braun, C. (2016) 'Predicting the outcome of physiotherapy in adults with painful partial-thickness rotator cuff tears' Unpublished PhD Thesis; Teesside University
Publisher:
Teesside University
Issue Date:
2-Nov-2016
URI:
http://hdl.handle.net/10149/621790
Abstract:
Rotator cuff disorders encompass a range of impairments from tendinopathy to partialor full-thickness rotator cuff tears, and represent the largest subgroup of shoulder pain. Rotator cuff tears, most of which are atraumatic, are common in adults with shoulder pain and are strongly associated with increasing age. Conservative treatment including physiotherapy is the first-line treatment, but some patients do not respond, and ultimately require surgery. Early predictions of response could allow individuals’ care pathways to be optimised, preventing unnecessary delays and suffering and benefiting patients and healthcare providers alike. My primary aim was to develop a prognostic model for the outcome of physiotherapy in adults with painful atraumatic partial-thickness tears (PTTs) of the rotator cuff. This was addressed by a prospective prognostic model study. The study was underpinned by a systematic review of prognostic models in adults undergoing physiotherapy for painful rotator cuff disorders and was further informed and complemented by the following work: the development and validation of the physiotherapy protocol for the prognostic study; the identification, selection and definition of the candidate prognostic factors for the prognostic study; the estimation of the Minimal Important Difference (MID) of the study’s primary outcome measure (the Western Ontario Rotator Cuff Index, WORC); and an exploratory responder analysis of the WORC outcome scores. The prognostic systematic review, prognostic study, MID analysis and responder analysis are original contributions to knowledge. The prognostic systematic review revealed important methodological deficiencies in the five included studies, and no clinically usable model. No study addressed a distinct PTT population. The process of identifying factors for my own prognostic model study revealed a lack of knowledge about the prognostic relevance of factors. All of the candidate models I explored in my prognostic study (n sample = 65, n analysed = 61) had low performance and precision. The estimated MID of the WORC was -300. The responder analysis resulted in different proportions of responders to treatment depending on the responder definition. My results highlight the difficulties involved in predicting outcomes in the field of shoulder pain and rotator cuff disorders, and the need for methodologically sound prognosis research.
Type:
Thesis or dissertation
Language:
en
Keywords:
shoulder pain; physiotherapy; rotator cuff tear; prognosis

Full metadata record

DC FieldValue Language
dc.contributor.advisorHanchard, N. C. A. (Nigel)en
dc.contributor.advisorHandoll, H. H. G. (Helen)en
dc.contributor.advisorBatterham, A. M. (Alan)en
dc.contributor.authorBraun, C. (Cordula)en
dc.date.accessioned2018-03-21T15:12:20Z-
dc.date.available2018-03-21T15:12:20Z-
dc.date.issued2016-11-02-
dc.identifier.urihttp://hdl.handle.net/10149/621790-
dc.description.abstractRotator cuff disorders encompass a range of impairments from tendinopathy to partialor full-thickness rotator cuff tears, and represent the largest subgroup of shoulder pain. Rotator cuff tears, most of which are atraumatic, are common in adults with shoulder pain and are strongly associated with increasing age. Conservative treatment including physiotherapy is the first-line treatment, but some patients do not respond, and ultimately require surgery. Early predictions of response could allow individuals’ care pathways to be optimised, preventing unnecessary delays and suffering and benefiting patients and healthcare providers alike. My primary aim was to develop a prognostic model for the outcome of physiotherapy in adults with painful atraumatic partial-thickness tears (PTTs) of the rotator cuff. This was addressed by a prospective prognostic model study. The study was underpinned by a systematic review of prognostic models in adults undergoing physiotherapy for painful rotator cuff disorders and was further informed and complemented by the following work: the development and validation of the physiotherapy protocol for the prognostic study; the identification, selection and definition of the candidate prognostic factors for the prognostic study; the estimation of the Minimal Important Difference (MID) of the study’s primary outcome measure (the Western Ontario Rotator Cuff Index, WORC); and an exploratory responder analysis of the WORC outcome scores. The prognostic systematic review, prognostic study, MID analysis and responder analysis are original contributions to knowledge. The prognostic systematic review revealed important methodological deficiencies in the five included studies, and no clinically usable model. No study addressed a distinct PTT population. The process of identifying factors for my own prognostic model study revealed a lack of knowledge about the prognostic relevance of factors. All of the candidate models I explored in my prognostic study (n sample = 65, n analysed = 61) had low performance and precision. The estimated MID of the WORC was -300. The responder analysis resulted in different proportions of responders to treatment depending on the responder definition. My results highlight the difficulties involved in predicting outcomes in the field of shoulder pain and rotator cuff disorders, and the need for methodologically sound prognosis research.en
dc.language.isoenen
dc.publisherTeesside Universityen
dc.subjectshoulder painen
dc.subjectphysiotherapyen
dc.subjectrotator cuff tearen
dc.subjectprognosisen
dc.titlePredicting the outcome of physiotherapy in adults with painful partial-thickness rotator cuff tearsen
dc.typeThesis or dissertationen
dc.publisher.departmentTeesside University.en
dc.publisher.departmentSchool of Health and Social Careen
dc.type.qualificationnamePhDen
dc.type.qualificationlevelDoctoralen
or.citation.harvardBraun, C. (2016) 'Predicting the outcome of physiotherapy in adults with painful partial-thickness rotator cuff tears' Unpublished PhD Thesis; Teesside Universityen
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