The Effect of a Personalized Newsletter to Physical Therapists on Patient Recruitment: A Cluster Randomized Trial in Primary Physiotherapy Care.

OBJECTIVE: To assess the effect of a personalized newsletter compared with a standard newsletter on patient recruitment in physiotherapy research. METHODS: We performed a cluster-randomized trial including 120 physiotherapists who recruited patients for a prospective cohort and were randomly assigned to either receiving personalized feedback in a newsletter (intervention group) or a standard newsletter (control group). We calculated the difference in the number of patients included in the study corrected for inclusion time between both groups. RESULTS: The physiotherapists in the control group (n = 59) included 110 patients (35.4% of the total number of patients included) compared with an inclusion of 200 patients (64.6% of the total number of patients included) by the physiotherapists in the intervention group (n = 61), a difference of 90 patients in favor of the intervention group. However, when corrected for inclusion time and a cluster effect, we found no statistically significant difference between both groups. In addition, therapists who did not include a single patient (inactive therapists) were evenly divided between the 2 groups (n = 29 [49%] in the control group; n = 30 [49%] in the intervention group). CONCLUSIONS: A personalized newsletter does not significantly increase the number of recruited patients by physiotherapists. However, therapists receiving personalized feedback recruited nearly double the number of patients compared with the ones receiving standard feedback.

The Responsiveness and Interpretability of the Shoulder Pain and Disability Index.

Study Design Clinical measurement study, prospective cohort design. Background Shoulder pain is a common disorder, and treatment is most often focused on a reduction of pain and functional disabilities. Several reviews have encouraged the use of the Shoulder Pain and Disability Index (SPADI) to objectify functional disability. It is important to assess the responsiveness and interpretability of the SPADI in patients seeking physical therapy treatment for their shoulder pain in a primary care setting. Objective To assess the responsiveness and interpretability of the SPADI in patients with shoulder pain visiting a physical therapist in primary care. Methods The target population consisted of patients who consulted a physical therapist for their shoulder pain. The patients received physical therapy treatment and completed the Dutch-language version of the SPADI at baseline and at 26-week follow-up. The interpretability floor and ceiling effects and the minimal important change (MIC) were assessed using the receiver operating characteristic method, and a visual anchor-based MIC distribution method was used to assess several Global Perceived Effect scale (GPE)-based anchors. The measurement error was calculated using the smallest detectable change. For the responsiveness, the area under the receiver operating characteristic curve was used, and correlations with the GPE and the change score of the Shoulder Disability Questionnaire (as this questionnaire measures the same construct) were assessed. Results A total of 356 patients participated at baseline and 237 (67%) returned the SPADI after 26 weeks. The mean score on the SPADI at baseline was 46.7 points (on a 0-100 scale). The SPADI showed no signs of floor and ceiling effects. The smallest detectable change was 19.7 points. The MIC was 20 (43% of baseline value), and therefore a change of 43% or more in an individual patient was considered to be clinically relevant. The area under the receiver operating characteristic curve (AUC) was 0.81, the Spearman correlation between the SPADI change score and the GPE was 0.53, and the Pearson correlation between the Shoulder Disability Questionnaire and the SPADI change score was 0.71. Conclusion The results of this study confirm the responsiveness of the SPADI, making it a useful instrument to assess functional disability in longitudinal studies; however, the measurement error should be taken into account when making decisions in individual patients. J Orthop Sports Phys Ther 2017;47(4):278-286. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7079.

Development of a Prognostic Model for Patients With Shoulder Complaints in Physical Therapist Practice.

