Psychosocial Factors of Persistent Shoulder Pain
Condition: Shoulder Pain
MeSH terms: Shoulder Pain
Study type: Observational

Summary: 
      Several studies have shown that in chronic pain conditions, factors such as lack of
      positivity and resilience, pain catastrophizing, stress, anxiety and depression can
      contribute to the persistence and maintenance of pain. Thus, the present project will
      identify psychosocial risk factors that predict the persistence of shoulder pain. Individuals
      with shoulder pain (n=112) will be recruited. At baseline, the participants will fill a
      series of questionnaires evaluating different biopsychosocial constructs (resilience,
      perceived stress, anxiety, depression, pain, disability, pain catastrophizing, self-efficacy,
      social support, physical activity). After baseline evaluation, the participants will take
      part in an educational program aimed at promoting self-management of shoulder pain. At the
      end of the project (6 months), participants will only fill questionnaires evaluating pain and
      disability. Based on the scores on these questionnaires, the participants will be classified
      as having persistent shoulder pain or as recovered. Thereafter, statistical analyses will be
      performed to identify significant predictors for persistent shoulder pain. The primary
      hypothesis of the study is that low levels of resilience, self-efficacy, social support and
      physical activity, and high levels of stress, pain, disability, catastrophizing, anxiety and
      depression will negatively influence the pain response resulting in increased pain ratings
      and persistent symptoms over time.
    

Detailed description: 
      A prospective cohort study will be conducted. One hundred and twelve individuals with rotator
      cuff related shoulder pain (RCRSP) will be evaluated twice: baseline and 6-month after
      baseline. At baseline, participants will complete a questionnaire on sociodemographic and
      symptomatology. Then, the participants will be asked to fill questionnaires covering a
      biopsychosocial spectrum: Brief Resilience Scale (BRS), Perceived Stress Scale (PSS-10),
      Numeric Pain Rating Scale (NPRS), abbreviated version of the Disabilities of the Arm,
      Shoulder, and Hand Questionnaire (QuickDASH), Patient-Health Questionnaire - 9 (PHQ-9),
      General Anxiety Disorder - 7 (GAD-7), Pain Catastrophizing Scale (PCS), Pain Self-Efficacy
      Questionnaire (PSEQ), Multidimensional Scale of Perceived Social Support (MSPSS) and short
      version of the International Physical Activity Questionnaire (IPAQ). After the baseline
      evaluation, participants will take part in an educational program aimed at promoting
      self-management of shoulder pain. The program will include two one-on-one sessions
      (approximately 30-45 minutes) within 2 weeks with a physiotherapist. The main reasons to
      propose an education intervention is that it is usual to receive a rehabilitation
      intervention when a person presents shoulder pain. It was therefore difficult to expect that
      the participants would not seek treatment during the study period and therefore that the
      investigators could only have considered the effect of time (natural evolution of the
      injury). Finally, at 6-months, participants will only be asked to fill NPRS and QuickDASH.
      Based on the scores on these questionnaires, the participants will be classified as having
      persistent shoulder pain or as recovered.The follow-up evaluation will be performed online
      (6-month follow-up) using RedCap. For the statistical analysis, participants will be
      dichotomized into 2 subgroups according to whether their symptoms have resolved or not at
      6-month, aiming to determine the baseline variables that predict the persistence of pain 6
      months after baseline. All variables found to be significant on univariate analyses will be
      considered potential predictors. Thereafter, logistic regression analyses will be performed
      to identify significant predictors for persistent rotator cuff related shoulder pain.
    

Intervention name(s): Education Program
Intervention type(s): Behavioral
Intervention description(s): After the baseline evaluation, all participants will take part in an education intervention, aiming at promoting self-management of shoulder pain, that will include two one-on-one sessions (approximately 30-45 minutes) within 2 weeks with a physiotherapist (1st session right after the baseline evaluation, 2nd session two weeks later). Participants will receive written information regarding shoulder (anatomy and function) and basic pain science and will be directed to watch a series of six educational videos on shoulder pain and function, persistent pain, physical activity, stress, sleep and eating habits. It should be noted that the objective of this study is not to assess the effectiveness of the intervention; the purpose of offering an intervention to participants is to control the intervention that will be received by them.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Potential participants will be recruited from a convenience sample through the electronic
        mailing lists of Université Laval (>40,000 individuals), social media (mainly Facebook,
        Twitter and Instagram), the medical communities in Quebec City (advertisements in medical,
        physiotherapy, radiology clinics and pharmacies) and advertisement with patient advocacy or
        professional organizations and with unions of workers at risk for rotator cuff related
        shoulder pain.