According to a recent study conducted in a military hospital-based outpatient clinic in the United States, physical therapy (PT) is a less costly option than corticosteroid injection (CSI) for shoulder impingement syndrome (SIS), though both work equally well. The participants of the study included 104 patients aged 18 to 65 years having unilateral SIS between June 2010 and March 2012. Patients who don’t like injections will obviously choose PT as an effective option. Physical therapists treating patients with shoulder pain will have to focus on their documentation related to physical therapy provided to improve patient outcome and satisfaction.
For the study, 104 patients were divided into two groups, those receiving 40-mg triamcinolone acetonide subacromial CSI and those receiving 6 sessions of manual PT. While the change in shoulder pain and disability index scores at 1 year was the primary outcome, secondary outcomes included the Global Rating of Change scores, the Numeric Pain Rating Scale scores and one year healthcare use. The study results showed approximately 50% improvement in Shoulder Pain and Disability Index scores for both groups. There were improvements in Global Rating of Change scale and pain rating scores for both groups as well. However, the significant finding is that CSI group had more SIS-related visits to their primary care provider (60% vs. 37%) and needed additional steroid injections (38% vs. 20%) during the 1 year follow-up.
The additional visits to the primary care provider indicate that there is a persistent problem. The study showed that the CSI group used more healthcare services and had significantly more shoulder-related visits compared to the PT group. It also says that 19% of CSI group needed PT also. This clearly indicates that patients receiving injections need to pay more than those who opted for physical therapy.
It is time for physical therapists to fine tune their practices in the backdrop of this study. They should not only ask the right questions about the nature of the pain, the aggravating and relieving factors during the assessment session before the treatment, but also document all these details accurately in a legible manner. It is also required to record the results of special tests that help to determine the structure causing the pain. Unless there is sufficient information available about the initial evaluation, it is not possible to provide quality care and improve practice outcomes.
