The influence of smoking on recovery from subacromial pain syndrome: a cohort from the Military Health System.
BACKGROUND: Smoking rates are higher in the military population than in the civilian sector. Smoking is associated with poor prognosis for many musculoskeletal injuries. The purpose of this study was to investigate the effects of smoking on recovery from a shoulder injury in a prospective cohort seeking care at a military treatment facility. METHODS: Secondary analysis of 98 patients referred to physical therapy for unilateral shoulder pain. Patients received a corticosteroid injection or 6 sessions of physical therapy. Sociodemographic and historical variables were analyzed to assess their influence on whether a patient achieved the minimally clinically important difference of 12 or more points on the Shoulder Pain and Disability Index following treatment. RESULTS: The mean improvement was almost 50% in both groups and maintained to one year. Smoking was associated with not achieving a clinically significant improvement in disability scores at 4 weeks, but not 6 months. Higher levels of disability at baseline and receiving only the treatment originally assigned (not crossing over) were associated with achieving clinically significant changes at both 4 weeks and 6 months. COMMENT: Smoking is a modifiable variable that may help explain lack of improvement in patients with shoulder pain. Healthcare providers in the military setting should keep this in mind when educating this patient population and determining their prognosis, especially given high rates of smoking. Further research is needed to validate these findings and determine their influence on other musculoskeletal injuries.
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