The primary aim of this study was to explore how people perceive different advice for rotator cuff disease in terms of words/feelings evoked by the advice and treatment needs.
We conducted a three-arm parallel-group randomised experiment. 2,237 people with rotator cuff-related shoulder pain were recruited to an online survey (via Qualtrics market research company) and randomised (1:1:1) to i) best practice education (highlights most shoulder pain is not serious or a good indicator of tissue damage and recommends simple self-management strategies); ii) best practice education plus pain science messages (which attempt to improve understanding of pain); and iii) structure-focused education (highlighting structural changes are responsible for pain and should be targeted with treatment). Education was delivered via a pre-recorded video from a physiotherapist. Immediately after hearing the education participants answered questions about: (1) words/feelings evoked by the advice; (2) treatments they feel are needed. Two researchers developed coding frameworks to analyse the responses using content analysis.
Participants mean (standard deviation, SD) age was 46 (16) years old and 62% were female. Across all groups, feelings of reassurance (25-29%), positivity (27-30%), and empowerment (8-9%) were the most prominent feelings participants expressed. Feelings of reassurance were most common among those who received best practice education, while trust in expertise was most common among those who received structure-focused education. A notable proportion of participants believed no treatment was needed (18-22%), and this was slightly more common among those who received best practice education (with or without pain science messages). Participants receiving best practice education (with or without pain science messages) more often perceived exercise as necessary (21-22%) compared to those who received structure-focused education (8%), whereas the opposite trend was observed for medication (11-15% vs. 19%) and surgery (1-2% vs. 4%).
Our study highlights the influence of education on patient emotions and treatment preferences in the management of rotator cuff-related shoulder pain, and may explain why best practice education is more reassuring than structure-focused education.
Our findings could help refine education-based interventions for rotator cuff-related shoulder pain, and help clinicians better pre-empt how patients will respond to different types of education.
advice
rotator cuff
