Changes in pain-related fear predict shoulder disability in rotator cuff tendinopathy with resistance exercise

Key Points

1. Pain-related fear and catastrophizing are dynamic rather than fixed: all four measures decreased during eight weeks of resistance exercise but the individuality of these responses varied greatly. Of note, patients with relatively low baseline psychological scores could still demonstrate meaningful changes.

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BACKGROUND & OBJECTIVE

Rotator Cuff (RC) tendinopathy is the most common cause of musculoskeletal shoulder pain (1). Research continues to provide a favorable argument for the use of resistance exercise in the treatment of RC tendinopathy, yet up to 50% of patients have persistent or recurrent symptoms (2). In addition to pathophysiological factors, comorbid psychological factors including pain-related fear, fear-avoidance beliefs, kinesiophobia and pain catastrophizing are often associated with greater disability and poorer treatment outcomes (3).

Research to date has primarily examined psychological factors at baseline. It is unclear if these psychological factors change with resistance exercise over an episode of care and how these changes may influence shoulder disability outcomes in patients with RC tendinopathy.

Research continues to provide a favorable argument for the use of resistance exercise in the treatment of RC tendinopathy, yet up to 50% of patients have persistent or recurrent symptoms.

If a patient is demonstrating limited functional improvement during the first few weeks alongside persistent or increasing fear-avoidance or kinesiophobia, one must consider they may represent an early nonresponse pattern.

METHODS

A prospective longitudinal observational study recruited 64 participants aged 18-55 years with RC tendinopathy. Participants had shoulder pain > 3/10 on a NRS, a Penn Shoulder Score

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