Healthcare professional information impacts frozen shoulder subjects’ recovery outlook, emotions, and catastrophizing. A cross-sectional study.

Autori

Brindisino Fabrizio (Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, Campobasso, Italy)

Rossettini Giacomo (School of Physiotherapy, University of Verona, Verona, Italy)

Andrea De Santis (Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, Campobasso, Italy)

Crestani Mauro (Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, Campobasso, Italy)

Turolla Andrea (Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Italy)

Background and aims

The significance of patient-clinician communication is acknowledged within broader musculoskeletal contexts [1,2]. However, the specific impact of information provided during the initial physiotherapy consultation on recovery expectations, emotional state, and catastrophizing thoughts in patients with frozen shoulder (FS) has not been previously investigated. This study aims to examine the influence of clinician-communicated information on recovery expectations, emotional state, and catastrophizing thoughts in individuals with FS.

Methods

This cross-sectional exploratory online survey followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [3]. Participants clinically diagnosed with FS according to Kelley’s criteria [4] completed a 32-item closed-multiple choice online questionnaire via Google Forms. Subjects were recruited through physiotherapy practices in Italy, between April and July 2023.

Results

A total of 110 Italian subjects diagnosed with FS were prospectively recruited for this study. Most participants reported feeling adequately informed by helpful, reassuring, and encouraging explanations, and they expressed a significant need for reassurance. Recovery expectations were generally high, while their emotional state was reported as lower. The most prevalent catastrophizing thoughts reported included the belief that FS is a long-term condition, that the pain is severe and persistent, and that they would never be able to return to previous activities. Participants also frequently reported feeling overwhelmed by FS.

Respondents who received unhelpful explanations —those that did not improve their ability to manage FS, increased anxiety and concerns about potential recovery failure, lacked reassurance, did not help manage pessimistic thoughts about FS, or were discouraging (e.g., increasing fear of movement)— were predominantly associated with negative recovery expectations. Conversely, a negative emotional state did not appear to be associated with perceived worrying, unhelpful, or un-reassuring information. Interestingly, some catastrophizing thoughts (e.g., “I will never raise my arm as I used to,” “the pain was never-ending,” “all efforts to heal were useless,” “I felt overwhelmed by FS,” “being afraid that FS is a long-term pathology”) did not seem to be associated with perceived worrying, unhelpful, or un-reassuring information, while others were.

Conclusion

The content and style of clinician communication play a crucial role in shaping recovery expectations among FS patients, potentially impacting treatment outcomes. It appears that emotional state might be influenced by variables other than perceived information. Lastly, catastrophizing thoughts should be mitigated through helpful, encouraging, and reassuring communication. Employing advanced communication skills and tailoring information delivery could increase recovery expectation and reduce catastrophic thinking, thereby fostering improved adherence and engagement in physiotherapy.

REFERENCES

[1] Rossettini G, Palese A, Geri T, Fiorio M, Colloca L, TestaM (2018) Physical therapists’ perspectives on using contextual factors in clinical practice: Findings from an Italian national survey. PLoS ONE 13(11): e0208159. https://doi.org/10.1371/journal.pone.0208159

[2] Palese A, Cadorin L, Testa M, Geri T, Colloca L, Rossettini G. Contextual factors triggering placebo and nocebo effects in nursing practice: Findings from a national cross-sectional study. J Clin Nurs. 2019 May;28(9-10):1966-1978. doi: 10.1111/jocn.14809. Epub 2019 Feb 18. PMID: 30706543.

[3] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. International journal of surgery (London, England). 2014;12:1495-9.

[4] Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, et al. Shoulder pain and mobility deficits: adhesive capsulitis. The Journal of orthopaedic and sports physical therapy. 2013;43:A1-31