C. Maxwell1, K. Robinson1, K. McCreesh1
1University of Limerick, Health Research Institute, Limerick, Ireland

Background: Shoulder pain is the third most common musculoskeletal condition reported in primary care, with about 4% of adults attending their GP with new shoulder pain each year. The general prognosis is highly variable, with 40% of individuals reporting persistent symptoms beyond 1 year. Approaches to the management of shoulder pain vary widely amongst healthcare providers (HCPs), with evidence of inconsistent implementation of first-line treatment options, such as exercise therapy. Researchers are increasingly utilizing qualitative methods in an effort to improve understanding of the challenges HCPs face when applying research evidence for various MSK conditions. However, few qualitative studies exist exploring the experiences of HCPs in managing MSK shoulder pain. Deepening our understanding of HCP experiences of managing shoulder pain is likely to play a key role in improving adherence to evidence-based recommendations.

Purpose: To review and synthesize qualitative research studies exploring the experiences of HCPs of managing shoulder pain to enhance understanding and facilitate improved adherence to evidence-based recommendations.

Methods: A meta-ethnographic approach was adopted to review and synthesize eligible studies. The findings from each included study were translated into one another using Noblit and Hares’ seven-stage process. A systematic search of 11 electronic databases was conducted in March 2020. Methodological quality was assessed using the CASP Appraisal Tool.

Results: Nine studies were included in the meta-synthesis, all deemed to be of high methodological quality. Three themes were identified;
1) Dealing with Uncertainty: “we all have different approaches.”,
2) Challenges to Changing Practice: It’s “really hard to change and switch to a different approach”,
3) Getting “Buy in” to Treatment: “…so you have to really sell it early”.
For many HCPs, their experience of treating people afflicted with shoulder pain was fraught with uncertainty, with no clear consensus on diagnosis or treatment. Widely varying views were reported in relation to common treatment approaches. Learnt practices as well as individual opinions and preferences strongly influenced readiness to explore new or alternative approaches. Many HCPs viewed exercise therapy as a challenging treatment option to ‘sell’ to patients.

Conclusion(s): Although HCPs are undoubtedly unified in their goal to provide care and support for individuals with shoulder pain, they face many uncertainties and challenges. It is hoped that a more in-depth understanding of these experiences can be used to close this perceived evidence-practice gap thereby ensuring that a more unified and consistent level of high-quality evidence-based care is delivered to patients impacted by this debilitating condition.

  • The findings of this review highlight the need to reduce variation and improve consistency amongst HCPs in the application of best practice recommendations for the management of shoulder pain. 
  • HCPs are urged to reflect on their opinions and preferences towards managing shoulder pain, recognising the potentially negative influence that arises when this conflicts with research recommendations.
  • Early education and early ‘buy-in’ to exercise have been identified as key factors to improve treatment outcomes. Accordingly, these should be prioritised by HCPs in their early encounters with patients.

Funding, acknowledgements: This work was supported by the Irish Research Council (IRC) - Postgraduate Scholarship awarded to Christina Maxwell in 2018. 

Keywords: Musculoskeletal Shoulder Pain, Healthcare Provider Experience, Qualitative Evidence Synthesis

Topic: Musculoskeletal: upper limb

Did this work require ethics approval? No
Institution: University of Limerick
Committee: University of Limerick Research Ethics Committee
Reason: This study is a review of published research, and therefore ethical approval was not required.

All authors, affiliations and abstracts have been published as submitted.

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