PHYSIOTHERAPY MANAGEMENT OF ROTATOR CUFF-RELATED SHOULDER PAIN IN GERMANY IS BROADLY CONSISTENT WITH RECOMMENDED PRACTICE: AN OBSERVATIONAL STUDY

¹European University of Applied Sciences Rhein/Erft, Department of Applied Health Sciences, Rostock, Germany

Background: Rotator cuff-related shoulder pain (RCRSP) is a common and disabling cause of shoulder pain. Current clinical practice guidelines recommend conservative treatment as initial management, including at least twelve weeks of patient education and exercise therapy.Study results from the United Kingdom, Belgium and the Netherlands, Italy, Australia, and France show that current physiotherapy practice is mostly consistent with guideline recommendations. In contrast to these countries, the primary qualification of physiotherapists in Germany is not academically based, but a three-year program of vocational training.It is unknown to what extent German physiotherapists are consistent with providing recommended management of RCRSP, and if this is similar to other countries.

Purpose: The aim of this study was to investigate the current state of physiotherapy management of RCRSP in Germany, and if this is consistent with recommended care. Study results aimed to reveal possible differences between academically and non-academically trained physiotherapists, as well as compare management to that of other countries.

Methods: An English case vignette-based questionnaire, which had been applied in other studies, was translated, and adapted into German context. An online cross-sectional survey was conducted from January 2022 to March 2022. Relationships between different data were analysed using a Chi-square test or Fisher's exact test. A qualitative content analysis was conducted for the open-ended questions.

Results: One hundred and ninety-two German physiotherapists responded to the survey. Results showed that most physiotherapists use exercise therapy (99%; 190/192) and patient education (99%; 190/192) for RCRSP management in line with guideline recommendations. Non-academically trained physiotherapists were more likely to use passive interventions (i.e., electrotherapy, taping) with unclear or missing evidence as to why. Views on the design of specific parameters of exercise therapy (i.e., type of exercise, dosage etc.) varied widely within the cohort, but were comparable with findings from the UK, Belgium and the Netherlands, Italy, Australia, and France.

Conclusions: German physiotherapy management for RCRSP is generally consistent with the recommendations of current evidence, but exercise strategies and exercise parameters show high heterogeneity. Compared to similar international studies, German physiotherapists provided less research based clinical reasoning to their management choices.

Implications: German physiotherapists although generally consistent with recommended management, were much less likely to be able to clinically reason their management choices compared to international cohorts. Physiotherapists who are non-academically trained have higher rates of passive interventions, not in line with current recommendations. The education pathway of physiotherapists in Germany compared with other countries may explain higher rates of passive interventions and non-evidence-based management, a review into education practices is indicated to understand why this gap exists.

Funding acknowledgements: No funding was received for this study.

Keywords:
Evidence-based practice
Physiotherapy management
Rotator cuff

Topics:
Musculoskeletal: upper limb
Professional practice: other

Did this work require ethics approval? No

Reason: An anonymous nationwide online-survey with physiotherapists was performed. All participants gave written consent as part of the survey prior to data collection. You will find the information letter (a translated English version below)