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Patient education and rehabilitation for persistent shoulder pain: The Otago Shoulder Health Study (OtShoH)

About the research

Gisela SoleShoulder pain associated with rotator cuff related shoulder pain (sub-acromial pain syndrome) is common in middle-aged and older adults, often leading to long term shoulder pain, stiffness and weakness, and limitations in terms of self-care, physical activity, and work-related tasks.

Rehabilitation guidelines for rotator cuff related shoulder pain have generally focused on potential pathology or injury of local shoulder structures (“local pathology model”). However, the pain experience is also dependent on how the brain processes information from the shoulder and elsewhere in the body with past experiences, the ‘neuroscience’ of pain. Lastly, general health conditions and lifestyle factors influence development and persistence of pain.

Patient understanding of their condition and of pain is critical for pain self-management. Besides understanding the possible injury (if present), we also need to understand how pain is influenced by possible stressors of life, other health disorders (such as diabetes, or being overweight), general physical activity and lifestyle factors.

This research explores the use of such patient education integrated into rehabilitation of patients with rotator cuff related shoulder pain. Specific objectives include:

  • Exploring patients’ understanding and experiences of their shoulder pain.
  • Determining patients’ needs, acceptability of and perceptions of the usefulness of pain education in the management of shoulder pain.
  • Exploring the role of general physical activity and exercise, and promotion of health and well-being as part of rehabilitation of persistent shoulder pain.
  • Strategies to enable clinicians to include patient education and self-management skills into the care of patients with shoulder pain.

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Research funding

Sole G, Ribeiro D, Perry M, Swain N, Wassinger C (2017). Feasibility of neuroscience-informed physiotherapy for persistent shoulder pain. Jack Thomson Arthritis Grant: $23,699

Sole G, Perry M, Ribeiro D, Swain N, Wassinger C (2017). My shoulder has a brain: patient and physiotherapists’ perspectives of a psychologically-informed rehabilitation approach for shoulder pain. Physiotherapy New Zealand Scholarship Trust Fund: $4,206

Sole G, Ribeiro D, Jayakaran P, Wassinger C (2015). A neuroscience approach to pain management for patients with rotator cuff syndrome: a case series. Physiotherapy New Zealand Scholarship Trust Fund $2,990; New Zealand Manipulative Physiotherapists Association: $4,670; Total: $7,660

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Research students

Honours students

Rosey Acker (2019): Patients’ perspectives a neuroscience-integrated physiotherapy programme for rotator cuff related shoulder pain.

Karen Meehan (2017): Advice and patient education in physiotherapy management of patients with rotator cuff-related pain: a scoping review and focus group study

Melissa Gillespie (2016): Rotator cuff syndrome: patients’ understanding and experiences of their pain.

Publications

Meehan K, Wassinger C, Roy JS, Sole G (2020). Seven key themes in physical therapy advice for patients living with subacromial shoulder pain. A scoping review. Journal of Orthopeadic and Sports Physical Therapy. 50:285-293. Doi: 10.2519/jospt.2020.9152

Wassinger CA, Lumpkins L, Sole G (2020). Lower extremity aerobic exercise as a treatment for shoulder pain. International Journal of Sports Physical Therapy, 15:74-80

Sole G, Maçznik A, Ribeiro D, Jayakaran P, Wassinger C (2019). Perspectives of participants with rotator cuff-related pain to a neuroscience-informed pain education session: an exploratory mixed method study. Disability and Rehabilitation, online doi: 10.1080/09638288.1542037

Gillespie M, Mącznik A, Wassinger C, Sole G (2017). Rotator cuff-related pain: patients’ understanding and experiences. Musculoskeletal Science and Practice 30:64-71

Spall P, Ribeiro DC, Sole G (2016). Electromyographic activity of shoulder girdle muscles in patients with symptomatic and asymptomatic rotator cuff tears: a systematic review and meta-analysis. Physical Medicine and Rehabilitation, doi: 10.1016/j.pmrj.2016.02.015

Ribeiro DC, Falla C, Shemmell J, Sole G (2016). Shoulder muscle activity during the modified dynamic relocation test and side-lying shoulder external rotation: a cross-sectional study on asymptomatic individuals. Journal of Manual and Manipulative Therapy, doi: 10.1080/10669817.2016.1157945.

