Abstract
Background: Rotator cuff related shoulder pain is the most commonly identified source of pain and loss of function in musculoskeletal disorders of the shoulder joint. There is good evidence to support exercise therapy as the primary intervention however more high quality research evidence is needed. In addition to managing people with rotator cuff related shoulder pain successfully with physiotherapy using traditional one to one sessions, a question has been raised as to whether or not this cohort of patients could be managed effectively and acceptably in group treatment sessions.Purpose: To design a feasibility study protocol for a future randomised controlled trial that would support service redesign by testing the question: "Do patients with rotator cuff related shoulder pain receiving physiotherapy intervention in group sessions have similar outcomes, a reduction in pain, restored function and satisfaction with their management, compared to those treated individually?"
Methods: Three separate phases of research were undertaken to provide evidence to underpin the design of the feasibility study (two systematic reviews and an observational study). The first systematic review used the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology to find the outcome measure/s with the most robust evidence to support use in a clinical setting. A second systematic review based on the Cochrane methodology, was used to identify an exercise programme with the best overall quality evidence to help rehabilitate patients with rotator cuff related shoulder pain. An observational study based on the Strengthening the Reporting of Observational Studies in Epidemiology checklist, provided useful background logistical information for the design of feasibility study.
Results: The shortened version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) and the Western Ontario Rotator Cuff Index (WORC) were identified as the outcome measures with the most robust evidence to support their use in clinical practice for patients with musculoskeletal shoulder pain. Additionally, other patient reported outcome measures were also deemed appropriate for clinical use whilst awaiting further research. In the second systematic review all types of exercise were found to be effective in the management of patients with rotator cuff related shoulder pain. One study was identified as being of lower risk of ineffectiveness in relation to dosage than the others (Blume et al., 2015), therefore the frequency, intensity, type and timing of that exercise programme was integrated into the feasibility study design. The observational study provided useful population characteristic data and identified a number of confounders, for example adherence to research protocol which has influenced the design of the feasibility study protocol.
Conclusion: Evidence based medicine is key to effective, appropriate and safe health care delivery. The feasibility study protocol designed as a result of three phases of research has been developed to enable the future testing of a clinical question which was posed to the researcher in relation to a mode of service delivery to support service redesign. To ensure appropriate rigor is applied a mechanism to address adherence has also been embedded.
| Date of Award | 2021 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Lesley Holdsworth (Supervisor), Lorna Paul (Supervisor) & Tracey Howe (Supervisor) |