Exploring clinician perceptions of a care pathway for the management of shoulder pain: a qualitative study

Abstract

Background Clinical care pathways may be useful tools to improve the quality of healthcare by facilitating the translation of evidence into practice. Our study is situated within a larger project, whereby end-users co-developed a care pathway for the management of shoulder pain. In this study, we explored end-user perceptions of the usefulness and practicality of implementing a care pathway to manage shoulder pain. We also solicited feedback for the pathway’s improvement. Methods We conducted a qualitative study using a transcendental phenomenological approach seen through a constructivist lens. Clinicians recorded themselves interacting with the care pathway while working through a clinical case. Clinicians described their thoughts and movements aloud as they completed the activity. Second, we conducted individual semi-structured interviews to discuss the usefulness and practicality of pathway implementation. Interview transcripts were coded independently by reviewers. Transcript codes and associated quotes were grouped into themes. Themes were sequenced and linked creating a ‘web’ of thematic connections. Summary statements were developed to synthesize the overall essence of the phenomena. Results Nine clinicians participated. Participants included eight chiropractors and one medical physician. We found that clinicians believed the care pathway could be useful at various levels, including education (students, interns), for early career clinicians, for engaging patients, facilitating interprofessional communication, and as a reminder of information for certain, less familiar conditions. When discussing the practicality of implementing the care pathway into practice settings, clinicians expressed that agreement with the care pathway and its recommendations may influence its acceptability among clinicians. Additionally, integrating recommendations into practice may be a skill requirement included into clinical training. Clinicians described the importance of opinion leaders in the acceptability of new evidence. Various difficulties with the replicability of interventions into clinical care was also discussed. In general, clinicians suggested the layout of the care pathway was manageable, and there was sufficient information for clinical decision-making. Clinicians also made several recommendations for improvement. Conclusions End-user involvement and collaboration provides tangible instruction to improve care pathways themselves, their implementation strategies and helps to support and strengthen future research for overcoming individual, systemic and contextual barriers.

Raising Awareness on the Clinical and Social Relevance of Adequate Chronic Pain Care

“…It has been suggested that clinical care pathways could serve as useful tools to improve the quality of healthcare by facilitating the translation of evidence into practice [58]. Therefore, great efforts have been put in place by multiple scientific bodies and societies to develop best practice recommendations and propose pain care pathways.…”

The Correlation between Various Shoulder Anatomical Indices on X‐Ray and Subacromial Impingement and Morphology of Rotator Cuff Tears

“…Our analyses suggest that the location of potential rotator cuff tears can be predicted by considering the radiographic indices from shoulder X‐rays. Thus, if the location of shoulder pain is accordant with the location of a potential rotator cuff tear, it is easier for the clinician to make an accurate diagnosis 13 . Furthermore, by knowing the location of a potential rotator cuff tear, daily shoulder activity or exercise should be considered so as to avoid excessive use of the susceptible tendon 28 .…”

“…Thus, if the location of shoulder pain is accordant with the location of a potential rotator cuff tear, it is easier for the clinician to make an accurate diagnosis. 13 Furthermore, by knowing the location of a potential rotator cuff tear, daily shoulder activity or exercise should be considered so as to avoid excessive use of the susceptible tendon. 28 When sub‐acromial block therapy is required, the location of the potential rotator cuff injury can be predicted from radiographic indices, thus allowing clinicians to guide the drug distribution.…”

“…However, our own clinical observations suggest that this can be divided into four types: horizontal tears, longitudinal tears, L‐shaped tears, and irregular tears. By understanding the correlation of the radiographic indices with the location of the rotator cuff tear, we can more accurately connect the location of shoulder pain to sub‐acromial impingement and then make an accurate diagnosis 13 . For patients with diagnosed sub‐acromial impingement and potential rotator cuff injury, this will allow us to guide patients to correct inappropriate habits of shoulder movements and prevent or delay rotator cuff injury 14 .…”

“…By understanding the correlation of the radiographic indices with the location of the rotator cuff tear, we can more accurately connect the location of shoulder pain to sub‐acromial impingement and then make an accurate diagnosis. 13 For patients with diagnosed sub‐acromial impingement and potential rotator cuff injury, this will allow us to guide patients to correct inappropriate habits of shoulder movements and prevent or delay rotator cuff injury. 14 This will also help surgeons to perform arthroscopic surgery on such patients and better repair the rotator cuff if the location or the shape of the rotator cuff tear can be predicted in advance, especially for inexperienced surgeons or when shoulder MRI cannot be acquired (even with shoulder MRI, the positional function is limited in early rotator cuff injury).…”