Physiotherapy for patients with shoulder pain in primary care: a descriptive study of diagnostic- and therapeutic management

Y H J M Karel; G G M Scholten-Peeters; M Thoomes-de Graaf; E Duijn; J B van Broekhoven; B W Koes; A P Verhagen

doi:10.1016/j.physio.2016.11.003

Physiotherapy for patients with shoulder pain in primary care: a descriptive study of diagnostic- and therapeutic management

Physiotherapy. 2017 Dec;103(4):369-378. doi: 10.1016/j.physio.2016.11.003. Epub 2016 Nov 28.

Authors

Y H J M Karel¹, G G M Scholten-Peeters², M Thoomes-de Graaf³, E Duijn⁴, J B van Broekhoven⁵, B W Koes⁶, A P Verhagen⁶

Affiliations

¹ Research Group Diagnostics, Avans University of Applied Sciences, Breda, The Netherlands; Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: yhjm.karel@avans.nl.
² Research Group Diagnostics, Avans University of Applied Sciences, Breda, The Netherlands; Faculty of Behavioural and Movement Sciences, MOVE Research Institute Amsterdam, VU University of Amsterdam, Amsterdam, The Netherlands.
³ Research Group Diagnostics, Avans University of Applied Sciences, Breda, The Netherlands; Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
⁴ Department of Human Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.
⁵ Group Practice for Physiotherapy Monné, Breda, The Netherlands.
⁶ Department of Family Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.

PMID: 28801032
DOI: 10.1016/j.physio.2016.11.003

Abstract

Background: Shoulder pain is one of the three main musculoskeletal complaints and more than 50% of the patients have symptoms longer than 6 months. Until now, limited data exist about the content of physiotherapy for patients with shoulder pain in primary care.

Objective: Describe current physiotherapeutic diagnostic- and therapeutic management, including the use of diagnostic ultrasound, in patients with shoulder pain in primary care.

Design and setting: A prospective cohort study in primary care physiotherapy with a 12 week follow-up.

Methods: Descriptive data from physiotherapists was collected, such as: the diagnostic hypotheses after patient history and physical examination, the use of specific tests and diagnostic ultrasound, the interventions used and possible changes in treatment plan.

Results: Subacromial impingement syndrome was the most common hypothesis after patient history (48%) as well as physical examination (39%). Diagnostic ultrasound was used in 31% and of these patients the clinical diagnosis changed in 29%. Various interventions were used in all clinical diagnoses. After 12 weeks 41% of patients still received physiotherapy treatment.

Conclusions: Patients with shoulder pain in physiotherapy practice frequently show signs of subacromial impingement syndrome. The interventions used by the physiotherapists were generally in line with the guideline for subacromial impingement syndrome however a small proportion of physiotherapists used massage and tape/bracing techniques. A large proportion of patients were still receiving treatment after 12 weeks when no improvement was observed. If treatment for patients with subacromial impingement shows no benefit patients should be referred back to the general practitioner or orthopedic surgeon. Conclusions from this study might be slightly biased because of the selection of physiotherapists.

Keywords: Care management; Cohort study; Physical therapy; Physiotherapy; Primary care; Shoulder pain.

MeSH terms

Adult
Aged
Disability Evaluation
Female
Humans
Male
Middle Aged
Netherlands
Physical Therapy Modalities*
Primary Health Care*
Prospective Studies
Recovery of Function
Shoulder Impingement Syndrome / diagnosis
Shoulder Impingement Syndrome / diagnostic imaging
Shoulder Impingement Syndrome / rehabilitation
Shoulder Pain / diagnosis*
Shoulder Pain / diagnostic imaging
Shoulder Pain / rehabilitation*