Shoulder pain patients in primary care - Part 1: Clinical outcomes over 12 months following standardized diagnostic workup, corticosteroid injections, and community-based care

Objective: Measure changes in pain and disability of primary care shoulder pain patients over a 12-month period. Design: A non-randomized audit with repeated measures of pain and disability at 3 weeks, 3, 6 and 12 months. Patients: Of 208 patients, 161 agreed to participate with 96.9%, 98.1%, 86.3%, 83.9% follow-up at 3 weeks, at 3, 6 and 12 months, respectively. Mean age was 44 years, mean symptom duration 3.6 months. Methods: Patients were treated with protocol driven corticosteroid injection and community based care. Primary outcome measure was the Shoulder Pain and Disability index (SPADI) questionnaire. Based on the SPADI and minimal clinically important difference (MCID), outcomes were categorized into: total recovery, 90% or more improved, better, unchanged and worse. Results: There was significant reduction of pain and disability at 3 weeks (p < 0.001), no change at the 3- and 6-month follow-up and a significant reduction at the 12-month followup (p < 0.001). Excellent outcomes were achieved by 32.9% and 45.3%, and a poor clinical outcome resulted for 32.8% and 14.9% at the 3- and 12-month follow-up, respectively. Conclusion: Though there was significant improvement at the 3-week and 12-month follow-up, 45% achieved an excellent outcome and a 16.7% of patients were the same or worse than baseline at 12 months.