This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research article
Ali Sheikhzadeh
New York University Medical Center: NYU Langone Health
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7000-8866
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The aim is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF), those that can be changed with intervention, on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment.
Methods
This is a systematic literature review. We searched five databases for longitudinal studies investigating the influence of MPF on the prognosis of patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. We assigned each MPF identified in the included references to one of six constructs and categorized all constructs into three domains. We then evaluated each construct for its predictive value of at least one outcome, and all outcomes reported were considered. Evidence was classified into three categories: evidence for, inconclusive evidence, and evidence against each construct.
Results
Of 1140 publications, 35 publications based on 33 studies were included (intervention type: 15 surgical; 18 conservative). Outcomes reported included pain, disability/function, perceived recovery, physical and mental health, and work status. Six modifiable psychological constructs were explored including self-efficacy, expectation of recovery, catastrophizing, avoidant coping, depression, and anxiety. The majority of the evidence suggested the prognostic value of all constructs except self-efficacy for patients managed surgically. In patients undergoing conservative intervention the evidence was inconclusive or against the prognostic value of MPF on outcomes.
Conclusions
Five constructs were found to be predictive of outcome for surgically managed patients. This suggests that implementing the biopsychosocial approach to patients with musculoskeletal shoulder disorders managed surgically may be advantageous. The same was not observed for conservative care. The importance of other MPF on outcome requires further investigation.
Keywords
conservative intervention, surgical intervention, modifiable psychological factors, treatment outcome, predictors
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
- Appendix.docx
Appendix 1A. Search strategies Embase Search 11.02.2017 (Elsevier© 2017 RELX Intellectual Properties SA). Appendix 1B. Search strategies Medline Search February 2, 2017 (EBSCOhost, search mode: find all my search terms). Appendix 2: SIGN quality. Bold font indicates high quality studies. Part A Y=yes, N=no, ?= unclear NA=not applicable. Columns in this table presenting the following questions: 1. Study question focused? 2. Included groups selected from source population that are comparable. 3. The study indicate how many who were asked to take part did so. 4. The likelihood that some eligible subjects might have the outcome at the time of the enrolment is assessed and taken into consideration. 5. What are the percentage of individuals recruited that dropped out before the study was completed. 6. Comparison is made between full participants and those lost to follow-up. 7. Outcomes clearly defined. 8. The assessment of outcome is made blind to exposure status. 9. Where blinding was not possible, there is some recognition that knowledge of the exposure status could have influenced the assessment of outcome. 10. The method of assessment of exposure is reliable? 11. Evidence from other sources is used to demonstrate that the method of outcome assessment is valid and reliable. 12. Exposure or prognostic factor assessed more than once? 13. Main potential confounders identified and taken into account in analysis. 14. Have confidence intervals been provided. 15. Overall assessment of risk of bias (++/+/-/0) Part B. Y=yes, N=no, ?= unclear NA=not applicable. Columns in this table presenting the following questions: 1. Clearly and focused question. 2. The assignment of subjects to treatment groups are randomized? 3. An adequate concealment method is used? 4. The design keeps subjects and investigators ‘blind’ about treatment allocation? 5. The groups are similar at start of the trials? 6. The only difference between the groups is the treatment under investigation? 7. All relevant outcomes are measured in a standard, valid and reliable way? 8. What percentage of the subjects recruited into each treatment arm dropped out before the study was completed? 9. All the subjects are analyzed in the groups to which they were allocated (Intention to treat analysis)? 10. Where the study is carried out at more than one site, results are comparable for all sites? Overall quality of the study? (++/+/-/0)
- PRISMAP2015checklist1.docx
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CURRENT STATUS: Under Revision
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Posted 23 Nov, 2020
No community comments so far
Review #2 received
Received 25 Nov, 2020
Editorial decision: Major revision
On 25 Nov, 2020
Reviewer #2 agreed
On 23 Nov, 2020
Reviewer #1 agreed
On 18 Nov, 2020
Review #1 received
Received 18 Nov, 2020
Reviewers invited
Invitations sent on 15 Nov, 2020
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On 25 Oct, 2020
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On 25 Oct, 2020
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On 25 Oct, 2020
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Subject Areas
Orthopedics
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Ali Sheikhzadeh
New York University Medical Center: NYU Langone Health
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7000-8866
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 23 Nov, 2020
No community comments so far
Review #2 received
Received 25 Nov, 2020
Editorial decision: Major revision
On 25 Nov, 2020
Reviewer #2 agreed
On 23 Nov, 2020
Reviewer #1 agreed
On 18 Nov, 2020
Review #1 received
Received 18 Nov, 2020
Reviewers invited
Invitations sent on 15 Nov, 2020
Editor assigned
On 25 Oct, 2020
Submission checks complete
On 25 Oct, 2020
Editor invited
On 25 Oct, 2020
First submitted
On 22 Oct, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The aim is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF), those that can be changed with intervention, on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment.
