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Rotator cuff-related shoulder pain (RCRSP): Semi-structured patient interviews to explore the barriers and enablers to rehabilitation exercises

Singh, Vincent; Berry, Alice; Cramp, Fiona


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Dr Alice Berry
Associate Professor of Rehabilitation

Fiona Cramp
Professor in Long Term Conditions


Purpose: RCRSP accounts for 50-85% of diagnoses for shoulder pain and rehabilitative exercises are recommended for management. In practice, 50-70% of patients are either non-adherent or only partially adherent to exercise. This study aimed to explore the barriers and enablers to rehabilitation exercises for people with RCRSP and to inform the development of a theoretically informed intervention.
Methods: Eleven individuals with RCRSP were identified via NHS England physiotherapy outpatient departments and invited to participate in semi-structured interviews. An advisory panel inputted at all stages of the study.
A topic guide was developed to explore why people with RCRSP did or did not adhere to physiotherapy prescribed exercises. Interviews were conducted via telephone and recorded. Recordings were transcribed, checked for accuracy and pseudonymised.
Data were analysed using content analysis and codes assigned to TDF domains through first level coding. Thematically similar responses were grouped in a process of data reduction and compared across transcripts. Tables were produced to highlight key thematic content, barriers and enablers within each TDF domain. Domains were identified as salient based on their frequency of inclusion and potential strength of impact.
Results: The following four themes were identified:
The impact of previous experience on beliefs.
Previous experience with physiotherapy exercises impacted beliefs. Those who had successful treatment experiences had positive beliefs that physiotherapy worked (TDF beliefs), whereas those who had no previous physiotherapy experience or did not see improvements with the physiotherapy exercises did not believe they worked. Those with less positive outcomes sometimes felt they were not listened to if they were not experiencing improvements.

Experience of investigations, diagnosis, and patient education.
During the initial consultation patients valued knowing what the problem was and being reassured that it would improve with rehabilitation exercises (TDF knowledge of condition, optimism). There was a disconnect between patient care guidelines and patient expectancies (TDF environmental context) with participants believing that investigations should have been undertaken to guide treatment (TDF belief expectancy).

A long and slow pathway to treatment.
Patients reported their treatment journey was ‘long winded’ with delayed access to services because of COVID-19. For some, alternative routes to treatment through private healthcare resulted in them seeing a healthcare professional much sooner.

Seeing positive outcomes and incorporating exercises into daily life.
Patients were more inclined to do the exercises if they felt improvements and incorporated them into their daily routine (TDF self-confidence and skill development).
Conclusion(s): Patients should be given clear information about the relevance of scans, a clear diagnosis and specific physiotherapy exercise prescription (TDF knowledge, skill development).
Identification of factors that influence adherence to shoulder rehabilitation exercises will inform the development of interventions designed to improve adherence, potentially improving clinical outcomes and reducing costs.
Impact: This research is intended to lead to better patient outcomes, improve clinicians understanding of patient support needs and reduce costs to both the health service and the individual service user.

Presentation Conference Type Presentation / Talk
Conference Name Chartered Society of Physiotherapy Annual Conference 2023
Start Date Nov 1, 2023
End Date Nov 1, 2023
Deposit Date Nov 3, 2023
Keywords adherence, shoulder, rehabilitation
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