Trajectory of patient-rated outcomes and association with patient acceptable symptom state in patients with musculoskeletal shoulder pain.

Objective: Characterize trajectory and predictors of patient acceptable symptom state (PASS) defined recovery at 6 months.

Methods: Individuals with musculoskeletal shoulder pain (n = 140) completed patient-reported disability and PASS at baseline, 1 and 6 months. The PASS was categorized into 3 trajectory groups; 1.) Early Recovery (answered yes to PASS at 1 and 6-months), 2.) Delayed Recovery (PASS-yes only at 6-months), and 3.) Unrecovered. Mixed models characterized the trajectory between PASS-groups using SPADI and QDASH disability change scores. Logistic regression identified predictors of Early Recovery versus Delayed+Unrecovered groups.

Results: PASS-defined recovery rates by group were Early Recovery (58%), Delayed Recovery (22%), and Unrecovered (20%). A group main effect indicated lower disability over time in the Early Recovery versus Unrecovered (QDASH mean difference = 11(2.4); p = 0.001; SPADI mean difference = 12(3); p < 0.001). The odds of an Early Recovery slightly increased with greater change scores on the SPADI (odds ratio = 1.06, 95%CI:1.02,1.11; p = 0.004) and QDASH (odds ratio = 1.08, 95%CI:1.03,1.13; p = 0.003) over the first month of treatment.

Conclusion: Recovery trajectories of patients indicate differing responses to treatment despite overall improvements over the first month of treatment. Incorporating both patient-reported disability (SPADI, QDASH) and acceptable satisfaction (PASS) may aid in determining recovery trajectory, but more evidence is needed to be clinically useful.