Authors (including presenting author) :
Chung MTK(1), Luk MLM(1), Ng DMT(1), Ng VTW(1), Lam CWS(1), Chow IHW(1), Chan ACM(1)
Affiliation :
(1)Physiotherapy Department, Queen Elizabeth Hospital
Introduction :
Frozen shoulder, characterized by pain and progressive motion restriction, raises concern in primary care regarding its increasing service demand. PT is crucial in the rehabilitation of patients with frozen shoulder. Clinically, Constant Murley Score (CM Score) evaluates shoulder function addressing pain, range of motion, strength and daily function. Existing evidence on triaging this population for appropriate PT management pathway is lacking. A screening tool could help to stratify patients to appropriate care.
Objectives :
To explore the potential of using CM Score as a triage screening tool of PT management for frozen shoulder patients in primary care.
Methodology :
One hundred subjects (mean age 62.1±10.8 years) with frozen shoulder, referred from GOPCs of KCC, underwent PT intervention including an educational talk, exercise training and pain-relieving treatment. Shoulder pain and function measured by Numeric Pain Rating Scale (NPRS) and CM Score respectively, were taken at baseline and upon discharge. Overall subjective improvement assessed by Numeric Global Rating of Change Scale (NGRCS) and the total number of PT sessions were recorded at discharge. Subjects were categorized for subgroup analysis according to baseline shoulder function (Group A:score 0-33, Group B:score 34-66, Group C:score 67-100). Two-way repeated measures ANOVA and one-way ANOVA were employed for statistical analysis.
Result & Outcome :
At discharge, significant improvement of CM Score was shown in all subgroups (pre- and post-intervention mean scores: Group A:27.2±5.4 to 53.0±12.8, p=0.035; Group B:47.7±8.7to 70.3±10.3, p< 0.001; Group C:72.3±5.7 to 81.2±5.6, p=0.011). Shoulder pain was significantly reduced in all subgroups (pre- and post-intervention mean NPRS scores: Group A:7.3±2.4 to 4.3±2.9, p=0.046; Group B:6.6±1.7 to 2.7±1.3, p< 0.001; Group C:5.2±1.6 to 1.8±1.8, p=0.021). No significant difference in NGRCS revealed among subgroups (p=0.199), indicating all subjects perceived similar percentage of overall improvement. Extent of PT training for reaching optimal improvement revealed Group A attended the highest number of sessions (8.3±1.5) whereas Group C the lowest (2.8±1.0).
All subjects showed significant improvement in pain and function after intervention. Patients with poorer baseline shoulder function require greater extent of PT training to attain similar outcome than patients with better baseline function. The results indicated CM Score could be a valid screening tool for frozen shoulder patients. That may imply patients with higher CM score may be beneficial by simply an educational talk and patient empowerment program for exercise reinforcement, while those with lower CM score required more department-based physiotherapy training to achieve equivalent improvement.
