Shoulder pain, shoulder disability, and depression as serial mediators between stress and health-related quality of life among middle-aged women

Use of a surgical referral algorithm within a standardized shoulder physical therapy program to assist clinical decision-making

PURPOSE

Determine (a) utility of a shoulder referral algorithm, (b) patients improving ≥15% on the Western Ontario Rotator Cuff(WORC) score with standardized Physical Therapy(PT) +home exercises, and (c) presenting characteristics among PT-Only, PT + Surgical Consult and Surgery participants.

MATERIALS AND METHODS

Prospective cohort study of patients 30-65 years old with shoulder pain. A standardized PT program assessed pain, ROM, strength and exercise tolerance (i.e., referral algorithm) at 2-, 6- and 12-weeks to determine if a surgical consultation might be beneficial. A blinded research assessor evaluated pain, ROM, strength and WORC score at 6-, 12-weeks and 6-months. The proportion improving WORC scores ≥15% and group differences were also evaluated.

RESULTS

32/128 (25%) participants underwent consultation with 16 (12.5%) undergoing surgery. WORC scores improved ≥15% by 12-weeks in most PT-Only/PT + Surgical Consult participants (n = 77[70%]) and was maintained at 6-months. Surgery participants used more NSAIDs (p = 0.01), injections (p = 0.002) and trended to higher opioid use (p = 0.06). PT + Surgical Consult/Surgery participants (n = 16/32; 50%) knew diagnostic imaging results more than PT-Only (n = 26; 31%) (p = 0.02). Surgery participants presented with worse pain, ROM, strength and WORC scores than PT-Only (p < 0.05).

CONCLUSIONS

The algorithm identified those with worse symptomology (25%), 50% of whom underwent surgery. WORC scores improved ≥15% in most participants (70%). Presenting characteristics were significantly worse between PT-Only and Surgery participants.

Cross-cultural adaptation and validation of the shoulder rating questionnaire in Spanish patients with chronic nonsurgical shoulder pain

Background

Chronic shoulder pain is characterized by persistent discomfort in the shoulder joint that can be due to various causes, affecting the patient's quality of life.

Methods

One hundred twenty three participants (54.83 ± 11.73 years) completed the Spanish SRQ. Internal consistency, floor and ceiling effect, and test-retest reliability were analyzed. We also studied construct validity, as well as convergent (quick Disabilities of the Arm, Shoulder, and Hand questionnaire) and concurrent (12-item Short Form Health Survey) validity. The ability and accuracy to discriminate between patients with and without anxiety and depression cases was evaluated with the Hospital Anxiety and Depression Scale; a receiver-operating characteristic curve analysis was used.

Results

The Spanish SRQ showed an appropriate level of internal consistency and test-retest reliability. Factor analysis revealed a 2-factor structure. The Spanish SRQ total score and domains showed good convergent and concurrent validity. The total score was significantly able to discriminate between participants with and without symptoms related to probable presence of anxiety or depression (cut-off point of 34.17).

Conclusion

The Spanish SRQ was found to be a valid and reliable instrument for assessing shoulder symptoms and function and discriminating the probable presence of anxiety and depression in patients with chronic nonsurgical shoulder pain.

Factors affecting physical and mental fatigue in adults from South Korea: A cross-sectional study

In modern society, demanding and stressful events contribute to increased fatigue in adults. Moreover, fatigue is the most prevalent symptom of long coronavirus disease 2019. Fatigue is a subjective feeling of tiredness that can be attributed to various causes. This cross-sectional study investigated factors affecting physical and mental fatigue in adults living in South Korea. Self-reported data were collected through an online survey conducted between July 11 and July 17, 2021. The final sample comprised 362 participants, excluding those with uncertain responses. The collected data were analyzed using IBM SPSS version 27.0. General characteristics and variables of the participants were examined through descriptive statistical analysis. Differences in fatigue level according to the general characteristics of the participants were analyzed using t tests and one-way analysis of variance. The correlation between variables was analyzed using Pearson correlation coefficients. To investigate factors affecting fatigue, stepwise multiple regression analysis was conducted. The overall level of fatigue according to participants' general characteristics differed significantly based on alcohol use, economic status, number of chronic diseases, stress, depression, and sleep problems. Factors affecting physical fatigue were depression, sleep problems, General Health Questionnaire (GHQ-12) scores, and number of chronic diseases. The factors affecting mental fatigue were depression, GHQ-12 score, and alcohol use. The variables that had the most significant impact on overall fatigue were alcohol consumption, the number of chronic illnesses, depression, and GHQ-12, in that order. This emphasizes the importance of lifestyle improvement and dietary management in adults for preventing chronic diseases and managing mental health. The results of this study should be considered when planning health services to provide fatigue interventions for Korean adults.