Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Cheryl Hill

Date of original Performance / Presentation

January 2022

Publication Date / Copyright Date

1-1-2022

Abstract

Problem Statement: The Staged Approach for Rehabilitation Classification for the Shoulder(STAR-Shoulder) has been proposed as a mechanism to improve outcomes for patients with shoulder pain, but the effect of its implementation on patient outcomes has not been established. Purpose: The primary purpose of this study was to determine whether patient outcomes were improved if care was matched to the STAR-Shoulder system compared to unmatched care. A secondary purpose of the study was to determine the interrater reliability of matching interventions to patient subgroups based on shoulder irritability and physical impairments using this system. Subjects/Methods: Outpatient clinics (n = 17) were randomly allocated into 2 groups (Wave 1 or Wave 2) for STAR-Shoulder education. Patient data was collected prior to education, 3-months post-education for Wave 1, and 3-months post-education for Wave 2. Outcome variables included Numeric Pain Rating Scale (NPRS), Quick Disabilities of Arm, Shoulder, and Hand Questionnaire (QuickDASH), Penn Shoulder Score (PSS), and number of visits. Clinical notes were audited for each patient to determine whether care provided was considered matched or unmatched. The interrater reliability of the matched/unmatched classification process was examined with a subset of 50 patients. Results: A total of 692 patients were examined. The interrater reliability of classifying care as matched or unmatched was substantial (Kappa = .63, 95% confidence interval [CI] .42 to .85), with 82% agreement. Changes in patient outcome scores were significantly greater for those patients whose care matched the STAR-Shoulder system (p < .001) for pain changes (mean difference = -1.19, 95% CI = 0.82 to 1.57) and QuickDASH score (mean difference = 12.7, 95% CI = 9.94 to 15.45), with significant improvement (p = .002) also noted for changes in the PSS (mean difference = 10.9, 95% CI = 3.61 to 18.19). No difference was noted for number of visits. Discussion: The STAR-Shoulder system appears to be a reliable way to classify patients based on tissue irritability and physical impairments. Furthermore, receiving interventions matched to the classification system is associated with better patient outcomes compared to unmatched care. These findings merit further research of this system to advance evidence-based practice for shoulder pain.

Disciplines

Physical Therapy

Keywords

Classification-system; Outcomes; Shoulder

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