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Exploration of the Usual Care Pathway for Rotator Cuff Related Shoulder Pain in the Western Australian Workers’ Compensation System

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A Publisher Correction to this article was published on 28 April 2023

This article has been updated

Abstract

Purpose

Investigate components of care for rotator cuff related shoulder pain in workers’ compensation in relation to claim outcomes (claim duration, total medical spend, total claim cost, return to work outcome).

Methods

Engagement with (had care, time to care) four components of care (prescribed exercise, imaging, injections, surgery) were obtained from auditing 189 closed workers’ compensation files. Associations were analysed between components of care and claim outcomes.

Results

80% received prescribed exercise, 81% imaging, 42% injection and 35% surgery. Median time to imaging (11 days) was shorter than the prescribed exercise (27 days), with injection at 38 days and surgery 118.5 days. With univariable regression analysis higher age, the involvement of legal representation and the presence of rotator cuff pathology from diagnostic imaging (partial thickness tear or full thickness tear) were all associated with increased claim duration, total medical spend, total claim cost and less successful return to work outcomes. After adjusting for these three associations, having an injection or surgery were both positively associated with longer claim duration and greater medical spend, and surgery with greater total claim costs. In general, longer time to receiving components of care was associated with increased claim duration and reduced odds of returning to full duties at work.

Conclusion

Early management was not consistent with clinical guidelines for managing workers’ compensation rotator cuff related shoulder pain. This may negatively affect claims outcomes.

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Data Availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

Change history

References

  1. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73–81.

    Article  CAS  PubMed  Google Scholar 

  2. Tekavec E, Joud A, Rittner R, Mikoczy Z, Nordander C, Petersson IF, et al. Population-based consultation patterns in patients with shoulder pain diagnoses. BMC Musculoskelet Disord. 2012;13:238.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Maxwell C, Robinson K, McCreesh K. Understanding shoulder pain: a qualitative evidence synthesis exploring the patient experience. Phys Ther. 2021;101(3).

  4. Safe Work Australia. Australian workers’ compensation statistics 2019-20. Canberra: Safe Work Australia; 2021.

    Google Scholar 

  5. Mroz TM, Carlini AR, Archer KR, Wegener ST, Hoolachan JI, Stiers W, et al. Frequency and cost of claims by injury type from a state workers’ compensation fund from 1998 through 2008. Arch Phys Med Rehabil. 2014;95(6):1048–54. e6.

    Article  PubMed  Google Scholar 

  6. WorkCoverWA. Shoulder Injuries Related Claim Statistics in the Western Australian workers’ compensation system 2012/13 to 2016/17 (Unpublished statistics). 2018.

  7. Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 2016;23:57–68.

    Article  PubMed  Google Scholar 

  8. Shanahan EM, Sladek R. Shoulder pain at the workplace. Best Pract Res Clin Rheumatol. 2011;25(1):59–68.

    Article  PubMed  Google Scholar 

  9. Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part I. evaluation and diagnosis. Am Fam Physician. 2008;77(4):453–60.

    PubMed  Google Scholar 

  10. Buchbinder R, Staples MP, Shanahan EM, Roos JF. General practitioner management of shoulder pain in comparison with rheumatologist expectation of care and best evidence: an australian national survey. PLoS ONE. 2013;8(4):e61243.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Thorpe A, Hurworth M, O’Sullivan P, Mitchell T, Smith A. Rotator cuff disease: opinion regarding surgical criteria and likely outcome. ANZ J Surg. 2017;87(4):291–5.

    Article  PubMed  Google Scholar 

  12. Doiron-Cadrin P, Lafrance S, Saulnier M, Cournoyer E, Roy JS, Dyer JO, et al. Shoulder Rotator Cuff Disorders: a systematic review of clinical practice guidelines and semantic analyses of recommendations. Arch Phys Med Rehabil. 2020;101(7):1233–42.

