The Use of Physiotherapy among Patients with Subacromial Impingement Syndrome: Impact of Sex, Socio-Demographic and Clinical Factors

Abstract

Background: Physiotherapy with exercises is generally recommended in the treatment of patients with subacromial impingement syndrome (SIS).

Objective: We aimed to investigate the use of physiotherapy in patients with SIS in Danish hospital settings as part of initial non-surgical treatment and after SIS-related surgery and to evaluate to which extent sex, socio-demographic and clinical factors predict the use of physiotherapy.

Methods: Using national health registers, we identified 57,311 patients who had a first hospital contact with a diagnosis of ICD-10, groups M75.1-75.9, 1 July 2007 to 30 June 2011. Records of physiotherapy were extracted within 52 weeks after first contact (or until surgery), and for surgically treated patients within 26 weeks after surgery. Predictors of the use of physiotherapy after first contact and after surgery were analysed as time-to-event.

Results: Within 52 weeks after first contact, 43% of the patients had physiotherapy and 30% underwent surgery. Within 26 weeks after surgery, 80% had a record of physiotherapy. After first contact and after surgery, exercise was part of physiotherapy in 65% and 84% of the patients, respectively. A public hospital contact, physiotherapy before hospital contact, administrative region, female sex, a diagnosis of other or unspecified disorders (M75.8-M75.9), and surgical procedure predicted higher use of physiotherapy. Low education level predicted slightly lower use of physiotherapy after first contact, but not after surgery.

Conclusion: In patients with SIS in Danish hospital settings, physiotherapy was more often used after surgery than as part of initial non-surgical treatment. The use of physiotherapy was less common among men than women, whereas unequal use of physiotherapy in relation to education level was not noticeable. The use of physiotherapy with exercises in initial non-surgical treatment was relatively limited.

Fig 1. Flowchart of inclusion of patients in the study.

* International Classification of Diseases, 10^th revision, codes M75.1-M75.9. † All KNB shoulder and upper-arm surgery codes from the Danish Nordic Medico-Statistical Committee (NOMESCO), ‡ Surgery codes KNBA, KNBE-H, and KNBK-M.

Fig 2. Overall distribution of codes of physiotherapy interventions after first contact and after surgery.

After first contact: Based on a total of 339,050 codes of physiotherapy interventions in patients who received physiotherapy within 52 weeks after first hospital contact (n = 24,452). After surgery: Based on a total of 233,630 codes of physiotherapy interventions in patients who received physiotherapy within 26 weeks after SIS-related surgery (n = 13,394). Of note, more than one code of physiotherapy intervention can be recorded per contact.