Background: Health care providers need prognostic factors to distinguish between patients who are likely to recover and those who are not likely to recover. Objective: The aim of this study was to: (1) describe the clinical course of recovery and (2) identify prognostic factors of recovery in patients with shoulder pain at the 26-week follow-up. Design: A prospective cohort study was carried out in the Netherlands and included 389 patients who consulted a physical therapist for a new episode of shoulder pain. Method: Participants were followed for 26 weeks. Potential predictors of recovery were selected from the literature and, with the addition of 2 new variables (ie, use of diagnostic ultrasound and working alliance), evaluated in the multivariable regression analysis. Multiple imputation was used to handle missing data, and bootstrap methods were used for internal validation. Results: The recovery rate was 60% for the total population and 65% for the working population after 26 weeks. Short duration of complaints, lower disability scores, having a paid job, better working alliance, and no feelings of anxiety or depression were associated with recovery. In the working population, only duration of complaints and disability remained in the final model. The area under the receiver operating characteristic curve (AUC) for the final model was 0.67 for the total population and 0.63 for the working population. After internal validation, the AUC was corrected to 0.66 and 0.63, respectively. Limitations: External validation of the prognostic model should be done prior to its use in clinical practice. Conclusion: The results of this study indicate that several factors can predict recovery.

The Dutch Shoulder Pain and Disability Index (SPADI): a reliability and validation study.

PURPOSE: To evaluate the reliability and validity of the Dutch Shoulder Pain and Disability Index (SPADI-D). BACKGROUND: The SPADI is recommended and frequently used. However, the validity and reliability of the SPADI-D are unknown. METHODS: The study population consisted of patients consulting a physical therapist for shoulder pain. We assessed construct validity, using known groups, convergent validity (SDQ) and divergent validity (EQ5D) for which the mean difference or Spearman correlations coefficients were calculated. The factor structure was assessed using principal component factor analysis, and we calculated Cronbach's alpha and the ICC to assess the reliability. RESULTS: A total of 356 patients and a randomly selected group of 74 subjects for the reliability analysis were included. There was a significant difference between extreme groups (a high/low level of pain and work absence/presence) in SPADI score. The correlation between the SPADI and the SDQ was 0.69, with the EQ5D mobility-item 0.25 and with the depression-item 0.14. The SPADI consisted of one factor according to principal component factor analysis, which showed high internal consistency (Cronbach's alpha = 0.94 for the total score), and the test-retest reliability was good (ICC = 0.89). CONCLUSION: The Dutch SPADI is a valid and reliable questionnaire for patients in primary care in assessing functional disability.

Current management and prognostic factors in physiotherapy practice for patients with shoulder pain: design of a prospective cohort study.

BACKGROUND: Shoulder pain is disabling and has a considerable socio-economic impact. Over 50% of patients presenting in primary care still have symptoms after 6 months; moreover, prognostic factors such as pain intensity, age, disability level and duration of complaints are associated with poor outcome. Most shoulder complaints in this group are categorized as non-specific. Musculoskeletal ultrasound might be a useful imaging method to detect subgroups of patients with subacromial disorders.This article describes the design of a prospective cohort study evaluating the influence of known prognostic and possible prognostic factors, such as findings from musculoskeletal ultrasound outcome and working alliance, on the recovery of shoulder pain. Also, to assess the usual physiotherapy care for shoulder pain and examine the inter-rater reliability of musculoskeletal ultrasound between radiologists and physiotherapists for patients with shoulder pain. METHODS: A prospective cohort study including an inter-rater reliability study. Patients presenting in primary care physiotherapy practice with shoulder pain are enrolled. At baseline validated questionnaires are used to measure patient characteristics, disease-specific characteristics and social factors. Physical examination is performed according to the expertise of the physiotherapists. Follow-up measurements will be performed 6, 12 and 26 weeks after inclusion. Primary outcome measure is perceived recovery, measured on a 7-point Likert scale. Logistic regression analysis will be used to evaluate the association between prognostic factors and recovery. DISCUSSION: The ShoCoDiP (Shoulder Complaints and using Diagnostic ultrasound in Physiotherapy practice) cohort study will provide information on current management of patients with shoulder pain in primary care, provide data to develop a prediction model for shoulder pain in primary care and to evaluate whether musculoskeletal ultrasound can improve prognosis.