What Is the Association Between Psychosocial Risk Factors and Pain and Function Outcomes in People With Rotator Cuff Disorders? A Systematic Review.

OBJECTIVE: To describe the association between psychosocial factors and pain and function/disability in people with rotator cuff (RC) disorders. DESIGN: Etiology systematic review. LITERATURE SEARCH: Systematic searches were conducted in CINAHL, EMBASE, MEDLINE, PsycINFO, and Scopus databases from inception to November 2025. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. STUDY SELECTION CRITERIA: Studies were eligible if they included adults with RC disorders and examined associations between psychosocial factors and pain and/or functional outcomes. DATA SYNTHESIS: Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Due to study heterogeneity, results were presented descriptively. RESULTS: Thirty-eight observational studies (n = 4845; 2024 males, 2170 females, 651 sex not reported) were included. Over 70% of studies were of medium-high methodological quality. Pain catastrophizing (r = -0.50 to 0.62, β = -0.54 to 0.50) and sleep (r = -0.59 to 0.54, β = -0.41) had moderate-to-strong associations with functional outcomes. Fear-avoidance had weak-to-strong associations with function (r = -0.61 to 0.24, β = -0.59 to -0.27, odds ratio [OR] = 1.39). Moderate evidence supported associations between fear-avoidance, sleep disturbance, pain catastrophizing, and functional outcomes. Poorer mental health had a moderate-to-strong association with pain severity (r = -0.52 to -0.48) and impaired function (r = -0.61 to 0.75); the strength of evidence was limited. Weak-to-strong associations with limited strength of evidence were observed between remaining psychosocial factors and pain. CONCLUSION: Pain catastrophizing and sleep disturbance demonstrated moderate-to-strong associations with functional impairment in people with RC disorders. Fear-avoidance beliefs had heterogenous associations with function. Poor emotional health was associated with greater pain severity and functional impairment. JOSPT Open 2026;4(4):420-441. Epub 19 June 2026. doi:10.2519/josptopen.2026.0194.