Coulthard C1,2, Cairns MC1,3, Williams D4, Hughes B4, Jaggi A4
1University of Hertfordshire, Department of Allied Health Professions, Midwifery & Social Work, Hatfield, United Kingdom, 2Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey iMSK, Chertsey, United Kingdom, 3Physiocare, Twyford, United Kingdom, 4Royal National Orthopaedic Hospital, The Shoulder & Elbow Unit, Therapies Department, Stanmore, United Kingdom
Background: The impact of atraumatic shoulder instability (ASI) on patients can be extensive, with significant functional loss being demonstrated. Management can be complex, with a biopsychosocial approach recommended. A high socioeconomic cost has been attributed to living with ASI; adopting best practice approaches may reduce the burden on limited resources. It is unknown how UK physiotherapists currently manage these patients, and whilst research is available to support exercise and specific rehabilitation protocols, there are no guidelines or overall consensus to direct clinical practice.
Purpose:
Methods: An electronic survey was developed and disseminated through numerous channels including social media, between July-September 2018, targeting UK based physiotherapists managing shoulder pain.
The study was a mixed methods design. Respondents were invited to describe how they would manage ASI using three vignettes depicting differing clinical presentations, and rate their awareness and utilisation of various management approaches. Respondents were asked to consider whether further research or education might be useful for improving management of ASI. Responses to open questions were analysed via content analysis; means and frequency analysis were used for closed questions.
Results: As data collection finished very recently, only preliminary analysis is presented. 149 people completed the survey; 136 met the eligibility criteria. Respondents had a range of experience; the majority (68%) reported that ASI made up a minority ( 10%) of their caseload. Approximately 50% of respondents used a classification system for the vignettes, with >90% using the Stanmore Classification. The majority of respondents (>80%) did not use a protocol to guide their management. The Derby Instability Rehabilitation Protocol was the most commonly used of protocols reported.
Only 23% (n=31/136) of physiotherapists reported feeling 'very confident' in managing ASI, the majority feeling 'somewhat confident' (70%, n=96/136), and 7% (n=9/136) feeling 'not confident'. Rotator cuff and scapular muscle strengthening were the most utilised management approaches; this was reflected in the vignettes. Patient education was commonly utilised in clinical practice; however this was not reflected in vignette answers, where more emphasis upon addressing biomedical needs was observed.
Conclusion(s): Findings indicate physiotherapists are aware of biopsychosocial approaches in managing ASI, utilising a wide range of treatment strategies. The majority reported not being very confident in managing this condition, however only small numbers use rehabilitation protocols to support their management. Some interventions selected lacked evidence to support their use in ASI and further research to establish their efficacy is required. National guidance outlining best practice would be valuable in supporting physiotherapists in managing these complex patients.
Implications:
Keywords: shoulder, instability, survey
Funding acknowledgements: This piece of work was unfunded.
Purpose:
- Establish how UK physiotherapists currently manage ASI, and extent to which guidelines are required to support clinical practice.
- Identify extent to which certain 'novel' treatment strategies extrapolated from other clinical specialities, such as Graded Motor Imagery, are used for managing ASI.
- Use feedback and responses from survey to help shape future research into physiotherapeutic management of ASI.
Methods: An electronic survey was developed and disseminated through numerous channels including social media, between July-September 2018, targeting UK based physiotherapists managing shoulder pain.
The study was a mixed methods design. Respondents were invited to describe how they would manage ASI using three vignettes depicting differing clinical presentations, and rate their awareness and utilisation of various management approaches. Respondents were asked to consider whether further research or education might be useful for improving management of ASI. Responses to open questions were analysed via content analysis; means and frequency analysis were used for closed questions.
Results: As data collection finished very recently, only preliminary analysis is presented. 149 people completed the survey; 136 met the eligibility criteria. Respondents had a range of experience; the majority (68%) reported that ASI made up a minority ( 10%) of their caseload. Approximately 50% of respondents used a classification system for the vignettes, with >90% using the Stanmore Classification. The majority of respondents (>80%) did not use a protocol to guide their management. The Derby Instability Rehabilitation Protocol was the most commonly used of protocols reported.
Only 23% (n=31/136) of physiotherapists reported feeling 'very confident' in managing ASI, the majority feeling 'somewhat confident' (70%, n=96/136), and 7% (n=9/136) feeling 'not confident'. Rotator cuff and scapular muscle strengthening were the most utilised management approaches; this was reflected in the vignettes. Patient education was commonly utilised in clinical practice; however this was not reflected in vignette answers, where more emphasis upon addressing biomedical needs was observed.
Conclusion(s): Findings indicate physiotherapists are aware of biopsychosocial approaches in managing ASI, utilising a wide range of treatment strategies. The majority reported not being very confident in managing this condition, however only small numbers use rehabilitation protocols to support their management. Some interventions selected lacked evidence to support their use in ASI and further research to establish their efficacy is required. National guidance outlining best practice would be valuable in supporting physiotherapists in managing these complex patients.
Implications:
- Further research is required to determine the efficacy of more novel approaches utilised in clinical practice of ASI.
- There is clear need for national guidance on the management of ASI to align practice with existing research and recommendations.
Keywords: shoulder, instability, survey
Funding acknowledgements: This piece of work was unfunded.
Topic: Musculoskeletal: upper limb; Orthopaedics
Ethics approval required: Yes
Institution: The University of Hertfordshire
Ethics committee: Health, Science, Engineering and Technology Ethics Committee
Ethics number: HSK/PGT/UH/03371
All authors, affiliations and abstracts have been published as submitted.
