Group versus Individual treatment in the management of rotator cuff tendinopathy in primary care

Shoulder pain is a common and disabling musculoskeletal disorder seen in Primary Care physiotherapy. Exercise-based treatment is effective for managing rotator cuff tendinopathy. Group-based and individual physiotherapy treatments have been found to have similar outcomes in terms of pain and disability in delivering exercise interventions for musculoskeletal disorders. Group treatment may be more resource efficient and result in decreased use of secondary care when compared to individual physiotherapy. Group participants have reported positive experiences of this format. There has been limited evidence comparing group versus individual treatment in the management of rotator cuff tendinopathy. i) to investigate whether group exercise is as effective as multi-modal one-to-one physiotherapy using the Shoulder Pain and Disability Index (SPADI) to assess changes in pain and disability from baseline to 6 weeks, 12 weeks and 24 weeks. (Design: Randomised Controlled Trial) ii) to explore participants’ experiences of and preferences for both formats of treatment delivery. (Design : Qualitative Descriptive) Methods The first study (presented in Chapters 2-4) is a two-arm, interventional, assessor blinded, randomised trial. Patients with a history of lateral arm were recruited from the waiting list of a Primary Care Physiotherapy department. Participants were screened for presence of rotator cuff tendinopathy. Baseline measures of the SPADI, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) and Constant-Murley Score (CMS) were administered by an independent assessor blinded to group allocation. These measures plus the Patient Global Impression of Change (PGIC) were reassessed at 6 weeks, 12 weeks and 24 weeks. The individual treatment participants received their physiotherapy according to their therapist’s discretion. The group intervention consisted of 12 sessions of a one-hour circuit-type exercise class. Results 69 eligible participants were recruited (n=35 group, n=34 individual treatment). Losses to follow-up and missing data were accounted for using an intention to treat analysis. Both groups achieved a statistically significant level of change from baseline in SPADI by 6 weeks. There was no statistically significant between group difference at any follow up time-point (p=0.11 at 6 weeks, p=0.21 at 12 weeks & p=0.07 at 24 weeks) for the SPADI total. The QuickDASH and CMS show similar results. However, the SPADI pain showed a statistically significant difference in favour of the group at 6 weeks (p=0.03) and 24 weeks (p=0.02). Participants of the group also experienced a clinically significant improvement in SPADI earlier the individual treatment participants. A higher proportion of group participants reported their shoulder condition as “improved” at 6 weeks and 24 weeks. Qualitative study The second study in this thesis (Chapter 5) is a qualitative descriptive study exploring participants experiences of and preferences for both formats of treatment delivery. Semi-structured interviews were conducted with RCT participants, five from group exercise, five from individual treatment. The transcribed data were analysed using thematic analysis. Three themes were identified – “What patients value from treatment”, “Engagement with exercise during and after treatment” and “Characteristics of a successful outcome”.