The online version of this article (https://doi.org/10.1186/s12891-018-2239-8) contains supplementary material, which is available to authorized users.
Rotator cuff disorders represent the commonest type of painful shoulder complaints in clinical practice. Although conservative treatment including physiotherapy is generally recommended as first-line treatment, little is known about the precise treatment indications for subgroups of rotator cuff disorders, particularly people with shoulder pain associated with partial-thickness tears of the rotator cuff, PTTs: “symptomatic PPTs”. The aim of this study was to develop a prognostic model for predicting the outcome of a phase of conservative treatment primarily with physiotherapy in adults with symptomatic PTTs.
A prospective observational cohort study was conducted in an outpatient setting in Germany. Ten baseline factors were selected to evaluate nine pre-defined multivariable candidate prognostic models (each including between two and nine factors) in a cohort of adults with symptomatic atraumatic PTTs undergoing a three-month phase of conservative treatment primarily with physiotherapy. The primary outcome was change in the Western Ontario Rotator Cuff Index. The models were developed using linear regression and an information-theoretic analysis approach: Akaike’s Information Criterion (AICC).
Eight candidate models were analyzed using data from 61 participants. Two “best models” were identified: smoking & pain catastrophizing and disability & pain catastrophizing. However, none of the models had a satisfactory performance or precision.
We could not determine a prognostic model with satisfactory performance and precision. Further high-quality prognostic model studies with larger samples are needed, but should be underpinned, and thus preceded, by robust research that enhances knowledge of relevant prognostic factors.
DRKS00004462. Registered 08 April 2014; retrospectively registered (prior to the analysis).
Additional file 1: Primary study reports and other articles used to identify prognostic factors (DOCX 21 kb)12891_2018_2239_MOESM1_ESM.docx
Additional file 2: Factors considered for inclusion in the study (DOCX 20 kb)12891_2018_2239_MOESM2_ESM.docx
Additional file 3: Model coefficient statistics (DOCX 21 kb)12891_2018_2239_MOESM3_ESM.docx
Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM. The demographic and morphological features of rotator cuff disease: a comparison of asymptomatic and symptomatic shoulders. J Bone Jt Surgery, Am Vol. 2006;88A:1699–704. CrossRef
Hedtmann A. Weichteilerkrankungen der Schulter – Subakromialsyndrome. Orthopädie und Unfallchirurgie up2date. 2009;4:85–106. CrossRef
Finnan RP, L a C. Partial-thickness rotator cuff tears. J Shoulder Elb Surg. 2010;19:609–16. CrossRef
Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev. 2013;9:CD009020.
Ryösä A, Laimi K, Äärimaa V, Lehtimäki K, Kukkonen J, Saltychev M. Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Disabil Rehabil. 2017;39(14):1357-63.
Ylinen J, Vuorenmaa M, Paloneva J, Kiviranta I, Kautiainen H, Oikari M, et al. Exercise therapy is evidence-based treatment of shoulder impingement syndrome. Current practice or recommendation only. Eur J Phys Rehabil Med. 2013;49:499–505. PubMed
Butler M, Forte M, Braman J, Swiontkowski M, Kane RL. Nonoperative and Operative treatments for rotator cuff tears: future research needs: identification of future research needs from comparative effectiveness review no. 22. Rockville: Agency for Healthcare Research and Quality (US). Report No.: 13-EHC050-EF. AHRQ Future Research Needs Papers. 2013. https://www.ncbi.nlm.nih.gov/pubmed/23905196.
Cochrane Prognosis Methods Group. 2018. http://prognosismethods.cochrane.org/. Accessed 21 Apr 2018.
Progress. mrc prognosis research strategy partnership. 2018. http://progress-partnership.org/. Accessed 21 Apr 2018.
Braun C. Predicting the outcome of physiotherapy in poeple with painful partial-thickness rotator cuff tears. A thesis submitted in partial fulfillment of the requirements of Teesside University for the award of the degree of Doctor of Philosophy (PhD) http://tees.openrepository.com/tees/handle/10149/621790 (2016). Accessed 21 Apr 2018.
DVSE. Untersuchungstechniken des Schultergelenks. Expertenevaluation auf der Basis einer Literaturanalyse. Obere Extermität. 2012;7(Suppl 1):3–68.
Konermann W, Gruber G. Ultraschalldiagnostik Der Bewegungsorgane. In: Kursbuch nach den Richtlinien der DEGUM und der DGOU. 2nd ed. Stuttgart: Thieme; 2007.
Hedtmann A, Fett H. Schultersonographie bei Subakromialsyndromen mit Erkrankungen und Verletzungen der Rotatorenmanschette (Sonography of the shoulder in subacromial syndromes with diseases and injuries of the rotator cuff). Orthopade. 1995;24:498–508. PubMed
Braun C, Hanchard NCA. Manual therapy and exercise for impingementrelated shoulder pain. Phys Ther Rev. 2010;15:62–83. CrossRef
Braun C, Bularczyk M, Heintsch J, Hanchard NCA. Manual therapy and exercises for shoulder impingement revisited. Phys Ther Rev. 2013;18:263–84. CrossRef
Anderson DA. Model based inference in the life sciences. In: A primer on evidence. New York: Springer science + business Media; 2008.
Burnham KP, Anderson DR, Huyvaert KP. AIC model selection and multimodel inference in behavioral ecology: some background, observations, and comparisons. Behav Ecol Sociobiol. 2011;65:23–35. CrossRef
Burnham KP, Anderson DR. Model selection and multimodel inference. A practical information-theoretic approach. 2nd ed. New York: Springer; 2002.
Miles J, Shevlin M. Applying regression & correlation. London: Sage Publications; 2001.
Flom PL, Cassell DL. Statistics and Data Analysis: Why stepwise and similar selection methods are bad , and what you should use (statistics and data analysis): North East SAS Users Group (NESUG) Annual Conference 2007. 2007. http://www.lexjansen.com/pnwsug/2008/DavidCassell-StoppingStepwise.pdf, https://www.lexjansen.com/nesug/. Accessed 21 Apr 2018.
Harrell FE. Regression modeling strategies. 1st ed. New York: Springer; 2001. CrossRef
Sullivan MJL, Bishop SR, Pivik J. The pain Catastrophizing scale: development and validation. Psychol Assess. 1995;7:524–32. CrossRef
- Predicting the outcome of conservative treatment with physiotherapy in adults with shoulder pain associated with partial-thickness rotator cuff tears – a prognostic model development study
Nigel C. Hanchard
Helen H. Handoll
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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