    Article  PubMed  Google Scholar 

  13. Hopman K, Krahe L, Krahe L, Lukersmith S, McColl A, Vine K. Clinical Practice Guidelines for the Management of Rotator Cuff Syndrome in the Workplace The University of New South Wales2013 [Available from: https://rcs.med.unsw.edu.au/sites/default/files/rcs/page/RotatorCuffSyndromeGuidelines.pdf.

  14. Beales D, Fried K, Nicholas M, Blyth F, Finniss D, Moseley GL. Management of musculoskeletal pain in a compensable environment: implementation of helpful and unhelpful models of care in supporting recovery and return to work. Best Pract Res Clin Rheumatol. 2016;30(3):445–67.

    Article  PubMed  Google Scholar 

  15. Pedowitz RA, Yamaguchi K, Ahmad CS, Burks RT, Flatow EL, Green A, et al. Optimizing the management of rotator cuff problems. T J Am Acad Orthop Surg. 2011;19(6):368–79.

    Article  Google Scholar 

  16. Naunton J, Harrison C, Britt H, Haines T, Malliaras P. General practice management of rotator cuff related shoulder pain: a reliance on ultrasound and injection guided care. PLoS ONE. 2020;15(1):e0227688.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Castillo RC, Heins S, Feldman D, DuGoff EH, Roberts E, Staguhn ED, et al. The impact of adherence to clinical practice guidelines on medical costs. J Occup Environ Med. 2020;62(9):712–7.

    Article  PubMed  Google Scholar 

  18. Beales D, Fulco M, Gullhaugen E, Peden A, Ranford S, Mitchell T. Utilisation of exercise as part of guideline-based care for hip pain in the australian workers’ compensation environment. Work. 2020;67(4):971–8.

    Article  PubMed  Google Scholar 

  19. WorkCoverWA. Government of Western Australia; List of approved insurers Perth (Western Australia)2018 [updated 2018 Aug. Available from: https://www.workcover.wa.gov.au/service-providers/insurers/.

  20. Ogundimu EO, Altman DG, Collins GS. Adequate sample size for developing prediction models is not simply related to events per variable. J Clin Epidemiol. 2016;76:175–82.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Whittle S, Buchbinder R. In the clinic. Rotator cuff disease. Ann Intern Med. 2015;162(1):ITC1–15.

    Article  PubMed  Google Scholar 

  22. Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79–86.

    Article  PubMed  Google Scholar 

  23. Rashid M, Kristofferzon ML, Nilsson A. Predictors of return to work among women with long-term neck/shoulder and/or back pain: a 1-year prospective study. PLoS ONE. 2021;16(11):e0260490.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bonde JP, Mikkelsen S, Andersen JH, Fallentin N, Baelum J, Svendsen SW, et al. Prognosis of shoulder tendonitis in repetitive work: a follow up study in a cohort of Danish industrial and service workers. Occup Environ Med. 2003;60(9):E8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Lotters F, Burdorf A. Prognostic factors for duration of sickness absence due to musculoskeletal disorders. Clin J Pain. 2006;22(2):212–21.

    Article  PubMed  Google Scholar 

  26. Murgatroyd DF, Casey PP, Cameron ID, Harris IA. The effect of financial compensation on health outcomes following musculoskeletal injury: systematic review. PLoS ONE. 2015;10(2):e0117597.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Aurbach R. Breaking the web of needless disability. Work. 2014;48(4):591–607.

    Article  PubMed  Google Scholar 

  28. Schaafsma FG, Whelan K, van der Beek AJ, van der Es-Lambeek L, Ojajarvi A, Verbeek JH. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database Syst Rev. 2013(8):CD001822-CD.

  29. Nicholas MK, Costa DSJ, Linton SJ, Main CJ, Shaw WS, Pearce G, et al. Implementation of early intervention protocol in Australia for ‘high risk’ injured workers is associated with fewer lost work days over 2 years than Usual (stepped) care. J Occup Rehabil. 2019.

  30. Beales D, McManus L, Tan JS, Elliott C, Mitchell T. Implementation of questionnaire-based risk profiling for clients in a workers’ compensation environment: an example in australian physiotherapy practice. J Occup Rehabil. 2019(29):609–16.

