High incidence of lost workdays in patients with subacromial impingement syndrome

INTRODUCTION

Loss of workdays is the main societal cost related to shoulder disorders with nine lost workdays per six months on average. The most common shoulder disorder is subacromial impingement syndrome (SIS), but it remains unknown if SIS is also a leading cause of shoulder-related loss of worktime. We aimed to investigate the incidence of workdays lost due to SIS during the six months following a SIS diagnosis in specialised care.

METHODS

Among 157 consecutive patients diagnosed with SIS in secondary care, 129 (82%) completed a structured six-month follow-up interview. Job status, average working hours and sick leave due to SIS were recorded. Only patients holding a job (n = 58) and patients who lost their job due to SIS (n = 8) were considered to be at risk of losing workdays, leaving 66 patients in the at-risk group. The number of lost workhours due to SIS was calculated and normalised to full-time workdays, and incidences of lost workdays were estimated using Poisson regressions.

RESULTS

In total, 1,781 workdays were lost. The mean number of lost workdays per six months was 27 days (95% confidence interval (CI): 18-40) for patients at risk (n = 66), corresponding to 14 days on average (95% CI: 9-21 days) for the entire cohort (n = 129). A total of 33 patients were responsible for all loss of workdays.

CONCLUSIONS

We found that an average of 27 workdays (> 5 work weeks) were lost due to SIS during the first six months after the diagnosis in patients who were otherwise fit to work. This is three times higher than the nine days previously reported for shoulder problems in general, indicating that productivity loss in patients diagnosed with SIS is a major concern.

FUNDING

none.

TRIAL REGISTRATION

not relevant.

Less than half of patients in secondary care adheres to clinical guidelines for subacromial pain syndrome and have acceptable symptoms after treatment: A Danish nationwide cohort study of 3306 patients

BACKGROUND

Evidence-based guidelines recommend exercise-therapy as first line treatment for subacromial pain syndrome, but no previous study has mapped the content of care for subacromial pain syndrome and knowledge about adherence to clinical guidelines are lacking. We aim to describe the content and outcome of current care and investigate the relationship between content and outcome of care.

METHODS

We invited all patients diagnosed with subacromial pain syndrome at any Danish hospital to participate in this nationwide retrospective population-based cohort-study. Patient-reported information on content of care was collected using a validated questionnaire. Outcome of care was assessed using global impression of change (GIC) and patient acceptable symptom state (PASS). Invitations were sent 14 weeks after diagnosis.

RESULTS

In total, 3306 eligible patients participated. At follow-up, 45% had completed the recommended 12 weeks of exercise-therapy. From the total cohort, 12% underwent surgery without completing 12 weeks of exercise-therapy. For patients undergoing non-operative care, 43% reached PASS while 61% were improved since diagnosis at the hospital. Completing 12 weeks with exercise-therapy did not increase the odds of improvement (OR 1.05, 95%CI:0.88-1.24), but having conducted strengthening exercises did (OR 1.65, 95%CI:1.25-2.19).

CONCLUSION

More than half of patients diagnosed with subacromial pain syndrome in specialist care settings do not adhere to recommendations regarding duration of exercise-therapy, but this is not related to symptom improvement. Conversely, conducting strengthening exercises relates to higher chance of symptom improvement. This challenges current clinical guidelines, indicating that a time-based cut-point may not be relevant while specific types of exercises are.