The Relationship of Pain Intensity, Physical Impairment, and Pain-Related Fear to Function in Patients With Shoulder Pathology

Josh A. Barabas, Tim Day, Mark D. Bishop, Steven Z. George, Trevor A. Lentz

DOI: 10.2519/jospt.2009.2879

STUDY DESIGN: Cross-sectional. OBJECTIVES: This study examined the baseline relationship of pain intensity, physical impairment, and pain-related fear to shoulder function. BACKGROUND: There is no consensus regarding the influence psychological variable have on function and recovery in individuals with shoulder pathologies. While pain-related fear has been shown to predict disability for patients with low-back and cervical pain, this relationship has not been consistently reported for patients with shoulder pain. METHODS AND MEASURES: One hundred forty-two subjects (78 male, 64 female; mean age, 41.4 years) with nonoperative unilateralshoulder disorders were identified from a clinical database of impairment and outcome measures.Demographic information, duration of symptoms, mechanism of injury, pain intensity, pain-related
fear, and range-of-motion (ROM) measures were collected. Self-report of function was measured with the Shoulder Pain and Disability Index (SPADI). Hierarchical regression analysis determinedthe proportions of explained variance in function. RESULTS: Demographic variables (durationof symptoms, sex, age, and mechanism of injury) collectively contributed approximately 9% (P = .003) of the variance in function scores. Average pain intensity and flexion ROM contributed an additional 22% (P<.001) of the variance, and Tampa Scale of Kinesiophobia (TSK-11) scores contributed an additional 3% (P<.001). In the final parsimonious model, presence of symptoms longer than 3 months (ß = .23, P = .003), pain intensity (ß = .25, P = .002), shoulder flexion ROM index (ß = –.35, P = .001), and kinesiophobia (ß = .17, P = .026) explained 33% of the variance in SPADI function score (P<.001). CONCLUSIONS: Presence of symptoms longer than 3 months, average pain intensity, flexion ROM index (strongest contributor in multivariate model), and fear-of-pain scores all contributed to baseline shoulder function. The immediate clinical relevance of these findings is unclear but they do provide direction for prospective studies. LEVEL OF EVIDENCE: Prognosis, level 2b.

J Orthop Sports Phys Ther 2009;39(4):270-277, Epub 15 December 2008. doi:10.2519/jospt.2009.2879

KEY WORDS: disability, kinesiophobia, psychological, physical therapy, shoulder flexion

This study examined the baseline relationship of pain intensity, physical impairment, and pain-related fear to shoulder function.

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