  31. Vincent K, Leboeuf-Yde C, Gagey O. Are degenerative rotator cuff disorders a cause of shoulder pain? Comparison of prevalence of degenerative rotator cuff disease to prevalence of nontraumatic shoulder pain through three systematic and critical reviews. J Shoulder Elbow Surg. 2017;26(5):766–73.

    Article  PubMed  Google Scholar 

  32. Di Donato M, Iles R, Lane T, Buchbinder R, Collie A. The impact of income support systems on healthcare quality and functional capacity in workers with low back pain: a realist review. Pain. 2020;161(12):2690–709.

    Article  PubMed  Google Scholar 

  33. Page MJ, Green S, McBain B, Surace SJ, Deitch J, Lyttle N, et al. Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev. 2016(6):CD012224.

  34. Burger M, Africa C, Droomer K, Norman A, Pheiffe C, Gericke A, et al. Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: a systematic review and meta-analysis. S Afr J Physiother. 2016;72(1):318.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lahdeoja T, Karjalainen T, Jokihaara J, Salamh P, Kavaja L, Agarwal A, et al. Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis. Br J Sports Med. 2020;54(11):665–73.

    Article  PubMed  Google Scholar 

  36. Karjalainen TV, Jain NB, Heikkinen J, Johnston RV, Page CM, Buchbinder R. Surgery for rotator cuff tears. Cochrane Database Syst Rev. 2019;12:CD013502.

    PubMed  Google Scholar 

  37. Steuri R, Sattelmayer M, Elsig S, Kolly C, Tal A, Taeymans J, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med. 2017;51(18):1340–7.

    Article  PubMed  Google Scholar 

  38. Desmeules F, Boudreault J, Dionne CE, Fremont P, Lowry V, MacDermid JC, et al. Efficacy of exercise therapy in workers with rotator cuff tendinopathy: a systematic review. J Occup Health. 2016;58(5):389–403.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Littlewood C, Malliaras P, Chance-Larsen K. Therapeutic exercise for rotator cuff tendinopathy: a systematic review of contextual factors and prescription parameters. Int J Rehabil Res. 2015;38(2):95–106.

    Article  PubMed  Google Scholar 

  40. Heins SE, Feldman DR, DuGoff EH, Wegener ST, Castillo RC. Development and evaluation of a categorization methodology for occupational back and shoulder injuries using claims data. Health Serv Outcomes Res Methodol. 2013;13(2–4):140–56.

    Article  Google Scholar 

  41. Sanchis MN, Lluch E, Nijs J, Struyf F, Kangasperko M. The role of central sensitization in shoulder pain: a systematic literature review. Semin Arthritis Rheum. 2015;44(6):710–6.

    Article  PubMed  Google Scholar 

  42. Lin MT, Chiang CF, Wu CH, Huang YT, Tu YK, Wang TG. Comparative effectiveness of injection therapies in rotator cuff tendinopathy: a systematic review, pairwise and network meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2019;100(2):336–49. e15.

    Article  PubMed  Google Scholar 

  43. Koorevaar RCT, Van’t Riet E, Ipskamp M, Bulstra SK. Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study. Arch Orthop Trauma Surg. 2017;137(3):293–301.

    Article  PubMed  Google Scholar 

  44. Haunschild ED, Gilat R, Lavoie-Gagne O, Fu MC, Tauro T, Forsythe B, et al. Return to work after primary rotator cuff repair: a systematic review and meta-analysis. Am J Sports Med. 2021;49(8):2238–47.

    Article  PubMed  Google Scholar 

  45. Finger L, Dunn R, Hughes J, Lesniak B, Lin A. Clinical outcomes secondary to time-to-surgery for atraumatic rotator cuff tears. J Shoulder Elbow Surg. 2022.

