Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Participants
2.2. Procedures
2.3. Sociodemographic Aspects
2.4. Biological Aspects Related to General Clinical Health Status
2.5. Biological Aspects Related to Shoulder Clinical Condition
2.6. Biological Aspects Related to Sensory Function
2.6.1. Two-Point Discrimination Threshold (TPDT)
2.6.2. Left/Right Judgment Task (LRJT)
2.6.3. Pressure Pain Threshold (PPT)
2.6.4. Temporal Summation (TS)
2.6.5. Conditioned Pain Modulation
2.7. Psychosocial Aspects
2.8. Statistical Analysis
3. Results
3.1. Study Population
3.2. Population characteristics
3.3. Clinical Decision Tree
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- ASP-1: presence of a previous painful complaint higher than seven points in another region of the body in addition to shoulder pain (n = 4; 26.7%);
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- ASP-2: presence of a previous pain lower than or equal to seven points and conditioned pain modulation during the cold pressor test higher than 75.8% of change on PPT-deltoid associated with unilateral pain and TSK score higher than 28 points (n = 8; 53.3%);
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- ASP-3: presence of a previous pain lower or equal to seven points and conditioned pain modulation during the cold pressor test lower than or equal to 75.8% of change on PPT-deltoid associated with positive scapular assistance test and angular onset of pain during external rotation lower than or equal to 73 degrees (n = 2; 13.3%).
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- CSP-1: conditioned pain modulation during the cold pressor test lower than or equal to 75.8% of change on PPT-deltoid associated with negative scapular assistance test (n = 22; 57.9%);
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- CSP-2: conditioned pain modulation during the cold pressor test lower than or equal to 75.8% of change on PPT-deltoid associated with positive scapular assistance test and angular onset of pain during external rotation higher than 73 degrees (n = 8; 21.0%);
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- CSP-3: conditioned pain modulation during the cold pressor test higher than 75.8% of change on PPT-deltoid associated with bilateral pain (n = 6; 15.8%);
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- CSP-4: conditioned pain modulation during the cold pressor test higher than 75.8% of change on PPT-deltoid associated with unilateral pain and a TSK score lower than or equal to 28 points (n = 2; 5.3%).
4. Discussion
4.1. Interpretation of the Results According to Literature
4.2. Implications for Clinical Practice
4.3. Limitations of the Study
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Acute RCRSP (n = 15) | Chronic RCRSP (n = 38) | p-Value | |
---|---|---|---|
Sociodemographic aspects | |||
Age (years) | 31.0 [20.0] | 33.5 [24.3] | 0.54 |
Sex | |||
Male | 9 (60.0%) | 23 (60.5%) | 0.97 |
Educational level | |||
Incomplete elementary school | 1 (6.7%) | 1 (2.6%) | 0.40 |
Elementary school | 0 (0.0) | 3 (7.9%) | |
High school | 6 (40.0%) | 9 (23.7%) | |
University education | 8 (53.3%) | 25 (65.8%) | |
Marital status | |||
Single | 7 (46.7%) | 16 (42.1%) | 0.92 |
Married | 7 (46.7%) | 18 (47.4%) | |
Divorced | 1 (6.7%) | 3 (7.9%) | |
Widowed | 0 (0.0%) | 1 (2.6%) | |
Arm dominance | |||
Right | 6 (40.0%) | 9 (23.7%) | 0.25 |
Left | 8 (53.3%) | 25 (65.8%) | |
Employment status | |||
Active | 14 (93.3%) | 33 (86.8%) | 0.66 |
Retired | 1 (6.7%) | 5 (13.2%) | |
Occupational demand | |||
Physical | 2 (13.3%) | 7 (18.4%) | 0.44 |
Psychological | 10 (66.7%) | 18 (47.4%) | |
Both | 3 (20.0%) | 13 (34.2%) | |
Presence of upper limb repetitive movement | |||
Yes | 11 (73.3%) | 25 (65.8%) | 0.75 |
No | 4 (26.7%) | 13 (34.2%) | |
Frequency of physical activity (days/week) | 4 [4] | 4 [4] | 0.73 |
