Risk Stratification of Patients With Shoulder Pain Seen in Physical Therapy Practice

J Eval Clin Pract. 2017 Apr;23(2):257-263. doi: 10.1111/jep.12591. Epub 2016 Jun 29.


Rationale, aims and objectives: Musculoskeletal shoulder pain is commonly treated in physical therapy. There is inconsistency in the literature regarding patient characteristics related to prognosis. Having prognostic information could be useful for improving clinical efficiency and decreasing the cost of associated care. The objective of this study was to identify predictive characteristics related to patients with shoulder pain who have a high-risk of a bad prognosis (lowest functional recovery compared with visit utilization) as well as those who are at low-risk of a bad prognosis (highest functional recovery compared with visit utilization).

Methods: We completed a secondary analysis of a retrospective cohort using data obtained from an existing commercial outcomes database. Data from 5214 patients with shoulder pain were analysed to determine predictive characteristics that identify patients who either have a low-risk or a high-risk of a bad prognosis to physical therapy care. Multinomial regression was used to identify significant patient characteristics predictive of treatment response.

Results: Statistically significant predictors of high-risk categorization included older age, no surgical history, insurance designated as worker's compensation, litigation or automotive and three or more co-morbidities. Predictors of low risk categorization were younger age, shorter duration of symptoms, no surgical history and payer type.

Conclusion: Selected variables were associated with both poor and good recovery. Further research on prognosis, efficacy of physical therapy care and cost appear warranted for patients with shoulder pain.

Keywords: cost; outcomes; rehabilitation.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Comorbidity
  • Disability Evaluation
  • Exercise
  • Female
  • Humans
  • Male
  • Middle Aged
  • Physical Therapy Modalities / statistics & numerical data*
  • Prognosis
  • Recovery of Function
  • Retrospective Studies
  • Shoulder Pain / rehabilitation*
  • Time Factors
  • Time-to-Treatment
  • Workers' Compensation / statistics & numerical data