Illness perceptions and emotional and behavioural responses in individuals with persistent rotator cuff related shoulder pain: a qualitative study

Shoulder pain is highly prevalent in the general population with rotator cuff related shoulder pain being the most commonly reported diagnosis. For a proportion of individuals, persistent symptoms are experienced despite a variety of conservative and surgical options being available. Persistent symptoms lead to considerable functional limitation and detrimental impact on individuals’ well-being. There is a qualitative evidence gap in our understanding of the interconnected cognitive, emotional and behavioural components of the experience of persistent rotator cuff related shoulder pain. A structured review of qualitative evidence was conducted to determine current understanding of the biopsychosocial factors influencing an individual’s experience of living with persistent rotator cuff related shoulder pain. The findings indicated that, although there were clear cognitive, behavioural and emotional components, the understanding of the interconnection between these components was limited. There was also a lack of understanding of the emotional and behavioural components compared to the cognitive influences, and a lack of qualitative research exploring the experience of rotator cuff related shoulder pain using phenomenological approaches. The findings of the evidence synthesis informed the aims and objectives of the primary research. Adopting a qualitative approach, the primary research of this Professional Doctorate aimed to explore illness perceptions and emotional and behavioural responses in individuals with persistent rotator cuff related shoulder pain. The research was underpinned by Merleau-Ponty’s phenomenology. Individuals with persistent rotator cuff related shoulder pain were purposively selected (n=8) from one health board in Scotland. Semi-structured interviews were carried out with data analysed using a three-step phenomenological approach. The findings indicated that the experience of persistent rotator cuff related shoulder pain was unique to each individual and may be embodied. Persistent symptoms may lead to biographical disruption and challenge the sense of self. The impact permeates many aspects of individuals lives both physically, cognitively and emotionally. The emotions experienced may fluctuate and at times be conflicting. Further research is required to broaden our understanding of the implicit and explicit behaviours of individuals with rotator cuff related shoulder pain. For the findings of this research to be implemented into clinical practice, understanding physiotherapists’ perceptions of the key concepts of embodiment and biographical disruption would be required.