Adherence of individuals with shoulder pain to home exercise booklets: Barriers, facilitators, and the impact of disability, self-efficacy, and treatment expectations.

BACKGROUND: home exercise booklets offer several benefits to individuals with shoulder pain. However, it is necessary to investigate the factors that determine adherence to home exercises. OBJECTIVES: 1) To investigate the level of adherence of individuals with chronic shoulder pain to a home exercise booklet conducted without the mediation of a healthcare professional, 2) To describe the barriers and facilitators to adherence, and 3) to determine if shoulder disability, self-efficacy, and treatment expectations are predictors of the level of adherence. DESIGN: prospective longitudinal study. METHODS: A total of 47 individuals with chronic shoulder pain were recruited. The Numeric Pain Rating Scale (NPRS) was used to assess pain intensity, the Shoulder Pain and Disability Index (SPADI) to measure shoulder disability, the Pain Self-Efficacy Questionnaire (PSEQ-10) for self-efficacy, and a likert scale to measure treatment expectations. Adherence was measured by Exercise Adherence Assessment Scale (EAAE-Br). RESULTS: A total of 23 individuals (48.93%) adhered to the home exercise program. The most commonly cited barriers were pain and health-related issues, while the most cited facilitators were pain improvement and symptom relief. Barriers associated with adherence were time constraints and other commitments, while the facilitator associated with adherence was enjoying the exercises. Binary logistic regression analysis revealed that shoulder disability, self-efficacy, and treatment expectations were unable to predict adherence to home exercises in individuals with shoulder pain [F (1,47) = 2.384; p = 0.130; R2 = 0.056]. CONCLUSION: The study revealed barriers and facilitators to home exercise in individuals with shoulder pain. Disability, self-efficacy, and treatment expectations were not able to predict adherence.

Association between perception of harm and valence of shoulder movement images with disability levels related to chronic shoulder pain.

ABSTRACT: Recent studies highlight an interplay between pain perception and emotional responses. This necessitates a thorough investigation into how beliefs and motivational influences respond to visual stimuli of movements. Such an analysis is crucial for understanding the extent to which these factors contribute to disability levels associated with shoulder pain. We aimed to investigate the relationship between the perception of harm and the valence in images depicting shoulder movements and determine how these perceptions are linked to disability levels associated with shoulder pain. This cross-sectional study recruited 42 individuals with chronic shoulder pain. Participants were presented with 58 shoulder movements images. Each participant evaluated these images for emotional valence and arousal using the self-assessment manikin. For every image, they provided their level of avoidance, fear, and perception of harm in a numerical scale. We measured disability levels and pain catastrophizing using the Shoulder Pain and Disability Index and the Pain Catastrophizing Scale. A direct acyclic graph was used. Multiple linear regression analysis was conducted with shoulder disability as the dependent variable and perception of harm and valence as independent variables, adjusted for the confounders catastrophizing and arousal. This analysis resulted in a significant model (F4,37 = 11.44; adjusted R2 = 0.547; P < 0.01). The perception of harm to shoulder movement (ß = 0.11; P < 0.001; 95% confidence interval = 5.6-11.8) was significantly associated with the level of shoulder disability, whereas valence did not show a significant association (ß = 0.26; P = 0.15; 95% confidence interval = 1.7-10.8). The perception of harm associated with shoulder movements images during daily activities was associated with disability. Individuals who believe that shoulder movements are harmful have greater disability.

Reliability and Validity of the Avoidance of Daily Activities Photo Scale for Patients With Shoulder Pain (ADAP Shoulder Scale).

OBJECTIVE: The Avoidance of Daily Activities Photo Scale for Patients With Shoulder Pain (ADAP Shoulder Scale) was developed to assess pain-related avoidance behavior during daily activities in people with shoulder pain. However, its measurement properties must be verified according to international guidelines. As such, this study investigated the following 4 measurement properties of the ADAP Shoulder Scale: reliability, measurement errors, convergent validity, and floor and ceiling effects. METHODS: The sample comprised 100 individuals with chronic shoulder pain (43 men and 57 women; mean duration of symptoms of 29.7 [SD = 89.0] months; mean age of 44.9 [SD = 15.9] years). The mean test-retest reliability range was 5 days via the intraclass correlation coefficient (ICC). Measurement errors included the standard error of measurement and the minimal detectable change. Convergent validity was analyzed by applying the Pearson correlation with the Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, and Shoulder Pain and Disability Index. RESULTS: The ADAP Shoulder Scale showed excellent test-retest reliability, both in all domains and in the total score [ICC(2,1) = 0.94; 95% CI = 0.92-0.96]. The standard errors of measurement for the free-movement, high-effort, and self-care domains were 8.1%, 6.0%, and 7.6%, respectively. The minimal detectable change for the total score of the ADAP Shoulder Scale was 16.0%. The total score of the ADAP Shoulder Scale was low to moderately correlated with the total scores of the Tampa Scale for Kinesiophobia (r = 0.52), Pain Catastrophizing Scale (r = 0.30), and Shoulder Pain and Disability Index (r = 0.72). No floor or ceiling effects were detected in the total score. CONCLUSION: The ADAP Shoulder Scale is a reliable, valid instrument for assessing avoidance behavior in adults who have chronic shoulder pain and are not athletes. IMPACT: This study provides evidence that the ADAP Shoulder Scale is appropriate for clinical and practical use in people with chronic shoulder pain.

