Prognostic AND Diagnostic Assessment of Shoulder Pain (PANDA-S)
Research type
Research Study
Full title
Maximising outcome for patients with shoulder pain: using optimal diagnostic and prognostic information to target treatment (PANDA-S)
IRAS ID
242750
Contact name
Danielle van der Windt
Contact email
Sponsor organisation
Keele University
Duration of Study in the UK
4 years, 9 months, 31 days
Research summary
Research Summary:
The problem:
Shoulder problems affect 20% of adults and are often very painful, affecting sleep, work, and everyday life. In England, annually about 1.5 million people visit their GP for shoulder pain, of whom 40% experience on-going pain. Most patients receive treatment from GPs or physiotherapists, but 7 times more patients are having surgery compared with 10 years ago. There is no evidence that surgery provides better results than non-surgical treatments such as shoulder exercises.
Aim:
To develop and test a better approach to assessing the likely cause (diagnosis) and future outcome (prognosis) of shoulder problems, so that treatments are offered to those patients who benefit the most.
This research will benefit patients and the NHS by:
Improving information and advice given to patients about the possible causes of shoulder pain and the best ways to assess and treat shoulder pain.
Research plan:
Recruit 1000 patients consulting their GP or self-referring to physiotherapy with shoulder pain to a follow-up study. Their GPs and physiotherapists will continue to treat them in the way they feel is most appropriate. Willing participants will;
i.Complete 6 questionnaires on pain, difficulties with everyday activities, treatments, and quality of life over 3 years, providing unique information about long-term outcomes
ii.Attend an optional clinical assessment including an ultrasound scan of the shoulder
iii.Complete an optional app or respond to text messages once a week for 12 weeks to provide short term information on shoulder pain and difficulties with everyday activities
iv.Participate in an optional interview about their shoulder painSummary of Results:
: PANDA-S cohort study
Background and aims
Up to 20% of adults report having pain as a result of a condition affecting their muscles or joints. Shoulder pain can have a large impact on impact on the ability to sleep, work, or take part in other activities. Every year 1.5 million people visit their doctor or a physiotherapist for shoulder pain. Many people with will recover within a few months, but in others shoulder pain may last much longer.
The PANDA-S study followed people with shoulder pain for up to 3 years. The study aimed to understand how shoulder pain affects people, how it develops over time, and what type of advice and treatment might help best.What did the study involve?
People who took part in the study were asked to complete questionnaires after they first saw their doctor or physiotherapist and then regularly over a period of 3 years. Every time questions asked how severe the shoulder pain was, what the impact was on their life, and what treatments participants had received. The questionnaire also asked some questions about their work, lifestyle, and general health.
If the people who completed the questionnaires were interested, they could also complete some optional parts of the study. This included completing regular questions about their pain using a smartphone app or text messaging service, so the research team could better understand early changes in pain, after receiving advice or treatment. Some people who completed the questionnaires were invited to be interviewed, and we also invited their doctor or physiotherapist for an interview. The interviews helped to better understand their thoughts, beliefs, and concerns about shoulder pain and their views about the way shoulder pain may best be managed. The final optional part of the study was a research clinic, where people had a physical examination and an ultrasound scan of their shoulder.How many people took part?
In total, 491 people took part in the study, with 70 to 75% completing questionnaires in the first 12 months. At the end of the study, after 3 years, 263 participants completed the final questionnaire. For the other, optional parts:
- 160 people attended a research clinic
- 114 people told us about their shoulder pain using the PANDA-S App
- 53 people told us about their shoulder pain using text messages
- 24 people were interviewed by a member of the research team about their experience of shoulder painWhat are the findings of the study?
The questionnaires highlighted the impact of shoulder pain on everyday life. At the start of the study, most participants (81-95%) said that shoulder pain affected their sleep, as well as everyday activities, such as getting dressed. Many people (46%) reported a quick recovery, with pain and impact of activities getting better within 6 months. In 36% of participants recovery was slower and pain only gradually recovered over the three years of the study. A smaller group (18%) still reported shoulder pain 3 years after the start of the study.
We used information from the questionnaires to develop a tool that can help to predict how quickly shoulder pain can improve in the first 6 months after seeing a doctor or physiotherapist. The prediction is based on information collected at the time of the first healthcare visit, including how long people have had their shoulder pain, how severe their pain is, if the pain is also in their neck, how much people worry about their shoulder, and how confident they are that treatment will help. The tool also includes some information about general health, such as level of physical activity, mental health, and whether people have diabetes. The PANDA-S tool helps patients and physiotherapists to discuss the shoulder pain, how it affects everyday life, how the pain may change over time, and what may help people with shoulder pain to manage their condition.
The findings from the 160 participants who also received a physical examination and ultrasound scan, showed that a few of the tests may help to make better predictions about the recovery of shoulder pain. This includes a test to assess the neck, tests to assess if muscles and tendons are contributing to the shoulder pain, and a test to assess general fitness.What are next steps?
We are still looking at the results from the PANDA-S study, and will work with health economists who can tell us how much shoulder pain costs to treat, and how shoulder pain affects to the ability to work.
The PANDA-S tool is now being used as part of a new study in physiotherapy services in England. This study (called PANDA-S II) will look at whether a more personalised consultation for people with shoulder pain, that takes account of their individual shoulder pain experiences, concerns, and expectations, will help people to better manage their shoulder pain, and whether it can improve their sleep as well as help them carry on their work, and daily activities.
The findings of the PANDA-S programme will be published in research articles and presented at conferences. Study findings will also be shared through our website: https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fwww.keele.ac.uk%252Fpanda-s%252F%2FNBTI%2FXQbFAQ%2FAQ%2Fedba8e66-eef6-42f8-83bd-ebc99c097ccf%2F1%2FYraOIdWwLd&data=05%7C02%7Csheffield.rec%40hra.nhs.uk%7C1c871d25c42c4bba928a08dea696149b%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639131360721199445%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=XLil9en32FOumsT%2FKPYGFqBDeXjnwflRxzuZlsCG%2FI4%3D&reserved=0REC name
Yorkshire & The Humber - Sheffield Research Ethics Committee
REC reference
18/YH/0346
Date of REC Opinion
16 Oct 2018
REC opinion
Further Information Favourable Opinion