Predicting Physiotherapy Outcome and the International e-Delphi Study

There are no proper prognostic trials, but cohort studies give hints. Range of motion under 50 degrees predicts a poor response. In Collin's study, 93 percent of posterosuperior tears did well, against 29 percent with subscapularis tears and 44 percent with three tendons torn. Absence of teres minor hypertrophy, glenohumeral arthritis and external rotation weakness are also named. Studies in other shoulder groups, such as Chester's trial and Dunn's work, show that expectation and self-efficacy often predict outcome better than biomechanics. The e-Delphi study involved 44 physiotherapists and 44 orthopedic surgeons from 25 countries. Over three rounds, 344 statements were reduced to 22 factors judged important, 12 of them modifiable. Grouped into patient and clinician factors, the non-modifiable ones include catastrophizing, depression, anxiety, strong biomechanical beliefs, subscapularis tear and glenohumeral arthropathy. Modifiable ones include positive expectation, motivation, kinesiophobia, good passive range, active flexion in supine, adequate exercise dose and the clinician's explanation.