Shoulder Pain in Primary Care Physiotherapy

Current physiotherapy management in patients with shoulder pain is unknown. Additionally, little is known about the effect of diagnostic imaging procedures, especially diagnostic ultrasound, as a relatively new imaging procedure in primary care physiotherapy. The current evidence statement do not makes a recommendation on the use of diagnostic ultrasound. Due to the lack of reproducibility of traditional diagnostic labels, subgroups based on prognostic factors could help facilitate more appropriate treatment plans. Several prognostic factors have been described and it is believed that diagnostic ultrasound and working alliance might also be potential prognostic factors for recovery. Therefore, the main objectives of this thesis are (1) to describe current management in relation to diagnostic work-up (including the use of diagnostic ultrasound) and treatment strategies of physiotherapy care for patients with shoulder pain (2) to identify prognostic factors and develop a prognostic model (including the use of diagnostic ultrasound and working alliance) of recovery for patients with shoulder pain

One question might be capable of replacing the Shoulder Pain and Disability Index (SPADI) when measuring disability: a prospective cohort study

Questions: Is it possible to replace the Shoulder Pain and Disability Index (SPADI) with a single substitute question for people with shoulder pain, when measuring disability and how well does this substitute question perform as a predictor for recovery. Design: A prospective cohort study. Participants: A total of 356 patients with shoulder pain in primary care. Analyses: Convergent, divergent, and “known” groups validity were assessed by using hypotheses testing. Responsiveness was assessed using the Receiver Operating Curve and hypothesis testing. In addition, we performed multivariate regression to assess if the substitute question showed similar properties as the SPADI and if it affected the model itself, using recovery as an outcome. Results: The Spearman correlation coefficient between the total SPADI score and the substitute question was high, and moderate with the Shoulder Disability Questionnaire. The correlation between the substitute question and the EQ-5D-3L was low and the responsiveness was acceptable. The substitute question did not significantly contribute to both prognostic prediction models as opposed to the SPADI. Regardless all models showed poor to fair discrimination. Conclusion: The single question is a reasonable substitute for the SPADI and can be used as a screening instrument for shoulder disability in primary clinical practice. It has slightly poorer predictive power and should therefore not be used for prognosis

The Working Alliance Inventory's Measurement Properties:A Systematic Review

Measurement properties of the Working Alliance Inventory (WAI) and its various translations and adaptations for specific target groups have been investigated for over 30 years. No systematic review analyzing studies on measurement properties of the WAI has been conducted to date. COnsensus-based Standards for the selection of health Measurements INstruments (COSMIN) were developed for conducting high-quality systematic reviews on measurement properties in a transparent and standardized way. Aim of this study was to systematically review studies on measurement properties of the WAI, and its adapted versions, within psychotherapy, and other healthcare contexts using COSMIN criteria. PsycINFO, Medline, and EMBASE were searched (1989-2021). In all phases of the review procedure, study selection, data extraction, risk of bias assessment, rating of the quality of measurement properties, and rating of the quality of evidence for measurement properties, disagreement between reviewers was resolved by discussion. Results on validity, internal structure, reliability, construct validity, and responsiveness were analyzed. In total 66 studies were included. In most studies, evidence for measurement properties was according to COSMIN criteria, insufficient, lacking, or conflicting. Content validity was rated insufficient because neither patients nor healthcare professionals were involved in the development and validation process. Hence evidence for content validity of the WAI is unknown. Conflicting evidence was found for structural validity. Evidence for internal consistency could not be established. Limited evidence was found for inter-rater reliability and convergent validity. Conflicting evidence was also found for test-retest reliability and divergent validity. COSMIN criteria exposed persistent problems in validation studies of the WAI. These findings may indicate that measurement properties of the WAI are not up to current standards, or that COSMIN criteria may be less appropriate for assessing measurement properties of the WAI, or it could indicate both. The results of this systematic review suggest that WAI outcomes should be interpreted with caution and further research is needed regarding the content validity and hypotheses development. For the future, the theoretical framework underlying the measurement of the working alliance needs to be studied in psychotherapy and other health contexts, and tested in methodologically sound studies

The Effect of a Personalized Newsletter to Physical Therapists on Patient Recruitment:A Cluster Randomized Trial in Primary Physiotherapy Care

