Poster Presentation 29th Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting 2019

Low health-related quality of life, greater psychological distress and productivity loss: The personal burden of shoulder pain among younger people (#133)

Ilana Ackerman 1 , Kathy Fotis 1 , Lauren Pearson 1 , Peter Schoch 2 , Nigel Broughton 1 , Sharon Brennan-Olsen 3 4 , Andrew Bucknill 5 , Tom Treseder 5 , Emily Cross 6 , Nicole Bunting-Frame 7 , Richard S Page 8 9
  1. Monash University, Clayton, Victoria
  2. Physiotherapy Department, Barwon Health, Geelong, Victoria, Australia
  3. University of Melbourne, St Albans, VIC, Australia
  4. Australian Institute for Musculoskeletal Science (AIMSS), St Albans, VIC, Australia
  5. Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  6. Physiotherapy department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  7. Physiotherapy Department, Frankston Hospital, Frankston, Victoria, Australia
  8. Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health, Geelong, Victoria, Australia
  9. School of Medicine, Deakin University, Geelong, Victoria, Australia

Objective:  To investigate the out-of-pocket healthcare expenditure, wellbeing and work-related impacts of shoulder pain in younger people.

Methods:  People aged 20-55 years with shoulder pain of >6 weeks’ duration (excluding those with recent fracture or dislocation) were recruited from orthopaedic outpatient clinics at three major public hospitals (2018-19). Average shoulder pain and function were assessed.  Health-Related Quality of Life (HRQoL) was evaluated using the Assessment of Quality of Life (AQoL) instrument and compared to population norms (minimal important difference 0.06 AQoL units).  Prevalence of the extremes of psychological distress (assessed using the K10 instrument) was compared to population norms. The Work Productivity and Activity Impairment Questionnaire was used to quantify absenteeism and presenteeism; productivity loss was evaluated using employment categories and national earnings data. Out-of-pocket shoulder-related healthcare expenditure was captured using a 2-week cost diary.

Results:  Of the 81 participants (54% men), 69% had shoulder pain for >12 months. Despite moderate pain (mean 5.74, SD 2.18), substantial HRQoL impairment was evident (mean reduction 0.33 AQoL units, 95%CI -0.38 to -0.27). High/very high psychological distress was over 3 times more prevalent in our sample compared to the general population (relative risk 3.67, 95%CI 2.94 to 4.59). One-quarter of participants had ceased paid employment due to shoulder pain and while absenteeism was low (13% in paid employment missed work in the previous week), presenteeism was high (73% reported shoulder-related impairment at work). Total productivity loss in the previous week was estimated at $AUD475 per employed participant. Shoulder-related opioid use was common (34%), although total healthcare expenditure was minimal (mean $AUD52 per week per person).

Conclusions:  Persistent shoulder pain in younger people is associated with markedly reduced HRQoL and increased distress, with clear implications for work participation and thus loss of productivity.