Patient experiences of rotator cuff-related shoulder pain and their views on diagnostic shoulder imaging: a qualitative study

Peter Malliaras; Mary O'Keeffe; Jacqueline Ridgway; Rhiannon Whale; Vasish Vasan; Patrick L'Huillier; Mitch Towers; Melanie K Farlie

doi:10.1080/09638288.2023.2296986

Patient experiences of rotator cuff-related shoulder pain and their views on diagnostic shoulder imaging: a qualitative study

Disabil Rehabil. 2023 Dec 28:1-8. doi: 10.1080/09638288.2023.2296986. Online ahead of print.

Authors

Peter Malliaras¹, Mary O'Keeffe², Jacqueline Ridgway³, Rhiannon Whale¹, Vasish Vasan¹, Patrick L'Huillier¹, Mitch Towers¹, Melanie K Farlie¹

Affiliations

¹ Physiotherapy Department, Monash University, Melbourne, Australia.
² Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia.
³ Physiotherapy Department, Frankston Hospital, Peninsula Health, Victoria, Australia.

PMID: 38153258
DOI: 10.1080/09638288.2023.2296986

Abstract

Purpose: To explore patient experiences of rotator cuff-related shoulder pain, and their views on the role and value of diagnostic shoulder imaging.

Materials and methods: Semi-structured interviews were conducted with 20 patients with shoulder pain exploring the impact and management of their shoulder condition, reasons for and experiences of diagnostic imaging, and feelings about and responses to diagnostic imaging findings. Framework analysis was used to analyse the dataset.

Results: Five themes were identified [1]: Lived experience and beliefs about pain and movement [2]; Contextualisation of imaging findings by health professionals is more important than the imaging report [3]; Factors influencing whether and when to have imaging [4]; Imaging can identify the actual problem and guide treatment; and [5] Treatment responses and treatment decision making.

Conclusion: Patients commonly believe imaging is needed to formulate a diagnosis. There was minimal concern about potential indirect harms that could arise (e.g., inappropriate diagnosis leading to unnecessary treatments). The context of the diagnostic imaging reports (i.e., what needed to be done) was perceived as more important than the exact meaning of the imaging findings. Patients felt that the diagnostic imaging confirmed their existing biomedical beliefs, and these beliefs were not challenged by their healthcare professionals.IMPLICATIONS FOR REHABILITATIONPatients with shoulder pain may believe imaging is necessary for diagnosis and defining treatment yet do not consider potential indirect harms (e.g., unnecessary treatment for findings that are not relevant).Health professionals should ensure patients are aware of imaging limitations and harms and facilitate shared decision-making about whether to have imaging.Health professionals also have an important role in the appropriate contextualisation of imaging findings (i.e., they do not necessarily relate to pain nor guide treatment).

Keywords: Tendinopathy; diagnostic imaging; phenomenological approach; qualitative; shoulder pain.