Fostering Adherence to Evidence-Based Care in the Management of Musculoskeletal Shoulder Pain: A Mixed-Methods Study

Abstract

Objective: The objective was to identify the priorities of individuals with musculoskeletal shoulder pain and their health care providers (HCPs) that are perceived to foster multistakeholder adherence to evidence-based recommendations.

Methods: The study used a mixed-methods design, informed by concept mapping. Patients with shoulder pain (ie, ≥6 weeks) and HCPs involved in their care (recruited via social media, email, etc) were invited to complete an initial survey to identify perceived priorities to foster adherence to evidence-based recommendations. Preliminary data sorting resulted in a final priority list, with a subset (n = 20) of respondents rating their importance using a Likert scale. A public and patient involvement (PPI) panel (N = 8) assisted in this rating phase, further sorting of priorities based on thematic similarities (ie, into categories and then domains), analysis, interpretation, and developing a concept map illustrating relationships between them.

Results: One hundred and fifty-four participants (HCPs = 133; patients = 21) responded to the initial survey, generating 77 priorities, grouped into 13 categories, and then into 3 domains: (1) Education, (2) Patient-centered care, and (3) Health care communication. Patients prioritized categories relating to the provision of a specific diagnosis, the establishment of a strong therapeutic relationship, and the need for education on progress and recovery timelines, as well as treatment options. HCPs prioritized these same educational categories, also prioritizing the need for tailoring exercise therapy and providing a unified message on best management. PPI panelists identified education on treatment options coupled with a strong therapeutic alliance and a unified message on best management to be of pivotal importance in fostering adherence. Panelists also stressed that future knowledge translation resources must provide tailored education.

Conclusion: HCPs and patients agree on the need to prioritize education related to progress and recovery timelines as well as treatment options, with a strong therapeutic alliance and a unified message on best management also considered of pivotal importance for adherence to evidence-based recommendations.

Impact: To the knowledge of the authors, this is the first study, including a broad range of stakeholder groups spanning across 11 different countries, to explore the priorities that stakeholders perceived to support stricter adherence to evidence-based recommendations for musculoskeletal shoulder pain, with the relationship between these priorities visually illustrated using a concept map. Patients and HCPs were united in their prioritization of education relating to expected progress and recovery timelines, as well as treatment options and supporting evidence. Stakeholders also identified the need for greater emphasis to be placed on establishing a therapeutic relationship and on integrating shared decision-making into clinical practice to further facilitate adherence. Education relating to treatment options and supporting evidence, a strong therapeutic relationship, and a unified message on best management were perceived by the PPI panel as being pivotal in facilitating adherence to evidence-based treatment. The findings of this study highlight the need for improved tailoring of educational resources for shoulder pain, as well as more cohesive messaging from health care providers, both assisting in supporting first-line treatments, such as exercise therapy, for musculoskeletal shoulder pain.

Keywords: Concept Mapping; Educational Priorities; Knowledge Translation; Mixed Methods; Public and Patient Involvement (PPI); Shoulder Pain.

Figure 1

Overview of Concept Mapping Approach Illustrating PPI During Phases 2 to 5, With Surveys Conducted as Part of Phases 2 and 3. PPI = public and patient involvement.

Figure 2

Survey Participants and PPI Advisory Panel Recruitment Steps. GP = general practitioner; HCPs = health care providers; ISCPs = Irish Society of Chartered Physiotherapists; OSs = orthopedic surgeons; PPI = public and patient involvement; PTs = physical therapists; SECEC-ESSE = Société Européenne pour la Chirurgie de l’Epaule et du Coude–European Society for Surgery of the Shoulder and the Elbow.

Figure 3

Concept Map Illustrating Categories Prioritized Among Stakeholders as Important for Adherence to Evidence-Based Treatment Recommendations, With the 3 Categories Perceived by the Public and Patient Involvement (PPI) Panel to be of Key Importance Highlighted in Black (ie, Strong Therapeutic Relationship, Unified Message, Treatment options). HCP = health care provider.