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Education and activation programme (EAP) ineffective on shoulder complaints
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August 2013
Education and activation programme (EAP) ineffective on shoulder complaints
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
Effect of an education and activation programme on functional limitations and patient-perceived recovery in acute and sub-acute shoulder complaints: A randomised clinical trial.
BMC Musculoskelet Disord. 2007 Nov 15;8:112Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
111 patients with shoulder complaints (SCs) were randomized into one of two treatment groups. The first group was assigned to an education and activation program (EAP) in addition to usual care (UC) and the second group was only assigned to UC. Results indicated that the EAP did not have any significant effects on functional limitations and patient-perceived recovery in acute and sub-acute shoulder complaints when assessed at 6 and 26 weeks. A coincidental relationship between a catastrophising variable and functional limitations was discovered.
Publication Funding Details
+
Funding:
Non-Industry funded
Sponsor:
The Netherlands Organization for Health Research and Development
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
4/4
Randomization
1/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Some studies suggest that psychological and social factors play a role in the development and progression of chronic musculoskeletal diseases. The education and activation programme (EAP) was designed to help prevent the development of chronic shoulder complaints (SCs) and aims to do this by assisting patients in coping with psychosocial determinants which may lead to SCs.This study examines the effect of EAP on shoulder complaints.
What was the principal research question?
What is the effect of the education and activation programme (EAP) on functional limitations and patient-perceived recovery in patients with shoulder complaints at 6 and 26 weeks?
Study Characteristics
-
Population:
111 Patients with shoulder complaints at rest or in motion for <3 months. (Age: >18)
Intervention:
Education and activation program (EAP) in addition to usual care (UC): The education portion of EAP involved providing patient-tailored education, while the activation portion involved assisting patients in the resumption or continuation of activities that were affected by SCs. The EAP included a minimum of 2 sessions for 20 minutes each for a maximum of 6 follow-up sessions over 6 weeks. (Mean age: 48.4) (n=56, 7 lost to follow up, M=36%)
Comparison:
Usual care (UC): UC was administered using the clinical guidelines of the Dutch College of General Practitioners. (Mean age: 49.9) (n=52, 15 lost to follow up)
Outcomes:
Patient-perceived recovery (PPR), Functional limitations (Assessed using the 16-item shoulder disability questionnaire (SDQ)), and other psychosocial variables measured at baseline (e.g. Catastrophising, coping, anxiety, depression, somatisation and distress)
Methods:
RCT
Time:
26 weeks (Follow-up at 6 and 26 weeks)
What were the important findings?
- No statistically significant difference were found between the two groups when comparing baseline characteristics, except for catastrophisising (p=0.022).
- The education and activation programme (EAP) did not demonstrate a significant effect on the outcomes of functional limitations (SDQ) or patient-perceived recovery (PPR) when a multilevel analysis was performed (p>0.05).
- There was a statistically significant positive relationship between the catastrophising variable at baseline and functional limitations. This was a coincidental finding of this study.
What should I remember most?
No significant effects were seen on the outcomes of shoulder complaints (SCs) at 6 and 26 weeks when patients were under the education and activation programme (EAP). A coincidental relationship between the measurement of "catastrophising" at baseline and functional limitations was discovered.
How will this affect the care of my patients?
Patients may not find any significant effects on shoulder complaints (SCs) when participating in the education and activation program (EAP) in addition to usual care (UC). Further studies are required to determine the effect of catastrophising on reducing functional limitations associated with shoulder complaints (SCs).
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