  46. Veen EJD, Stevens M, Koorevaar CT, Diercks RL. Appropriate care for orthopedic patients: effect of implementation of the clinical practice cuideline for diagnosis and treatment of Subacromial Pain Syndrome in the Netherlands. Acta Orthop. 2019;90(3):191–5.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Theodore BR, Mayer TG, Gatchel RJ. Cost-effectiveness of early versus delayed functional restoration for chronic disabling occupational musculoskeletal disorders. J Occup Rehabil. 2015;25(2):303–15.

    Article  PubMed  Google Scholar 

  48. Loisel P, Durand MJ, Berthelette D, Vezina N, Baril R, Gagnon D, et al. Disability prevention: new paradigm for the management of occupational back pain. Dis Manage Health Outcomes. 2001;9(7):351–60.

    Article  Google Scholar 

  49. Iles RA, Wyatt M, Pransky G. Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia. J Occup Rehabil. 2012;22(4):478–88.

    Article  PubMed  Google Scholar 

  50. Choi T-Y, Yeom SR, Choi J, Lee JA, Jun JH, Kang B-K, et al. Provision of a clinical practice guidelines leaflet improves levels of satisfaction for patients suffering from shoulder pain: a randomized crossover trial. Eur J Integr Med. 2021;43:101321.

    Article  Google Scholar 

  51. Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Klintberg IH, Cools AM, Holmgren TM, Holzhausen AC, Johansson K, Maenhout AG, et al. Consensus for physiotherapy for shoulder pain. Int Orthop. 2015;39(4):715–20.

    Article  PubMed  Google Scholar 

  53. Panattoni N, Longo UG, De Salvatore S, Castaneda NSC, Risi Ambrogioni L, Piredda M, et al. The influence of psychosocial factors on patient-reported outcome measures in rotator cuff tears pre- and post-surgery: a systematic review. Qual Life Res. 2022;31(1):91–116.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank CGU Workers’ Compensation.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia

    Darren Beales, Tim Mitchell, David Seneque, Shin Yin Chang, Tak Ho Cheng & YiHui Quek

  2. Pain Options, Ground Floor, 7 Hardy Street, South Perth, WA, 6151, Australia

    Darren Beales, Tim Mitchell & Stephen Ranford

Authors
  1. Darren Beales
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Contributions

DB, TM and SR contributed to the study conception. All authors contributed to the study design, material preparation, data collection and analysis. The first draft of the manuscript was written by DB and all authors provided feedback/comments. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Darren Beales.

Ethics declarations

Clinical Significance

Early management of work-related shoulder pain did not align to clinical practice guidelines, with a potential over-reliance of imaging and comparative delay in starting prescribed exercise in this cohort. This may negatively affect claims outcomes and is worth targeting in pragmatic implementation trials.

Competing/Conflicting Interests

SR was employed part-time by the CGU Workers’ Compensation during the time this study took place. DB, TM and SR work as musculoskeletal physiotherapists in the WA workers’ compensation environment, in which they manage injured workers whose employers have policies with the insurer. The insurer had no influence on the production of this manuscript.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.  A data access and confidentiality agreement was established between Curtin University and CGU for access to the CGU file records.

Ethics Approval

Ethical approval was obtained through Curtin University Human Research Ethics Committee (Approval Number HRE2018-0539). A data access and confidentiality agreement was established between Curtin University and the insurer.

Consent to Participate

Given the data was retrospective, participant permission could not be gained for this study, however the insurer had previously gained consent to acquire and maintain appropriate medical information upon lodgement of all participant’s workers’ compensation claims.

Consent to Publish

Workers compensation claims files were viewed in a secure area within the insurer’s premises and de-identified data was stored on password protected computers to avoid unauthorised dissemination of claim details. There is no identifying personal data (i.e. individuals details, images or videos) shared within this study which would require consent to publish.

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Beales, D., Mitchell, T., Seneque, D. et al. Exploration of the Usual Care Pathway for Rotator Cuff Related Shoulder Pain in the Western Australian Workers’ Compensation System. J Occup Rehabil 33, 506–517 (2023). https://doi.org/10.1007/s10926-022-10088-x

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