How do people perceive different advice for rotator cuff disease? A content analysis of qualitative data collected in a randomised experiment
Ian A Harris,
Adrian C Traeger,
Christopher G Maher,
Mary O'Keeffe,
Giovanni E Ferreira,
Richard Page,
Zoe A Michaleff,
Joshua R Zadro,
Andrew R Gamble,
Frederick Afeaki,
Yaozhuo Li,
Erya Wen,
Jiawen Yao,
Kejie Zhu
Affiliations
Ian A Harris
6 Whitlam Orthopaedic Research Centre, Ingham Institute, Sydney, New South Wales, Australia
Adrian C Traeger
1 Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
Christopher G Maher
2 Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
Mary O'Keeffe
Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
Giovanni E Ferreira
Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
Richard Page
School of Medicine, Deakin University Faculty of Health, Geelong, Victoria, Australia
Zoe A Michaleff
Northern NSW Local Health District, Lismore, New South Wales, Australia
Joshua R Zadro
2 Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
Andrew R Gamble
1 School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Frederick Afeaki
School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Yaozhuo Li
School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Erya Wen
School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Jiawen Yao
School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Kejie Zhu
School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Objectives To explore how people perceive different advice for rotator cuff disease in terms of words/feelings evoked by the advice and treatment needs.Setting We performed a content analysis of qualitative data collected in a randomised experiment.Participants 2028 people with shoulder pain read a vignette describing someone with rotator cuff disease and were randomised to: bursitis label plus guideline-based advice, bursitis label plus treatment recommendation, rotator cuff tear label plus guideline-based advice and rotator cuff tear label plus treatment recommendation. Guideline-based advice included encouragement to stay active and positive prognostic information. Treatment recommendation emphasised that treatment is needed for recovery.Primary and secondary outcomes Participants answered questions about: (1) words/feelings evoked by the advice; (2) treatments they feel are needed. Two researchers developed coding frameworks to analyse responses.Results 1981 (97% of 2039 randomised) responses for each question were analysed. Guideline-based advice (vs treatment recommendation) more often elicited words/feelings of reassurance, having a minor issue, trust in expertise and feeling dismissed, and treatment needs of rest, activity modification, medication, wait and see, exercise and normal movements. Treatment recommendation (vs guideline-based advice) more often elicited words/feelings of needing treatment/investigation, psychological distress and having a serious issue, and treatment needs of injections, surgery, investigations, and to see a doctor.Conclusions Words/feelings evoked by advice for rotator cuff disease and perceived treatment needs may explain why guideline-based advice reduces perceived need for unnecessary care compared to a treatment recommendation.
