Patients’ perceptions of the causes and treatments for rotator cuff-related shoulder pain: a content analysis of patient responses and implications for clinician communication

OBJECTIVES: To explore patients' perceptions of the causes and treatments for rotator cuff-related shoulder pain, based on advice recalled from health professionals. METHOD: We conducted an online survey of people with rotator cuff-related shoulder pain who previously received advice from a health professional about their shoulder pain. Participants provided data on demographics, healthcare use and shoulder symptoms, and answered the following free-text response questions: (1) Based on advice you received from a health professional, what is your understanding about what causes shoulder pain? (2) Based on advice you received from a health professional, what is your understanding about the best treatment for shoulder pain? Responses were analysed using summative content analysis. RESULTS: 810 participants completed the survey. Participants commonly attributed their rotator cuff-related shoulder pain to structural (28.5%, n = 231), activity-related (27.9%, n = 226), and trauma (21.4%, n = 173) causes, with limited recognition of psychosocial factors (3.9%, n = 32). Non-invasive treatments were most frequently endorsed, including strengthening exercise (21.4%, n = 173), medication (19.1%, n = 155), rest (13.8%, n = 112), physiotherapy (13.1%, n = 106), hot and cold modalities (12.1%, n = 98). Psychological (0.2%, n = 2) and surgical (7%, n = 57) treatments were comparatively infrequently endorsed. CONCLUSION: Based on advice recalled from healthcare professionals, patients' perceptions of the causes and best treatments for rotator cuff-related shoulder pain were predominantly framed in biomechanical terms including structural, activity or acute injury causes, with psychosocial dimensions largely underrepresented. These findings highlighted the need for clinicians to consistently deliver evidence-based explanations, including education on pathology and multi-factorial nature of pain, and promote active simple management strategies.