Persistent shoulder pain: the influence of pain self-efficacy and patient expectation


Birgit Castelein, New in / Friday, February 1st, 2019

A study of Chester et al. (2019) identified predictors of for physiotherapy management of shoulder pain in 810 patients. They found that high levels of pain and disability at baseline were associated with high levels of pain and disability at 6 months follow-up, and that low levels of baseline pain and disability were associated with low levels of follow-up pain and disability. Of importance is that the study found that pain self-efficacy and patient expectations of the physiotherapy treatment are the most influential predictors of patient rated outcome at 6 months follow-up. High levels of pain and disability at baseline could be modified to a better outcome if the patient has high pain self-efficacy and a greater expectation of the treatment. Low levels of baseline pain have a poor outcome if the patient has low pain self-efficacy. 

Based on this study, we recommend to formally assess and discuss pain self-efficacy and patient expectations in the first consultation.

  • Pain self-efficacy is the extent or strength of the patient’s belief in their ability to complete tasks and reach a desired outcome despite their shoulder pain.
  • Patient expectation can be assessed by asking “How much do you expect your shoulder to change as a result of physiotherapy treatment” (measured by a 7-point Likert scale ranging from “completely recover” to “worse than ever”).

In the future, it should be investigated whether these factors can be modified by therapeutic interventions.

Chester R, Khondoker M, Shepstone L, Lewis JS, Jerosch-Herold C. Self-efficacy and risk of persistent shoulder pain: results of a Classification and Regression Tree (CART) analysis. Br J Sports Med. 2019 Jan 9.

Written by: Birgit Castelein

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