Methods
This is a systematic literature review. We searched five databases for longitudinal studies investigating the influence of MPF on the prognosis of patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. We assigned each MPF identified in the included references to one of six constructs and categorized all constructs into three domains. We then evaluated each construct for its predictive value of at least one outcome, and all outcomes reported were considered. Evidence was classified into three categories: evidence for, inconclusive evidence, and evidence against each construct.
Results
Of 1140 publications, 35 publications based on 33 studies were included (intervention type: 15 surgical; 18 conservative). Outcomes reported included pain, disability/function, perceived recovery, physical and mental health, and work status. Six modifiable psychological constructs were explored including self-efficacy, expectation of recovery, catastrophizing, avoidant coping, depression, and anxiety. The majority of the evidence suggested the prognostic value of all constructs except self-efficacy for patients managed surgically. In patients undergoing conservative intervention the evidence was inconclusive or against the prognostic value of MPF on outcomes.
Conclusions
Five constructs were found to be predictive of outcome for surgically managed patients. This suggests that implementing the biopsychosocial approach to patients with musculoskeletal shoulder disorders managed surgically may be advantageous. The same was not observed for conservative care. The importance of other MPF on outcome requires further investigation.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
- Appendix.docx
Appendix 1A. Search strategies Embase Search 11.02.2017 (Elsevier© 2017 RELX Intellectual Properties SA). Appendix 1B. Search strategies Medline Search February 2, 2017 (EBSCOhost, search mode: find all my search terms). Appendix 2: SIGN quality. Bold font indicates high quality studies. Part A Y=yes, N=no, ?= unclear NA=not applicable. Columns in this table presenting the following questions: 1. Study question focused? 2. Included groups selected from source population that are comparable. 3. The study indicate how many who were asked to take part did so. 4. The likelihood that some eligible subjects might have the outcome at the time of the enrolment is assessed and taken into consideration. 5. What are the percentage of individuals recruited that dropped out before the study was completed. 6. Comparison is made between full participants and those lost to follow-up. 7. Outcomes clearly defined. 8. The assessment of outcome is made blind to exposure status. 9. Where blinding was not possible, there is some recognition that knowledge of the exposure status could have influenced the assessment of outcome. 10. The method of assessment of exposure is reliable? 11. Evidence from other sources is used to demonstrate that the method of outcome assessment is valid and reliable. 12. Exposure or prognostic factor assessed more than once? 13. Main potential confounders identified and taken into account in analysis. 14. Have confidence intervals been provided. 15. Overall assessment of risk of bias (++/+/-/0) Part B. Y=yes, N=no, ?= unclear NA=not applicable. Columns in this table presenting the following questions: 1. Clearly and focused question. 2. The assignment of subjects to treatment groups are randomized? 3. An adequate concealment method is used? 4. The design keeps subjects and investigators ‘blind’ about treatment allocation? 5. The groups are similar at start of the trials? 6. The only difference between the groups is the treatment under investigation? 7. All relevant outcomes are measured in a standard, valid and reliable way? 8. What percentage of the subjects recruited into each treatment arm dropped out before the study was completed? 9. All the subjects are analyzed in the groups to which they were allocated (Intention to treat analysis)? 10. Where the study is carried out at more than one site, results are comparable for all sites? Overall quality of the study? (++/+/-/0)
- PRISMAP2015checklist1.docx
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