Rotator cuff disorders encompass a range of impairments from tendinopathy to partialorfull-thickness rotator cuff tears, and represent the largest subgroup of shoulder pain.Rotator cuff tears, most of which are atraumatic, are common in adults with shoulderpain and are strongly associated with increasing age. Conservative treatment includingphysiotherapy is the first-line treatment, but some patients do not respond, andultimately require surgery. Early predictions of response could allow individuals’ carepathways to be optimised, preventing unnecessary delays and suffering and benefitingpatients and healthcare providers alike.My primary aim was to develop a prognostic model for the outcome of physiotherapy inadults with painful atraumatic partial-thickness tears (PTTs) of the rotator cuff. This wasaddressed by a prospective prognostic model study. The study was underpinned by asystematic review of prognostic models in adults undergoing physiotherapy for painfulrotator cuff disorders and was further informed and complemented by the followingwork: the development and validation of the physiotherapy protocol for the prognosticstudy; the identification, selection and definition of the candidate prognostic factors forthe prognostic study; the estimation of the Minimal Important Difference (MID) of thestudy’s primary outcome measure (the Western Ontario Rotator Cuff Index, WORC);and an exploratory responder analysis of the WORC outcome scores. The prognosticsystematic review, prognostic study, MID analysis and responder analysis are originalcontributions to knowledge.The prognostic systematic review revealed important methodological deficiencies in thefive included studies, and no clinically usable model. No study addressed a distinctPTT population. The process of identifying factors for my own prognostic model studyrevealed a lack of knowledge about the prognostic relevance of factors. All of thecandidate models I explored in my prognostic study (n sample = 65, n analysed = 61)had low performance and precision. The estimated MID of the WORC was -300. Theresponder analysis resulted in different proportions of responders to treatmentdepending on the responder definition.My results highlight the difficulties involved in predicting outcomes in the field ofshoulder pain and rotator cuff disorders, and the need for methodologically soundprognosis research.
|Date of Award||2 Nov 2017|
|Supervisor||Nigel Hanchard (Supervisor), Helen Handoll (Supervisor) & Alan Batterham (Supervisor)|