How do people perceive different advice for rotator cuff disease? A content analysis of qualitative data collected in a randomised experiment

• Published in: BMJ open Vol. 13; no. 5; p. e069779
• Main Authors: Zadro, Joshua R, Michaleff, Zoe A, O'Keeffe, Mary, Ferreira, Giovanni E, Traeger, Adrian C, Gamble, Andrew R, Afeaki, Frederick, Li, Yaozhuo, Wen, Erya, Yao, Jiawen, Zhu, Kejie, Page, Richard, Harris, Ian A, Maher, Christopher G
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 05.05.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Bursitis; Content analysis; Data collection; Elbow & shoulder; Exercise; Exercise Therapy; Experiments; General practice / Family practice; Humans; Labeling; Musculoskeletal disorders; Pain; Rehabilitation medicine; Rheumatology; Rotator cuff; Rotator Cuff - surgery; Rotator Cuff Injuries - therapy; Shoulder; Shoulder Pain - therapy; Surgery; Treatment Outcome; Musculoskeletal disorders; Elbow & shoulder; REHABILITATION MEDICINE; Rheumatology
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-069779

ObjectivesTo explore how people perceive different advice for rotator cuff disease in terms of words/feelings evoked by the advice and treatment needs.SettingWe performed a content analysis of qualitative data collected in a randomised experiment.Participants2028 people with shoulder pain read a vignette describing someone with rotator cuff disease and were randomised to: bursitis label plus guideline-based advice, bursitis label plus treatment recommendation, rotator cuff tear label plus guideline-based advice and rotator cuff tear label plus treatment recommendation. Guideline-based advice included encouragement to stay active and positive prognostic information. Treatment recommendation emphasised that treatment is needed for recovery.Primary and secondary outcomesParticipants answered questions about: (1) words/feelings evoked by the advice; (2) treatments they feel are needed. Two researchers developed coding frameworks to analyse responses.Results1981 (97% of 2039 randomised) responses for each question were analysed. Guideline-based advice (vs treatment recommendation) more often elicited words/feelings of reassurance, having a minor issue, trust in expertise and feeling dismissed, and treatment needs of rest, activity modification, medication, wait and see, exercise and normal movements. Treatment recommendation (vs guideline-based advice) more often elicited words/feelings of needing treatment/investigation, psychological distress and having a serious issue, and treatment needs of injections, surgery, investigations, and to see a doctor.ConclusionsWords/feelings evoked by advice for rotator cuff disease and perceived treatment needs may explain why guideline-based advice reduces perceived need for unnecessary care compared to a treatment recommendation.