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 selfmanaged loaded exercise for patients with rotator cuff tendinopathy in the real-world and in further research studies appears feasible but challenging. (C) 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.