Musculoskeletal shoulder pain: Home exercise frequency and adherence to appointments are not mediators of outcome

Chester, Rachel, Khondoker, Mizanur, Jerosch-Herold, Christina, Lewis, Jeremy, Gurney, Claire and Shepstone, Lee (2024) Musculoskeletal shoulder pain: Home exercise frequency and adherence to appointments are not mediators of outcome. Journal of Bodywork and Movement Therapies, 40. pp. 153-160. ISSN 1360-8592

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Abstract

Objective: To investigate whether appointment adherence and frequency of home exercises mediates the association of baseline i) pain self-efficacy (PSE) or ii) patient expectation of recovery, with outcome at 6 months.Design: Multicentre longitudinal cohort study. Methods: Six-month outcome data (SPADI, QuickDASH) were provided by 810 of 1030 recruited participants. Daily frequency of home exercises over 6 weeks, were expressed as the proportion of days exercises were completed. Measures of adherence included proportion of appointments attended and completing a course of physiotherapy. Mediation analyses were conducted using Baron and Kennys’ four-step method, and for continuous variables, testing the indirect effect using a non-parametric version of Sobel’s test. Results: Appointment adherence, completing a course of physiotherapy and frequency of home exercise did not mediate the relationship between PSE or patient expectation with 6 months SPADI or QuickDASH. Higher PSE was significantly associated with appointment adherence and completing a course of physiotherapy. Patient expectation was significantly associated with frequency of home exercise. However, none of the hypothesised mediators had a significant effect on outcome. Conclusion: Appointment adherence and higher frequency of home exercise do not appear to be the mechanisms by which high PSE or expectation of recovery predict a good outcome. This study was not designed to address the effectiveness of a home exercise programme for which no conclusions should be drawn. However, our results do support the need for a greater emphasis on the assessment and incorporation of techniques to facilitate high pain self-efficacy and expectation of recovery.

Item Type:	Article
Additional Information:	Funding information: RC was funded by the National Institute for Health Research (NIHR CAT CDRF 10–008). The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report or decision to submit the article for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Population Health (former - to 2025) Faculty of Medicine and Health Sciences > Research Groups > Rehabilitation Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Science > Research Groups > Statistics Faculty of Medicine and Health Sciences > Research Centres > Public Health Faculty of Medicine and Health Sciences > Research Centres > Mental Health and Social Care (fka Lifespan Health)
Related URLs:	http://www.scopus.com/inward/record.url?...
Depositing User:	LivePure Connector
Date Deposited:	08 Apr 2024 10:30
Last Modified:	25 Aug 2025 00:26
URI:	https://ueaeprints.uea.ac.uk/id/eprint/94855
DOI:	10.1016/j.jbmt.2024.03.074

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