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Publication: Emotional distress was associated with persistent shoulder pain after physiotherapy


Emotional distress was associated with persistent shoulder pain after physiotherapy: a prospective cohort study


This study was published in BMC Musculoskeletal Disorders, in august 2018.

View the article here: https://rdcu.be/41E2


The aim of this study was to investigate whether emotional distress, measured before physiotherapy treatment, was associated with pain intensity and self-reported disability after treatment. The study found that higher emotional distress at study onset was associated with higher pain intensity after the physiotherapy treatment, but not with disability.





The study was a prospective cohort study of consecutive patients treated at two student clinics located at the Department of Physiotherapy at OsloMet - Oslo Metropolitan University. Patients receiving physiotherapy at the two clinics answered questionnaires for the FysioPol database. The FysioPol database contains pre- and post-treatment information about the patients and was established in order to measure the quality of treatment and facilitate research at the department.


Data from 145 patients treated at the clinics aged ≥18 years with self-reported pain in the shoulder or arm, and activity problems related to the upper-extremity were included. Outcome measures were pain intensity measured by the Numeric Pain Rating Scale and disability measured by the Patient Specific Functional Scale. Demographic and clinical characteristics, including emotional distress measured by Hopkins Symptom Checklist – 25, were obtained at study onset.


The analyses showed that higher emotional distress at study onset, in combination with higher pre-treatment pain intensity and duration of pain for 4 to 12 months in comparison to 0 to 3 months, was associated with a poor outcome in terms of pain intensity after physiotherapy in patients with shoulder pain. Emotional distress was not associated with self-reported disability.


Psychological factors in general are little emphasised in the examination of shoulder pain, and it is rather the structural and biomechanical aspects of the condition that are usually considered in clinical decision-making. The findings if this study indicate, however, that emotional distress should be included in the initial physiotherapy examination of shoulder pain. Future research should identify whether targeting emotional distress in shoulder pain rehabilitation is likely to improve the outcome for shoulder patients with a high degree of emotional distress, to identify whether and how to best individualise the treatment for these patients.



Kaja Smedbråten is a PhD-student and a former master student at the Department of Physiotherapy at Oslo Metropolitan University. She conducted this study as her master thesis.

Britt Elin Øiestad and Yngve Røe are both associate professors at the Department of Physiotherapy at Oslo Metropolitan University.