A. Smythe1,2, S. Rathi1, N. Pavlova1, D. Connell3,4, C. Littlewood5, P. Malliaras1, T. Haines1
1Monash University, School of Primary and Allied Health Care, Frankston, Australia, 2Health Base, Somerville, Australia, 3Monash University, Department of Medical Imaging and Radiation Sciences, Clayton, Australia, 4Imaging @ Olympic Park, Melbourne, Australia, 5Manchester Metropolitan University, Faculty of Health, Psychology and Social Care, Manchester, United Kingdom
Background: Shoulder pain is one of the most common musculoskeletal conditions with an estimated prevalence of 15-30% of the population at any one time, rotator cuff related shoulder pain (RCRSP) is thought to be the most common presentation accounting for 70% of shoulder pain cases. Recommended first-line treatment includes advice, activity modification and clinician guided exercise, for 6 – 12 weeks before considering imaging, injection or surgical opinion. Recent surveys indicate that physiotherapists in Australia, the United Kingdom, Belgium and The Netherlands, broadly deliver guideline based management for people with RCRSP. A recent Australia-wide survey and a database study of RCRSP management by general practitioners both demonstrate high rates of imaging referral prior to recommended non-invasive first-line, and to a lesser extent injection and surgical referrals. It is important to understand treatment trends from the patient’s perspective to determine whether they receive guideline recommended care and understand the impact of their beliefs on care experiences.
Purpose: The primary aim of this study was to investigate self-reported management among people with RCRSP and the extent to which current management of RCRSP is consistent with guideline recommendations. Understanding patient beliefs and their impacts on patient management journey was the secondary aim.
Methods: A cross-sectional survey exploring patient experience of RCRSP management and beliefs of 120 patients with RCRSP. Qualitative content analysis and statistical analysis were used to analyse survey results.
Results: In our cohort, most people with RCRSP had tried exercise but patient opinion of exercise being helpful or un-helpful was mixed. Some don’t receive advice on activity modification, those that do receive inconsistent messaging that often is contrary to guideline recommendations. Regardless of traumatic onset, most people have interventions such as imaging, injections, and surgery prior to commencing or completing guideline recommended conservative management. This could be explained by beliefs of the cohort, the majority deeming imaging necessary for correct diagnosis and often highlighting surgery as the most effective treatment modality.
Conclusion(s): Patient reported management of RCRSP is often inconsistent with guideline recommended management. This may partially be explained by patient beliefs that best management requires interventionalist care.
Implications:
- Consideration should be given to patient beliefs on diagnosis and management that may influence treatment pathways. Education or discussion could reduce the impact of interventionalist belief systems but this should be investigated further.
- Although most people (82.5%) tried exercise, only about one in five people reported it was helpful and one in six people reported it was unhelpful or harmful. More research is required to understand why are patient experiences so varied.
- Contrary to guideline recommendations, many patients don’t receive activity modification advice and have earlier than recommended imaging, injections or surgery.
- Physiotherapists as primary healthcare practitioners have an opportunity to decrease the rate of interventionalist care and provide best practice conservative management.
Funding, acknowledgements: This work was unfunded
Keywords: rotator cuff related shoulder pain, management, shoulder
Topic: Musculoskeletal: upper limb
Did this work require ethics approval? Yes
Institution: Monash University
Committee: Monash University Human Research Ethics Committee
Ethics number: 12800
All authors, affiliations and abstracts have been published as submitted.
