Between-session changes predict overall perception of improvement but not functional improvement in patients with shoulder impingement syndrome seen for physical therapy: an observational study.

Do between-session changes in global rating of change (GRoC) predict change in GRoC and self-report of function at discharge in patients with shoulder impingement that initially improve in early sessions of treatment (GRoC>5)? Is there a difference between individuals who initially respond to treatment (GRoC>5) compared to those that do not (GRoC<5) for self-report of function? This longitudinal, observational study had 55 patients seen for a formal physical therapy program after a medical diagnosis of shoulder impingement. Physical therapy used a standardized protocol. The American Shoulder and Elbow Surgeons Subjective Shoulder Scale (ASES) and self-report of improvement of condition using the GRoC were measured. We found no significant correlation between the first visits between-sessions changes of the GRoC and the change score of the ASES (r=0.13; p=0.39) in patients with shoulder impingement that initially improve in early sessions of treatment (GRoC>5). There was a moderate correlation between the first visits between-session changes of the GRoC and the final reported GRoC (r=0.48; p<0.01) for the patients who responded to treatment. There was no difference in ASES change scores between those who initially respond to treatment (N=10) and those who do not (N=34). ASES mean change scores were 21.5 for the responders and 14.3 for the non-responders. These findings suggest that a GRoC of 5 or greater is related to a perceived change in one's condition upon termination of formal physical therapy but is not related to actual improvement in one's self-report of function. This finding suggests that the construct of the GRoC may not be related to the constructs of the ASES, or between-session changes are not prognostic in patients with shoulder impingement and should not solely dictate treatment decision making.

Duke Scholars

Author Charles Alden Thigpen Orthopaedic Surgery, Physical Therapy

Author Chad E. Cook Orthopaedic Surgery, Physical Therapy