Managing shoulder pain: a meta-ethnography exploring healthcare providers’ experiences

Abstract

Objective

To review and synthesize qualitative research studies exploring the experiences of Healthcare Providers (HCPs) of managing shoulder pain.

Methods

A meta-ethnographic approach was adopted to review and synthesize eligible studies. The findings from each included study were translated into one another using Noblit and Hares’ seven-stage process. A systematic search of eleven electronic databases was conducted in February 2021. Methodological quality was assessed using the CASP Appraisal Tool.

Results

Ten studies were included in the meta-synthesis, all deemed of high methodological quality. Three themes were identified; (1) Lack of consensus: “we all have different approaches.” (2) Challenges to Changing Practice: It’s “really hard to change and switch to a different approach,” (3) Getting “Buy in” to Treatment: “…so you have to really sell it early”.

Conclusion

Healthcare providers working with people with shoulder pain struggle to reconcile, often conflicting, research recommendations with their own clinical experience, beliefs and patient expectations. These findings help explain the continued lack of consensus on how best to manage shoulder pain in clinical practice.

IMPLICATIONS FOR REHABILITATION

• Healthcare providers (HCPs) working with people with shoulder pain struggle to resolve conflicts between evidence-based recommendations, clinical experience, their own shoulder pain beliefs and patient expectations and preferences.

• Stronger collaboration across professional disciplines is needed to address the current lack of consensus on the management of shoulder pain.

• Many HCP’s find it difficult to engage patients with shoulder pain in exercise and they work hard to “sell” this approach to patients using strategies such as education, shared decision making and therapeutic alliance.

Keywords:

• Shoulder pain
• healthcare provider
• rotator cuff
• qualitative research
• qualitative evidence synthesis
• meta-ethnography

Author contributions

The IRC had no role in conducting or publishing this review. KM is responsible for the conception of the review. All authors contributed to the study design and search strategy. CM conducted the search and the screening of titles and abstracts for eligibility. CM and KR assessed all full-text articles for eligibility, with disagreements reviewed by KM. CM and KR appraised the quality of included studies. CM performed data coding and thematic analysis, with contributions from KR and KM. CM wrote the first draft of the article, with KM and KR contributing to each revised version. All authors approved the final submitted article.

Disclosure statement

The authors report no conflict of interest. The Irish Research Council, which provided funding for this review, had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit this article for publication.

Additional information

Funding

This work was supported by the Irish Research Council (IRC) - Postgraduate Scholarship awarded to CM.