How do people perceive different labels for rotator cuff disease? A content analysis of data collected in a randomised controlled experiment

Abstract

ObjectivesExplore how people perceive different labels for rotator cuff disease in terms of words or feelings evoked by the label and treatments they feel are needed.SettingWe performed a content analysis of qualitative data collected in a six-arm, online randomised controlled experiment.Participants1308 people with and without shoulder pain read a vignette describing a patient with rotator cuff disease and were randomised to one of six labels: subacromial impingement syndrome, rotator cuff tear, bursitis, rotator-cuff-related shoulder pain, shoulder sprain and episode of shoulder pain.Primary and secondary outcomesParticipants answered two questions (free-text response) about: (1) words or feelings evoked by the label; (2) what treatments they feel are needed. Two researchers iteratively developed coding frameworks to analyse responses.Results1308/1626 (80%) complete responses for each question were analysed. Psychological distress (21%), uncertainty (22%), serious condition (15%) and poor prognosis (9%) were most often expressed by those labelled with subacromial impingement syndrome. For those labelled with a rotator cuff tear, psychological distress (13%), serious condition (9%) and poor prognosis (8%) were relatively common, while minor issue was expressed least often compared with the other labels (5%). Treatment/investigation and surgery were common among those labelled with a rotator cuff tear (11% and 19%, respectively) and subacromial impingement syndrome (9% and 10%) compared with bursitis (7% and 5%).ConclusionsWords or feelings evoked by certain labels for rotator cuff disease and perceived treatment needs may explain why some labels drive management preferences towards surgery and imaging more than others.

How do people perceive different advice for rotator cuff disease? A content analysis of qualitative data collected in a randomised experiment

“… 32 Labelling rotator cuff disease as a rotator cuff tear more often elicited words or feelings of psychological distress, uncertainty, having a serious issue and perceiving a poor prognosis, and treatment needs of surgery, compared with labelling as bursitis . 15 This likely explains why labelling as bursitis (vs rotator cuff tear ) reduces perceived need for surgery. 11 Similarly, labelling non-specific low back pain as a disc bulge , degeneration or arthritis more often elicited feelings of perceiving a poor prognosis and having tissue damage compared with labelling as lumbar sprain , non-specific low back pain and an episode of low back pain , 32 which likely explains why the latter group of labels reduce perceived need for unnecessary care (eg, surgery, imaging).…”

“…We did not ask any questions to explore perceptions about labels as this had already been done in our previous study (Trial 1). 15 …”

“…First, the two researchers (JRZ and ZAM) and a group of five Master of Public Health students (FA, YL, EW, JY and KZ) familiarised themselves with the responses and with the coding frameworks used in our previous content analysis exploring how people perceive different labels for rotator cuff disease (trial 1). 15 Trial 1 asked participants almost identical free-text response questions (except focused on labels instead of advice) and provided a good starting point to develop new frameworks for this study. Second, using an inductive approach embedded in grounded theory, JRZ and ZAM independently developed draft frameworks (one for each question) and coded 100 responses from each group for both questions (~5% of all responses).…”

“… 11 A content analysis of qualitative data collected in this study suggests that the label rotator cuff tear more often evokes feelings of psychological distress, the perception that the condition is serious and has a poor prognosis and increases perceived need for diagnostic imaging and surgery, compared with other labels (eg, bursitis ). 15 These findings are important because surgery and diagnostic imaging are of limited value for most people with shoulder pain, 8 16 17 yet their use is common and increasing in some countries. 18–23…”

Public and patient perceptions of diagnostic labels for non-specific low back pain: a content analysis

“…Uninformative responses (e.g.,"I don't want to answer this question") were not coded. Content analysis combines both qualitative and quantitative methods, allowing both the content and frequency of categories to be reported [14,15]. Content analysis is an appropriate research method for examining text data [16], and has been used in a previous study to examine people's responses to different labels for rotator cuff disease [15,17].…”