Patients with rotator cuff tendinopathy can successfully self-manage, but with certain caveats: A qualitative study

Objectives: Evidence has emerged supporting the value of loaded exercises for rotator cuff tendinopathy but there are barriers that might prevent implementation of this intervention in the real-world. The purpose of this study was to explore these potential barriers with participants involved in a pilot randomised controlled trial (RCT) investigating a self-managed loaded exercise intervention. Design: A qualitative study within the framework of a mixed methods design. Data were collected using individual interviews and analysed using the framework method. Setting: One private physiotherapy clinic in northern England. Participants: Six patients and two physiotherapists were purposively sampled from those allocated to the self-managed exercise group within the RCT. Results: Three themes were generated: (1) Expectations and preferences, (2) characteristics of an unsuccessful outcome, (3) characteristics of a successful outcome. Most patients expressed expectations contrary to the philosophy of a self-managed approach. But this did not serve as a barrier when the intervention was offered within a positive and supporting environment where patients understood the reasons for undertaking the exercise, effectively self-monitored and engaged with pro-active follow-up. An early and appreciable response to therapy was also a key factor influencing continuing engagement with the exercise programme. Conclusion: With certain caveats including the need to recognise and respond to individual characteristics, implement effective knowledge translation strategies and the need to engage with appropriately timed pro-active follow-up, the potential to implement programmes of self-managed loaded exercise for patients with rotator cuff tendinopathy in the real-world and in further research studies appears feasible but challenging.