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Predicting pain and function outcomes in people consulting with shoulder pain: the PANDA-S clinical cohort and qualitative study protocol

Predicting pain and function outcomes in people consulting with shoulder pain: the PANDA-S clinical cohort and qualitative study protocol
Predicting pain and function outcomes in people consulting with shoulder pain: the PANDA-S clinical cohort and qualitative study protocol

INTRODUCTION: People presenting with shoulder pain considered to be of musculoskeletal origin is common in primary care but diagnosing the cause of the pain is contentious, leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (1) to investigate the short-term and long-term outcomes (overall prognosis) of shoulder pain, (2) estimate costs of care, (3) develop a prognostic model for predicting individuals' level and risk of pain and disability at 6 months and (4) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis and management of shoulder pain.

METHODS AND ANALYSIS: The Prognostic And Diagnostic Assessment of the Shoulder (PANDA-S) study is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via Short Message Serevice (SMS) text or software application. Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with ≈15 dyads of patients and their healthcare professional (general practitioner or physiotherapist).Short-term and long-term trajectories of Shoulder Pain and Disability Index (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6 months using penalisation methods to adjust for overfitting. The added predictive value of prespecified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making, perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options.

ETHICS AND DISSEMINATION: The PANDA-S study has ethical approval from Yorkshire and The Humber-Sheffield Research Ethics Committee, UK (18/YH/0346, IRAS Number: 242750). Results will be disseminated through peer-reviewed publications, social and mainstream media, professional conferences, and the patient and public involvement and engagement group supporting this study, and through newsletters, leaflets and posters in participating sites.

TRIAL REGISTRATION NUMBER: ISRCTN46948079.

Humans, Physical Therapy Modalities, Prognosis, Referral and Consultation, Shoulder, Shoulder Pain/diagnosis
2044-6055
Wynne-Jones, Gwenllian
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Myers, Helen
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Hall, Alison
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Littlewood, Chris
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Hennings, S
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Saunders, Benjamin
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Bucknall, Milica
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Jowett, Sue
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Riley, Richard
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Wathall, Simon
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Heneghan, Carl
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Cook, Johanna
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Pincus, Tamar
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Mallen, Christian
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Roddy, Edward
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Foster, Nadine
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Beard, David
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Lewis, Jeremy
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Rees, J L
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Higginbottom, Adele
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van der Windt, Danielle
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Wynne-Jones, Gwenllian
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Myers, Helen
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Hall, Alison
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Littlewood, Chris
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Hennings, S
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Saunders, Benjamin
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Bucknall, Milica
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Jowett, Sue
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Riley, Richard
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Wathall, Simon
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Heneghan, Carl
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Cook, Johanna
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Pincus, Tamar
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Mallen, Christian
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Roddy, Edward
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Foster, Nadine
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Beard, David
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Lewis, Jeremy
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Rees, J L
887b8c66-2c0d-4321-b61b-f3e2327a1cb2
Higginbottom, Adele
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van der Windt, Danielle
a51e943b-e0ed-4aba-9d2d-5e0c7a3e7aee

Wynne-Jones, Gwenllian, Myers, Helen, Hall, Alison, Littlewood, Chris, Hennings, S, Saunders, Benjamin, Bucknall, Milica, Jowett, Sue, Riley, Richard, Wathall, Simon, Heneghan, Carl, Cook, Johanna, Pincus, Tamar, Mallen, Christian, Roddy, Edward, Foster, Nadine, Beard, David, Lewis, Jeremy, Rees, J L, Higginbottom, Adele and van der Windt, Danielle (2021) Predicting pain and function outcomes in people consulting with shoulder pain: the PANDA-S clinical cohort and qualitative study protocol. BMJ Open, 11 (9), [e052758]. (doi:10.1136/bmjopen-2021-052758).

Record type: Article

Abstract

INTRODUCTION: People presenting with shoulder pain considered to be of musculoskeletal origin is common in primary care but diagnosing the cause of the pain is contentious, leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (1) to investigate the short-term and long-term outcomes (overall prognosis) of shoulder pain, (2) estimate costs of care, (3) develop a prognostic model for predicting individuals' level and risk of pain and disability at 6 months and (4) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis and management of shoulder pain.

METHODS AND ANALYSIS: The Prognostic And Diagnostic Assessment of the Shoulder (PANDA-S) study is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via Short Message Serevice (SMS) text or software application. Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with ≈15 dyads of patients and their healthcare professional (general practitioner or physiotherapist).Short-term and long-term trajectories of Shoulder Pain and Disability Index (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6 months using penalisation methods to adjust for overfitting. The added predictive value of prespecified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making, perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options.

ETHICS AND DISSEMINATION: The PANDA-S study has ethical approval from Yorkshire and The Humber-Sheffield Research Ethics Committee, UK (18/YH/0346, IRAS Number: 242750). Results will be disseminated through peer-reviewed publications, social and mainstream media, professional conferences, and the patient and public involvement and engagement group supporting this study, and through newsletters, leaflets and posters in participating sites.

TRIAL REGISTRATION NUMBER: ISRCTN46948079.

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Accepted/In Press date: 2 September 2021
Published date: 17 September 2021
Additional Information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: Humans, Physical Therapy Modalities, Prognosis, Referral and Consultation, Shoulder, Shoulder Pain/diagnosis

Identifiers

Local EPrints ID: 471341
URI: http://eprints.soton.ac.uk/id/eprint/471341
ISSN: 2044-6055
PURE UUID: 45c9410f-f565-4f41-a1e5-fbeade9637cc
ORCID for Tamar Pincus: ORCID iD orcid.org/0000-0002-3172-5624

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Date deposited: 03 Nov 2022 17:53
Last modified: 17 Mar 2024 04:11

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Contributors

Author: Gwenllian Wynne-Jones
Author: Helen Myers
Author: Alison Hall
Author: Chris Littlewood
Author: S Hennings
Author: Benjamin Saunders
Author: Milica Bucknall
Author: Sue Jowett
Author: Richard Riley
Author: Simon Wathall
Author: Carl Heneghan
Author: Johanna Cook
Author: Tamar Pincus ORCID iD
Author: Christian Mallen
Author: Edward Roddy
Author: Nadine Foster
Author: David Beard
Author: Jeremy Lewis
Author: J L Rees
Author: Adele Higginbottom
Author: Danielle van der Windt

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