Use of a surgical referral algorithm within a standardized shoulder physical therapy program to assist clinical decision-making
Bibliographic record
Abstract
Determine (a) utility of a shoulder referral algorithm, (b) patients improving ≥15% on the Western Ontario Rotator Cuff(WORC) score with standardized Physical Therapy(PT) +home exercises, and (c) presenting characteristics among PT-Only, PT + Surgical Consult and Surgery participants. Prospective cohort study of patients 30–65 years old with shoulder pain. A standardized PT program assessed pain, ROM, strength and exercise tolerance (i.e., referral algorithm) at 2-, 6- and 12-weeks to determine if a surgical consultation might be beneficial. A blinded research assessor evaluated pain, ROM, strength and WORC score at 6-, 12-weeks and 6-months. The proportion improving WORC scores ≥15% and group differences were also evaluated. 32/128 (25%) participants underwent consultation with 16 (12.5%) undergoing surgery. WORC scores improved ≥15% by 12-weeks in most PT-Only/PT + Surgical Consult participants (n = 77[70%]) and was maintained at 6-months. Surgery participants used more NSAIDs (p = 0.01), injections (p = 0.002) and trended to higher opioid use (p = 0.06). PT + Surgical Consult/Surgery participants (n = 16/32; 50%) knew diagnostic imaging results more than PT-Only (n = 26; 31%) (p = 0.02). Surgery participants presented with worse pain, ROM, strength and WORC scores than PT-Only (p < 0.05). The algorithm identified those with worse symptomology (25%), 50% of whom underwent surgery. WORC scores improved ≥15% in most participants (70%). Presenting characteristics were significantly worse between PT-Only and Surgery participants. Patients presenting with rotator-cuff related shoulder pain are likely to report reduced pain, and improved range of motion, strength and health-related quality of life within 3-months of starting a physical therapy program that includes home exercises.A surgical referral algorithm based on patient symptomology and response to treatment may assist physical therapists in determining when patients with shoulder pain might benefit from a surgical consult, often in advance of 3-months.Patients who required surgery tended to present with more pain, loss of range of motion and strength than those who received physical therapy only, as well as a history of more injections and non-steroidal anti-inflammatory drug use. Patients presenting with rotator-cuff related shoulder pain are likely to report reduced pain, and improved range of motion, strength and health-related quality of life within 3-months of starting a physical therapy program that includes home exercises. A surgical referral algorithm based on patient symptomology and response to treatment may assist physical therapists in determining when patients with shoulder pain might benefit from a surgical consult, often in advance of 3-months. Patients who required surgery tended to present with more pain, loss of range of motion and strength than those who received physical therapy only, as well as a history of more injections and non-steroidal anti-inflammatory drug use.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".