Ribeiro DC, Castro M, Sole G, Vicenzino B (2016). The initial effects of a sustained glenohumeral postero-lateral glide during elevation on shoulder muscle activity: a repeated measures study on asymptomatic shoulders. Manual Therapy 22:101-108

Fyhr C, Gustavsson L, Wassinger C, Sole G (2015). The effects of shoulder injury on kinaesthesia: a systematic review and meta-analysis. Manual Therapy, 20:28-37

Sole G, Osborne H, Wassinger C (2015). The effect of experimentally-induced subacromial pain on proprioception. Manual Therapy, 20:166-170

Sole G, Osborne H, Wassinger C (2014). Electromyographic response of shoulder muscles to acute experimental subacromial pain. Manual Therapy, 19:343-348

Wassinger CA, Sole G, Osborne H (2013). Clinical measurement of scapular upward rotation in response to acute subacromial pain. Journal of Orthopaedic and Physical Therapy, 43:199-203

Ho CC, Sole G, Munn J (2009). The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review. Manual Therapy 14:463-474

Brandt C, Sole G, Krause MW, Nel M (2007). An evidence-based review on the validity of the Kaltenborn rule as applied to the glenohumeral joint. Manual Therapy 12:3-11

Sole G (2003). A multi-structural approach to treatment of a patient with sub-acromial impingement: a case report. Journal of Manual and Manipulative Therapy 11(1) 49-55

Presentations

Shoulder360 : Navigating between clinical practice and research. Symposium presented by CHARR, January 2020, School of Physiotherapy, University of Otago, Dunedin. www.otago.ac.nz/physio/research/otago725200.html

Jones JF, McGrath J, Clayton A, Buehler M, Sole G, Wassinger CA Common Shoulder Pain Websites: An Assessment of Content Quality, Bias, and Readability. American Physical Therapy Association Combined Sections Meeting. Washington, D.C., January 23-26, 2019.

Meehan K, Perry M, Wassinger C, Sole G. Physiotherapists’ perspectives on the use of advice and education for patients with rotator cuff-related pain. Physiotherapy New Zealand biennial conference, Dunedin, New Zealand, 14-16th September 2018.

Sole G. Biomechanics and Neurosciences: conflict or concordance for musculoskeletal disorders? Invited speaker at the Physiotherapy New Zealand biennial conference, Dunedin, New Zealand, 14-16th September 2018

Sole G, Mącnik A, Ribeiro DC, Jayakaran P, Wassinger C. “It’s about our whole”: responses of participants with rotator cuff-related pain to a neuroscience pain education session. Podium presentation at the NZ Manipulative Physiotherapists Association, Rotorua, 19/20 August 2017 (Abstract book p 18)

Gillespie M, Mącnik A, Wassinger C, Sole G. Rotator cuff-related pain: patients’ understanding and experiences. Podium presentation at the NZ Manipulative Physiotherapists Association, Rotorua, 19/20 August 2017 (Abstract book p 18) Won the “Best Presentation” award at the conference.

Roy JS, Michener L, Cools A, Sole G, Struyf F. Why rotator cuff tendinopathies become chronic. Member of this international Focussed Symposium that was accepted by the World Confederation of Physical Therapy (WCPT) conference, Cape Town, 2-4 July 2017. http://www.wcpt.org/wcpt2017/FS-16

Gillespie M, Mącznik, Wassinger C, Sole G (2016). Rotator cuff related pain: patients’ understanding and experience. Presentation at Otago Medical School Research Society Masters/Honours meeting, November 2016. Abstract published in the proceedings, NZ Medical Journal (2017), 130 (1448).

Research team

Project lead: Associate Professor Gisela Sole gisela.sole@otago.ac.nz

Co- researchers:
Dr Meredith Perry, Dr Prasath Jayakaran, Dr Daniel Cury Ribeiro (CHARR, School of Physiotherapy, University of Otago)

Associate Professor Nicola Swain (Department of Psychological Medicine, University of Otago)

International collaborator: Dr Craig Wassinger (Department of Physical Therapy, East Tennessee State University, USA)

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