The effect of the treatment environment on pain, function, self-efficacy and satisfaction in rotator cuff related shoulder pain

The aim of this thesis was to investigate the short-term effects of implementing the same rehabilitation program in treatment environments with varying social and physical factors on the treatment outcomes of patients diagnosed with rotator cuff-related shoulder pain (RCRSP). Thirty-four patients with RCRSP were randomly assigned to two groups: an enriched therapeutic environment (Group 1) and an isolated therapeutic environment (Group 2). Both groups received a standardized 60-minute treatment program, which included patient education, exercise therapy, and cold application, for a total of 15 sessions over 6 weeks (2-3 sessions per week). Pain intensity was measured using the Numeric Pain Rating Scale (NPRS), range of motion (ROM) was evaluated with a goniometer, functional status was assessed using the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (Q-DASH) and the Western Ontario Rotator Cuff Index (WORC), self-efficacy was measured with the Pain and Self-Efficacy Questionnaire (PSEQ), and treatment satisfaction was evaluated using the Global Rating of Change (GRC). Assessments were conducted at baseline, week 3, and week 6. The Statistical Package for the Social Sciences (SPSS), "2x3 Mixed Model Repeated Measures ANOVA", and "Pre-post ANCOVA" were used for data analysis. Analysis of the six-week treatment program revealed significant difference in pain, range of motion (ROM), functionality, and self-efficacy parameters in both groups compared to baseline measurements. This difference was higher in Group 1 across all parameters. Statistically significant differences were found between the groupsin pain (p=0.03), Q-DASH score (p=0.01), WORC total score (p=0.01), WORC physical symptoms (p=0.01), WORC emotions score (p=0.01), and PSEQ score (p=0.02). In conclusion, an enriched treatment environment with positive contextual factors demonstrated superior outcomes in pain, ROM, functionality, and self-efficacy for patients with rotator cuff-related shoulder pain compared to an isolated therapeutic environment. These findings suggest that the physical and social characteristics of the treatment environment should be carefully considered in the management of musculoskeletal disorders, as they have the potential to enhance the effectiveness of various interventions and provide additional therapeutic benefits.