Smoking status | |||
Yes | 2 (13.3) | 5 (13.2) | 1.00 |
No | 13 (86.7) | 33 (86.8) | |
Biological aspects related to general clinical health status | |||
Presence of any other pain previous to shoulder pain | 10 (66.7%) | 22 (57.9%) | 0.55 |
Pain intensity of the previous most painful complaint besides the shoulder pain (0–10) | 4.8 ± 3.1 | 2.9 ± 1.6 | 0.10 |
CSI-part A | 23.0 ± 9.8 | 28.0 ± 11.3 | 0.14 |
Biological aspects related to shoulder clinical condition | |||
Affected shoulder | |||
Dominant | 6 (40.0%) | 14 (36.8%) | 0.44 |
Non-dominant | 6 (40.0%) | 10 (26.3%) | |
Both | 3 (20.0%) | 14 (36.8%) | |
Duration of symptoms (months) | 3.0 [2.3] | 36.0 [48.8] | 0.001 |
Pain intensity during arm movement (0–10) | 8.0 [4.0] | 7.0 [2.3] | 0.418 |
ROM (degrees) | |||
Angular onset of pain during abduction | 148.0 [35] | 132.0 [64.0] | 0.065 |
Angular offset of pain during abduction | 175.0 [14] | 169.0 [15.0] | 0.43 |
Angular onset of pain during external rotation | 85.5 ± 15.3 | 92.1 ± 19.0 | 0.23 |
Angular offset of pain during external rotation | 95.9 ± 11.9 | 99.0 ± 13.1 | 0.43 |
Scapular dyskinesis | |||
Present | 14 (93.3%) | 36 (94.7%) | 1.00 |
Absent | 1 (6.7%) | 2 (5.3%) | |
Scapular assistance test | |||
Positive | 5 (33.3%) | 11 (28.9%) | 0.75 |
Negative | 10 (66.7%) | 27 (71.1%) | |
Total number of positive special tests for shoulder rotator cuff related pain | 4.5 ± 2.1 | 4.9 ± 2.0 | 0.46 |
DASH | 12.5 [15.0] | 18.3 [16.6] | 0.295 |
Acute RCRSP (n = 15) | Chronic RCRSP (n = 38) | p-Value | |
---|---|---|---|
Biological aspects related to sensory function | |||
TPDT-anterior (mm) | 34.9 ± 19.0 | 40.2 ± 15.8 | 0.30 |
TPDT-posterior (mm) | 44.1 ± 16.7 | 44.9 ± 12.6 | 0.85 |
LRJT-accuracy (%) | 100.0 [10.0] | 100.0 [0.0] | 0.55 |
LRJT-time (s) | 1.4 [0.4] | 1.3 [0.5] | 0.60 |
PPT-acromion (KPa) | 305.6 [215.0] | 271.0 [255.5] | 0.79 |
PPT-deltoid (KPa) | 353.4 ± 163.3 | 360.0 ± 173.8 | 0.90 |
PPT-tibialis anterior (KPa) | 379.0 [160.3] | 376.8 [208.4] | 0.91 |
TS-acromion (0–10) | 3.0 [3.0] | 2.0 [3.0] | 0.62 |
TS-tibialis anterior (0–10) | 3.0 [2.0] | 2.0 [2.3] | 0.15 |
CPM during Cold Pressor Test (% change) | 82.2 ± 44.7 | 49.8 ± 42.5 | 0.02 * |
CPM post-Cold Pressor Test (% change) | 7.2 ± 28.9 | 11.8 ± 32.5 | 0.64 |
Psychosocial aspects | |||
FABQ-Br | |||
FABQ-PA | 15.1 ± 4.7 | 11.8 ± 6.4 | 0.08 |
FABQ-W | 7.0 [13.0] | 8.5 [15.8] | 0.70 |
TSK | 37.1 ± 3.2 | 35.9 ± 7.2 | 0.55 |
PCS | |||
Rumination | 6.7 ± 2.6 | 6.4 ± 3.4 | 0.80 |
Magnification | 4.0 [5.0] | 3.0 [3.5] | 0.95 |
Helplessness | 5.0 [10.0] | 3.0 [6.3] | 0.46 |
CPSS | |||
Pain management | 400.0 [110.0] | 390.0 [115.0] | 0.48 |
Coping with symptoms | 612.0 ± 117.0 | 608.2 ± 109.2 | 0.91 |
Physical function | 880.0 [110.0] | 875.0 [95.0] | 0.98 |
Total score | 1950.0 [350.0] | 1860. [330.0] | 0.68 |
DASS-21 | |||
Depression | 0.0 [4.0] | 2.0 [3.0] | 0.43 |
Anxiety | 1.0 [2.0] | 1.0 [2.3] | 0.41 |
Stress | 1.0 [5.0] | 3.5 [7.3] | 0.47 |
EQ-5 D | 0.82 [0.15] | 0.88 [0.11] | 0.93 |
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Haik, M.N.; Alburquerque-Sendín, F.; Fernandes, R.A.S.; Kamonseki, D.H.; Almeida, L.A.; Liebano, R.E.; Camargo, P.R. Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis. Diagnostics 2020, 10, 928. https://doi.org/10.3390/diagnostics10110928
Haik MN, Alburquerque-Sendín F, Fernandes RAS, Kamonseki DH, Almeida LA, Liebano RE, Camargo PR. Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis. Diagnostics. 2020; 10(11):928. https://doi.org/10.3390/diagnostics10110928
Chicago/Turabian StyleHaik, Melina N, Francisco Alburquerque-Sendín, Ricardo A S Fernandes, Danilo H Kamonseki, Lucas A Almeida, Richard E Liebano, and Paula R Camargo. 2020. "Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis" Diagnostics 10, no. 11: 928. https://doi.org/10.3390/diagnostics10110928