Background & Aims

Background: Rotator cuff-related shoulder pain is an umbrella diagnosis that captures pathology related to the rotator cuff (e.g. tendinopathy, tear, tendinitis) or subacromial bursa (e.g. bursitis).[1] It is the most common cause of shoulder pain.[2] Education is recommended in clinical practice guidelines for most musculoskeletal conditions.[3] However, guidelines for the management of rotator cuff-related shoulder pain rarely mention education.[4] This likely due to a paucity of trials evaluating it as an intervention.

Aims: The primary aim of this study was to investigate the immediate effect of best practice education (with and without pain science messages) and structure-focused education on reassurance among people with rotator cuff-related shoulder pain. Our secondary aims were to investigate the effect of this education on management intentions, credibility and relevance of the education, and similarity to previous education.

Methods

Methods: We conducted a three-arm parallel-group randomised experiment. People with rotator cuff-related shoulder pain were randomised (1:1:1) to i) best practice education (highlights most shoulder pain is not serious or a good indicator of tissue damage and recommends simple self-management strategies); ii) best practice education plus pain science messages (which attempt to improve understanding of pain); and iii) structure-focused education (highlighting structural changes are responsible for pain and should be targeted with treatment). Co-primary outcomes were self-reported reassurance that no serious condition is causing their pain and continuing with daily activities is safe (both measured on a 0-10 scale). Secondary outcomes measured management intentions (0-10), credibility (0-40) and relevance of the education (0-10), and similarity to previous education (yes/no).

Results

Results: 2,237 participants were randomised and provided primary outcome data. Best practice education increased reassurance that no serious condition is causing their pain (estimated mean effect 0.5 on a 0-10 scale, 95% CI 0.2 to 0.7) and continuing with daily activities is safe (0.6, 95% CI 0.3 to 0.8) compared to structure-focused education. Adding pain science messages to best practice education slightly increased both measures of reassurance (0.2, 95% CI 0.0 to 0.4) compared to best practice education alone. For our secondary outcomes, best practice education (with or without pain sciences messages) led to greater intentions to stay active and was slightly more credible and relevant than structure-focused education. Only best practice education alone led to lesser intentions to see a health professional and see a surgeon, while adding pain science messages led to greater intentions to request diagnostic imaging.

Conclusions

Conclusion: Clinicians treating patients with rotator cuff-related shoulder pain should highlight most shoulder pain is not serious or a good indicator of tissue damage and recommend simple self-management strategies. The benefit of adding pain science messages is likely small.

References

1. Whittle S, Buchbinder R. In the clinic. Rotator cuff disease. Ann Intern Med. 2015;162(1):Itc1-15.
2. Ostor AJ, Richards CA, Prevost AT, Speed CA, Hazleman BL. Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology (Oxford). 2005;44(6):800-5.
3. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-803.
4. Doiron-Cadrin P, Lafrance S, Saulnier M, Cournoyer É, Roy JS, Dyer JO, et al. Shoulder Rotator Cuff Disorders: A Systematic Review of Clinical Practice Guidelines and Semantic Analyses of Recommendations. Arch Phys Med Rehabil. 2020;101(7):1233-42.

Presenting Author

Joshua Zadro

Poster Authors

Joshua Zadro (PhD)

PhD

The University of Sydney

Lead Author

Giovanni Ferreira

PhD

The University of Sydney

Lead Author

Ryan Muller

DC

VA Connecticut Healthcare System

Lead Author

Luis Fernando Sousa Filho

Monash University

Lead Author

Peter Malliaras

Monash University

Lead Author

Courtney West

BMCS

The University of Sydney

Lead Author

Mary O’Keeffe

PhD

The University of Sydney

Lead Author

Chris G. Maher - DMedSc

Institute for Musculoskeletal Health, The University of Sydney

Lead Author

Topics

  • Education