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๐ช๐ต๐ ๐ฑ๐ผ๐ฒ๐ ๐๐ผ๐บ๐ฒ๐ผ๐ป๐ฒ ๐ฒ๐น๐ฒ๐ฐ๐ ๐๐๐ฟ๐ด๐ถ๐ฐ๐ฎ๐น ๐ฟ๐ฒ๐ฝ๐ฎ๐ถ๐ฟ ๐ผ๐ณ ๐ฟ๐ผ๐๐ฎ๐๐ผ๐ฟ ๐ฐ๐๐ณ๐ณ ๐๐ฒ๐ป๐ฑ๐ผ๐ป ๐๐ฒ๐ฎ๐ฟ?
Excellent qualitative study by @DrPeteMalliaras et al.
A thread about this article: https://www.tandfonline.com/doi/abs/10.1080/09638288.2021.1879945
[1/12]
![๐ช๐ต๐ ๐ฑ๐ผ๐ฒ๐ ๐๐ผ๐บ๐ฒ๐ผ๐ป๐ฒ ๐ฒ๐น๐ฒ๐ฐ๐ ๐๐๐ฟ๐ด๐ถ๐ฐ๐ฎ๐น ๐ฟ๐ฒ๐ฝ๐ฎ๐ถ๐ฟ ๐ผ๐ณ ๐ฟ๐ผ๐๐ฎ๐๐ผ๐ฟ ๐ฐ๐๐ณ๐ณ ๐๐ฒ๐ป๐ฑ๐ผ๐ป ๐๐ฒ๐ฎ๐ฟ? Excellent qualitative study by @DrPeteMalliaras et al. A thread about this article: https://www.tandfonline.com/doi/abs/10.1080/09638288.2021.1879945 [1/12]](https://pbs.twimg.com/media/EuXZlhvXcAodmyT.jpg "๐ช๐ต๐ ๐ฑ๐ผ๐ฒ๐ ๐๐ผ๐บ๐ฒ๐ผ๐ป๐ฒ ๐ฒ๐น๐ฒ๐ฐ๐ ๐๐๐ฟ๐ด๐ถ๐ฐ๐ฎ๐น ๐ฟ๐ฒ๐ฝ๐ฎ๐ถ๐ฟ ๐ผ๐ณ ๐ฟ๐ผ๐๐ฎ๐๐ผ๐ฟ ๐ฐ๐๐ณ๐ณ ๐๐ฒ๐ป๐ฑ๐ผ๐ป ๐๐ฒ๐ฎ๐ฟ? Excellent qualitative study by @DrPeteMalliaras et al. A thread about this article: https://www.tandfonline.com/doi/abs/10.1080/09638288.2021.1879945 [1/12]")
Excellent qualitative study by @DrPeteMalliaras et al.
A thread about this article: https://www.tandfonline.com/doi/abs/10.1080/09638288.2021.1879945
[1/12]
15 individuals who had rotator cuff repair with or without subacromial decompression for rotator cuff related shoulder pain were interviewed to understand decision making to elect surgical intervention.
Age ranged 34 - 71 years old
Duration of symptoms 6 to >52 weeks
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Age ranged 34 - 71 years old
Duration of symptoms 6 to >52 weeks
[2/12]
Major Themes:
1. Needing to get it done: โIt was necessary to remedy the dire situation.โ
2. Non-surgical treatment experience: โI knew that Iโd done all I couldโ
3. Mechanical problem: โPhysioโs not going to repair a torn tendonโ
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1. Needing to get it done: โIt was necessary to remedy the dire situation.โ
2. Non-surgical treatment experience: โI knew that Iโd done all I couldโ
3. Mechanical problem: โPhysioโs not going to repair a torn tendonโ
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4. Trust in medical professionals โif they told me that I needed to swallow a thousand spiders, I would have done it.โ
5. Varied information sources required โDr Google played a big part in itโ
6. Organisational barriers โit was absolutely useless, my insuranceโ
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5. Varied information sources required โDr Google played a big part in itโ
6. Organisational barriers โit was absolutely useless, my insuranceโ
[4/12]
Key takeaway: "A commonly held belief among participants in this study was that surgery was inevitable because of mechanical damage or tears in their rotator cuff tendons. The relationship between imaging abnormality and their symptoms was not
[5/12]
[5/12]
questioned by many of the interviewees. Health professionals often confirmed the view that abnormalities on imaging may require surgery, which left patients with the sense that there was no option.โ
[6/12]
[6/12]
Important related factors in decision making:
- pain (intensity, duration, and impact)
- sacrificed quality of life (unable to engage in desired activities, work, etc) [7/12]
- pain (intensity, duration, and impact)
- sacrificed quality of life (unable to engage in desired activities, work, etc) [7/12]
- Feeling conservative management had failed: steroid injections (10/15), exercise (15/15), massage, dry needling and acupuncture (7/15). Inclusive of conservative management such as exercise provoking symptoms being a factor. [8/12]
- Viewing their pain experience primarily mechanical driven based on clinician narratives and imaging findings
- Overwhelming trust in medical professionals, specifically surgeons, their opinions, and reputation. Some were critical of non-surgical health professionals. [9/12]
- Overwhelming trust in medical professionals, specifically surgeons, their opinions, and reputation. Some were critical of non-surgical health professionals. [9/12]
- Participants felt inadequately informed on risks vs benefits of treatment. Many turned to the internet but still gave more weight to HCPs advise. Often, anecdotal re-assurance via word of mouth from othersโ having similar surgery was sought out. [10/12]
Overall, decision making is multifactorial but the repeated narratives found in qualitative studies is further demonstration of just how difficult it is to shift a paradigm surrounding pain experiences. [11/12]
It will take continued collective effort to shift our narratives from purely biological, biomedical, and biomechanical rationale with an over reliance on imaging and perceived authority.
Thoughts? Comment below for a discussion. [12/12]]
Thoughts? Comment below for a discussion. [12/12]]
