Barriers and facilitators related to self-management of shoulder pain: a systematic review and qualitative synthesis

Abstract

Objective The objective of this review was to identify barriers and facilitators related to self-management from the perspectives of people with shoulder pain and clinicians involved in their care. Data sources CINAHL, MEDLINE, PsycINFO, SPORTDiscus, Embase, ProQuest Health, Web of Science, and Scopus were searched from inception to March 2022. Review methods A meta-aggregative approach to the synthesis of qualitative evidence was used. Two independent reviewers identified eligible articles, extracted the data, and conducted a critical appraisal. Two reviewers independently identified and developed categories, with validation by two further researchers. Categories were discussed among the wider research team and a comprehensive set of synthesized findings was derived. Results Twenty studies were included. From the perspective of patients, three synthesized findings were identified that influenced self-management: (1) support for self-management, including subthemes related to patient-centred support, knowledge, time, access to equipment, and patient digital literacy; (2) personal factors, including patient beliefs, patient expectations, patient motivation, pain, and therapeutic response; and (3) external factors, including influence of the clinician and therapeutic approach. From the perspective of clinicians, two synthesized findings were identified that influenced self-management: (1) support for self-management, including education, patient-centred support, patient empowerment, time, and clinician digital literacy; and (2) preferred management approach, including clinician beliefs, expectations, motivation, therapeutic approach, and therapeutic response. Conclusion The key barriers and facilitators were patient-centred support, patient beliefs, clinician beliefs, pain, and therapeutic response. Most of the included studies focused on exercise-based rehabilitation, and therefore might not fully represent barriers and facilitators to broader self-management.

Assessment of Pain Treatments in Disorders of Upper Limbs: A Qualitative Study Protocol Based on Patients’ Experiences

“…Moreover, to alleviate their condition, sometimes patients may seek alternatives (e.g., physiotherapy, which has been shown to be effective [ 10 , 36 ], and coping strategies that may influence the monitoring of pain. Patients with shoulder pain, for example, reported different barriers and facilitators, such as: support, knowledge, time/daily routine, access to equipment, beliefs, expectations, motivation, therapeutic response, and influence of the clinician [ 37 ]. Foo et al highlighted the importance of considering the different views of professionals and users in policy formulation and planning for community care [ 34 ].…”

Is exercise therapy therighttreatment for rotator cuff‐related shoulder pain? Uncertainties, theory, and practice

“…Everyone does the same thing approach. (Powell et al, 2023) Other commonly expressed barriers to engaging with an exercise programme are poor access to equipment, uncertainty about approximate recovery timeframe, lack of motivation and time, and beliefs and expectations about whether exercise is the appropriate treatment for their shoulder pain (O'Shea et al, 2022;Sandford et al, 2017). Conversely, cogent advice and education about their shoulder condition and how to perform their exercise programme, access to equipment, lack of exercise burden, and a supportive social network were key facilitators of engaging with an exercise programme (O'Shea et al, 2022;Sandford et al, 2017).…”

A Virtual Assistant to Guide Early Postoperative Rehabilitation after Reverse Shoulder Arthroplasty: A Pilot Randomized Trial

“…In developed countries, postoperative rehabilitation care after major surgeries is usually implemented, which involves a period of inpatient-immediately after surgery-and outpatient supervised programs, along with education sessions for self-management. However, adherence to caregivers' recommendations represents one of the main barriers to recovery [11]. The reasons for low adherence are aspects such as patient-centered support, patient and clinician beliefs, and overall therapeutic response.…”