Objective: To assess the effect of a personalized newsletter compared with a standard newsletter on patient recruitment in physiotherapy research. Methods: We performed a cluster-randomized trial including 120 physiotherapists who recruited patients for a prospective cohort and were randomly assigned to either receiving personalized feedback in a newsletter (intervention group) or a standard newsletter (control group). We calculated the difference in the number of patients included in the study corrected for inclusion time between both groups. Results: The physiotherapists in the control group (n = 59) included 110 patients (35.4% of the total number of patients included) compared with an inclusion of 200 patients (64.6% of the total number of patients included) by the physiotherapists in the intervention group (n = 61), a difference of 90 patients in favor of the intervention group. However, when corrected for inclusion time and a cluster effect, we found no statistically significant difference between both groups. In addition, therapists who did not include a single patient (inactive therapists) were evenly divided between the 2 groups (n = 29 [49%] in the control group; n = 30 [49%] in the intervention group). Conclusions: A personalized newsletter does not significantly increase the number of recruited patients by physiotherapists. However, therapists receiving personalized feedback recruited nearly double the number of patients compared with the ones receiving standard feedback

Current management and prognostic factors in physiotherapy practice for patients with shoulder pain: Design of a prospective cohort study

Background: Shoulder pain is disabling and has a considerable socio-economic impact. Over 50% of patients presenting in primary care still have symptoms after 6 months; moreover, prognostic factors such as pain intensity, age, disability level and duration of complaints are associated with poor outcome. Most shoulder complaints in this group are categorized as non-specific. Musculoskeletal ultrasound might be a useful imaging method to detect subgroups of patients with subacromial disorders.This article describes the design of a prospective cohort study evaluating the influence of known prognostic and possible prognostic factors, such as findings from musculoskeletal ultrasound outcome and working alliance, on the recovery of shoulder pain. Also, to assess the usual physiotherapy care for shoulder pain and examine the inter-rater reliability of musculoskeletal ultrasound between radiologists and physiotherapists for patients with shoulder pain. Methods. A prospective cohort study including an inter-rater reliability study. Patients presenting in primary care physiotherapy practice with shoulder pain are enrolled. At baseline validated questionnaires are used to measure patient characteristics, disease-specific characteristics and social factors. Physical examination is performed according to the expertise of the physiotherapists. Follow-up measurements will be performed 6, 12 and 26 weeks after inclusion. Primary outcome measure is perceived recovery, measured on a 7-point Likert scale. Logistic regression analysis will be used to evaluate the association between prognostic factors and recovery. Discussion. The ShoCoDiP (Shoulder Complaints and using Diagnostic ultrasound in Physiotherapy practice) cohort study will provide information on current management of patients with shoulder pain in primary care, provide data to develop a prediction model for shoulder pain in primary care and to evaluate whether musculoskeletal ultrasound can improve prognosis

Shoulder pain in primary care physiotherapy: Schouderpijn in de eerstelijns fysiotherapie praktijk [proefschrift]

Current physiotherapy management in patients with shoulder pain is unknown. Additionally, little is known about the effect of diagnostic imaging procedures, especially diagnostic ultrasound, as a relatively new imaging procedure in primary care physiotherapy. The current evidence statement do not makes a recommendation on the use of diagnostic ultrasound. Due to the lack of reproducibility of traditional diagnostic labels, subgroups based on prognostic factors could help facilitate more appropriate treatment plans. Several prognostic factors have been described and it is believed that diagnostic ultrasound and working alliance might also be potential prognostic factors for recovery. Therefore, the main objectives of this thesis are (1) to describe current management in relation to diagnostic work-up (including the use of diagnostic ultrasound) and treatment strategies of physiotherapy care for patients with shoulder pain (2) to identify prognostic factors and develop a prognostic model (including the use of diagnostic ultrasound and working alliance) of recovery for patients with shoulder pain

The concept of Positive Health for students/ lecturers in the Netherlands

Introduction: The future healthcare workforce are expected to serve as role models given that their roles cover patient education concerning positive health behavior. In light of the changes in healthcare, towards patient centered care and positive health, the need to encourage students of health sciences to adopt the concept of positive health will be necessary. Aim: To explore the attitudes of lecturers and students of health to the new concept of Positive Health, using the 6 domains, in Dutch health education systems with different health care professionals. Methods: A cross-sectional study comparing the perception towards health in students and lecturers of the health department of an Applied University in the Netherlands with the data of patients and other stakeholders. Results: Students scored aspects of social participation, mental functioning and daily functioning as less important compared to patients. Lecturers scored the aspects of bodily functions and daily functioning less important compared to patients. Conclusion: These differences in scores should be addressed in educational programs of health professionals because all aspects of health are important to the patient’s experienced health