Development of the Avoidance Daily Activities Photo Scale for Patients With Shoulder Pain.

OBJECTIVES: The purpose of this study was to develop the Avoidance of Daily Activities Photo Scale (ADAP Shoulder Scale) to measure shoulder pain-related avoidance behavior in patients with shoulder pain and evaluate and report the structural validity and internal consistency of the scale. METHODS: Potential daily activities involving the shoulder were selected from the activities and participation domain of the International Classification of Functioning, Disability and Health. The selected activities were presented to an expert panel, health care professionals, and patients with shoulder pain with the question "How much do you think it is important to ask patients with shoulder pain about this activity?" Activities attaining a content validity index (CVI) ≥ 0.8 were represented using a digitally colored photograph. Activity photographs were evaluated by health care professionals and patients with shoulder pain. Photographs with a CVI ≥ 0.8 were included in the scale. To evaluate structural validity and internal consistency of the scale, exploratory factor analysis was performed to determine the presence of any scale domain. Cronbach alpha was calculated to indicate the internal consistency of each domain. RESULTS: Of the 107 preselected activities, 21 attained a CVI ≥ 0.8. Eighteen photographs (CVI ≥ 0.8) were included in the scale after being analyzed by 120 health care professionals and 50 patients with shoulder pain. Exploratory factor analysis (N = 156) showed that the ADAP Shoulder Scale consists of 3 domains: free movement, high effort, and self-care. The internal consistencies of the domains were 0.92, 0.89, and 0.92, respectively. CONCLUSION: The ADAP Shoulder Scale included 15 photographs distributed in 3 domains. All domains had a high internal consistency. The scale is easily applicable, well understood, and relevant for shoulder pain. IMPACT: The ADAP Shoulder Scale can be used to rate shoulder pain-related avoidance behaviors.

Fear and avoidance of shoulder movement according to the International Code of Functioning: cross-sectional study / Medo e evitação de movimento do ombro segundo o Código Internacional de Funcionalidade: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Shoulder pain is a limiting condition that has a major impact on daily activities and work. Knowing which specific activities involving the shoulder are associated with the occurrence of higher levels of pain may be of interest to professionals. The use of images of shoulder movements can be an effective tool to check the presence of pain and fear of movement, break down language and cultural barriers, and facilitate communication between professional and patient. The objectives of this study were: (1) to carry out a descriptive analysis of fear responses and movement avoidance based on passive viewing of images of shoulder movements based on the International Classification of Functioning, Disability and Health (ICF) codes; (2) to check whether there is a correlation between fear responses and movement avoidance with the Shoulder Pain and Disability Index (SPADI). METHODS: In this cross-sectional observational study, individuals with chronic shoulder pain were recruited. Participants responded to the Shoulder Pain and Disability Index (SPADI) and the TAMPA Scale of Kinesiophobia (TSK) to measure the intensity of shoulder pain and disability, and fear of movement, respectively. Participants viewed 58 movement images based on codes and descriptors from the third chapter of ICF. In addition, they responded to a numerical scale to judge fear of movement and a second numerical scale to judge movement avoidance. RESULTS: The study included 42 individuals. The activities belonging to the mobility subgroup (chapter 4), which refers to chapter 3 of the ICF, are those that present greater responses of fear and movement avoidance. Multiple regression resulted in a significant model [F(1, 40) = 31.119; p<0.001; R2 = 0.438], when verifying whether fear and movement avoidance responses related to ICF images are associated with SPADI in participants with chronic shoulder pain. The fear response is associated with SPADI (β=0.661; t=5.578; p<0.001), however, the avoidance response did not present a significant result with the scale (β=−0.063; t=-0.160; p=0.874). CONCLUSION: Movements that refer to mobility seem to be the most feared and avoided by people with chronic shoulder pain. Fear of movement is associated with shoulder disability.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor no ombro é uma condição limitante, que apresenta grande impacto nas atividades de vida diárias e no trabalho. Conhecer quais atividades específicas envolvendo o ombro estão associadas à ocorrência de maiores níveis de dor pode ser de interesse dos profissionais. A utilização de imagens de movimentos do ombro pode ser uma ferramenta eficaz para verificar a presença de dor e medo de movimento, quebrar barreiras de linguagem e culturais e facilitar a comunicação entre profissional e paciente. Os objetivos deste estudo foram: (1) realizar a análise descritiva das respostas de medo e evitação do movimento a partir da visualização passiva de imagens de movimentos do ombro baseadas nos códigos da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF); (2) verificar se há correlação das respostas de medo e evitação do movimento com o Índice de dor e Incapacidade do Ombro (SPADI). METODOS: Neste estudo observacional do tipo transversal foram recrutadas pessoas com dor crônica no ombro. Os participantes responderam ao Shoulder Pain and Disability Index (SPADI) e à Escala TAMPA de Cinesiofobia (TSK) para mensurar a intensidade da dor e incapacidade do ombro, e de medo do movimento, respectivamente. Os participantes visualizaram 58 imagens de movimentos baseadas em códigos e descritores do terceiro capítulo de Atividade e Participação da CIF. Além disso, responderam a uma escala numérica para julgar o medo do movimento e a uma segunda escala numérica para julgar a evitação ao movimento. RESULTADOS: Participaram do estudo 42 pessoas. As atividades pertencentes ao subgrupo mobilidade (capítulo 4), referente ao capítulo 3 da CIF, são as que apresentam maiores respostas de medo e evitação do movimento. A regressão múltipla resultou em um modelo significativo [F (1, 40) = 31, 119; p<0,001; R2 = 0,438], ao verificar se as respostas de medo e evitação do movimento referente às imagens da CIF estão associadas ao SPADI dos participantes com dor crônica no ombro. A resposta de medo é associada ao SPADI (β=0,661; t=5,578; p<0,001), porém a resposta de evitação não apresentou resultado significativo com a escala (β=−0,063; t=−0,160; p=0,874). CONCLUSÃO: Os movimentos que se referem à mobilidade parecem ser os mais temidos e evitados por pessoas com dor crônica no ombro. O medo do movimento está associado com a incapacidade do ombro.

