Cuff Dysfunction: Classification And Outcome
Seitz A, Harris B, Watkins M
Purpose: This study describes a clinical classification system created to subcategorize patients with rotator cuff dysfunction, outlines the defined intervention that is distinct for each group and describes outcomes of physical therapy intervention on patients classified into one of the three clinical classifications.
Background: Demonstrating the efficacy of physical therapy intervention is paramount to progress of the profession. Rose, Delitto, Sarhmann, and other physical therapy leaders have reiterated the idea that categorizing patients into homogenous diagnostic groups with distinct intervention is thought to optimize outcome. Currently there is not uniformity in labeling or defining shoulder disorders. There is nothing in the literature describing physical therapy intervention that categorizes patients into homogenous treatment groups.
Method: A retrospective study using secondary analysis of an existing database identified 136 subjects, age 25-85 (mean 58.9 +/- 11.3) who were treated in physical therapy between April 1999 and January 2004 at MGH PT services, had completed both an intake and discharge Penn Score, and were previously classified during the evaluation as a RTC dysfunction stage I, II or III. The classification system used was previously devised with defined distinguishing characteristics, (such as age, etiology, duration of symptoms) and common exam findings (range of motion, strength impairments) that were distinct for each RTC group. Four experienced physical therapists collected patient Penn Score and demographic information contained in the database. Patients were treated according to the defined treatment specified in the guidelines that was distinct for each RTC groups. The Penn Shoulder Score is a reliable, valid, and responsive self report outcome tool with three sub scores for pain, satisfaction and function that was used to measure treatment outcome.
Analysis: Descriptive variables such as age, hand dominance, side injured, referral source, and gender were examined to describe the cohorts of patients in each of the three sub classifications. Means and standard deviations were used to describe patients Penn Score results at intake, discharge, and quantity of change. Paired T-tests were used to determine the differences between pre and post treatment Penn Score within each diagnostic group. An analysis of variance was used to determine the differences among the groups at intake, discharge and quantity of change in Penn Score.
Results: Patients classified as RTC stage III were significantly older (p=.05, mean 63.7+/- 10.9) than patients in both RTC stage I (mean 52.2 +/-12.3) and stage II (mean 57.4 +/-10.3). There were no significant differences among the three groups in gender, hand dominance, side injured, or referral source. All three groups demonstrated clinically significant improvements in Penn Shoulder Score (p-.05, mean 20.8 +/- 14.3) across all three domains: pain (mean 7.4 +/- 6.1), satisfaction (mean 5.3 +/- 3.2), and function (mean 13.4 +/- 9.7). There were no significant differences among the groups (p=.05) at intake, discharge, in total Penn Score change or change in any sub scores.
Conclusion: All patients with rotator cuff dysfunction treated according to guidelines set forth by a shoulder diagnostic and treatment classification system demonstrated significant improvements in pain satisfaction and function. This is the first study to examine outcomes of physical therapy intervention in patients with rotator cuff dysfunction utilizing a diagnostic and treatment classification system.