Use of a surgical referral algorithm within a standardized shoulder physical therapy program to assist clinical decision-making
Creators: name: Chepeha, Judy C.
name: Silveira, Anelise
name: Luciak-Corea, Charlene
name: Sheps, David
name: Beaupre, Lauren A.
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Medicine
subject: Neuroscience
subject: Ecology
subject: FOS: Biological sciences
subject: Immunology
subject: FOS: Clinical medicine
subject: Cancer
subject: Science Policy
subject: Mental Health

description: Determine (a) utility of a shoulder referral algorithm, (b) patients improving ≥15% on the Western Ontario Rotator Cuff(WORC) score with standardized Physical Therapy(PT) +home exercises, and (c) presenting characteristics among PT-Only, PT + Surgical Consult and Surgery participants. Prospective cohort study of patients 30–65 years old with shoulder pain. A standardized PT program assessed pain, ROM, strength and exercise tolerance (i.e., referral algorithm) at 2-, 6- and 12-weeks to determine if a surgical consultation might be beneficial. A blinded research assessor evaluated pain, ROM, strength and WORC score at 6-, 12-weeks and 6-months. The proportion improving WORC scores ≥15% and group differences were also evaluated. 32/128 (25%) participants underwent consultation with 16 (12.5%) undergoing surgery. WORC scores improved ≥15% by 12-weeks in most PT-Only/PT + Surgical Consult participants (<i>n</i> = 77[70%]) and was maintained at 6-months. Surgery participants used more NSAIDs (<i>p</i> = 0.01), injections (<i>p</i> = 0.002) and trended to higher opioid use (<i>p</i> = 0.06). PT + Surgical Consult/Surgery participants (<i>n</i> = 16/32; 50%) knew diagnostic imaging results more than PT-Only (<i>n</i> = 26; 31%) (<i>p</i> = 0.02). Surgery participants presented with worse pain, ROM, strength and WORC scores than PT-Only (<i>p</i> &lt; 0.05). The algorithm identified those with worse symptomology (25%), 50% of whom underwent surgery. WORC scores improved ≥15% in most participants (70%). Presenting characteristics were significantly worse between PT-Only and Surgery participants. Patients presenting with rotator-cuff related shoulder pain are likely to report reduced pain, and improved range of motion, strength and health-related quality of life within 3-months of starting a physical therapy program that includes home exercises.A surgical referral algorithm based on patient symptomology and response to treatment may assist physical therapists in determining when patients with shoulder pain might benefit from a surgical consult, often in advance of 3-months.Patients who required surgery tended to present with more pain, loss of range of motion and strength than those who received physical therapy only, as well as a history of more injections and non-steroidal anti-inflammatory drug use. Patients presenting with rotator-cuff related shoulder pain are likely to report reduced pain, and improved range of motion, strength and health-related quality of life within 3-months of starting a physical therapy program that includes home exercises. A surgical referral algorithm based on patient symptomology and response to treatment may assist physical therapists in determining when patients with shoulder pain might benefit from a surgical consult, often in advance of 3-months. Patients who required surgery tended to present with more pain, loss of range of motion and strength than those who received physical therapy only, as well as a history of more injections and non-steroidal anti-inflammatory drug use.