Facilitators and barriers for adherence of shoulder pain patients to a home-based exercise program: cross-sectional study / Facilitadores e barreiras para a adesão de pacientes com dor no ombro a um programa de exercícios domiciliares: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Home-based exercises can improve function and quality of life in shoulder pain patients. Knowing the facilitators and barriers is crucial for adherence to shoulder pain treatment. It is believed that individuals who adhere to home exercises have fewer environmental barriers, pain intensity and shoulder disability. The aim of this study is to identify facilitators and barriers for adherence to a home-based exercise program in shoulder pain individuals, and to investigate the influence of environmental barriers, shoulder pain and disability, and kinesiophobia on adherence to a program. METHODS: This is a cross-sectional study. Shoulder pain individuals performed home-based exercises for eight weeks based on a booklet in addition to supervised physical therapy or as their sole therapy. They reported the perceived facilitators and barriers to home exercises adherence and answered the Craig Hospital Inventory of Environmental Factors (CHIEF), Shoulder Pain and Disability Index (SPADI), and the Tampa Scale for Kinesiophobia (TSK) questionnaires. Logistic regression models analyzed the scores of the CHIEF, SPADI, and TSK as predictors of adherence. RESULTS: Fifty individuals participated in this study and 88% adhered to the program. The most frequent facilitator and barrier were "having guidance from a professional," and "lack of available time," respectively. Pain and disability were the only predictor of adherence (p=0.044), and an increase of one point in SPADI reduced the likelihood of adherence to home exercises by 14% (Exp(B) =0.86). CONCLUSION: Individuals reported facilitators and barriers to the exercise program. Environmental barriers assessed using the CHIEF and kinesiophobia were not predictors of adherence.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os exercícios domiciliares podem melhorar a função e a qualidade de vida de pacientes com dor no ombro. Conhecer facilitadores e barreiras é fundamental para adesão ao tratamento da dor no ombro. Acredita-se que indivíduos que aderem aos exercícios domiciliares apresentem poucas barreiras ambientais, baixa intensidade de dor e incapacidade do ombro. O objetivo deste estudo foi identificar facilitadores e barreiras para a adesão a um programa de exercícios domiciliares em indivíduos com dor no ombro e investigar a influência de barreiras ambientais, da dor e incapacidade no ombro, e da cinesiofobia na adesão ao programa. MÉTODOS: Neste estudo transversal, indivíduos com dor no ombro realizaram exercícios domiciliares por oito semanas com base em uma cartilha além da fisioterapia supervisionada ou como sua única terapia. Os indivíduos relataram facilitadores e barreiras percebidos para a adesão aos exercícios em casa e responderam ao Craig Hospital Inventory of Environmental Factors-Brasil (CHIEF-Br), Shoulder Pain and Disability Index-Brasil (SPADI-Br) e Escala Tampa de Cinesiofobia (TAMPA). Os escores do CHIEF-Br, SPADI-Br e TAMPA foram analisados como preditores de adesão por meio de modelos de regressão logística. RESULTADOS: Participaram do estudo 50 indivíduos e 88% aderiram ao programa. O facilitador e a barreira mais frequentes foram "receber orientação de um profissional" e "falta de tempo disponível", respectivamente. Dor e incapacidade foram os únicos preditores de adesão (p=0,044), e o aumento de um ponto no SPADI-Br reduziu a probabilidade de adesão aos exercícios domiciliares em 14% (Exp(B) =0,86). CONCLUSÃO: Os indivíduos relataram facilitadores e barreiras ao programa de exercícios. A barreiras ambientais avaliadas por meio do CHIEF-Br e a cinesiofobia não foram preditores da adesão.