French physiotherapy management of rotator cuff related shoulder pain: An observational study

Abstract

Background: Rotator cuff related shoulder pain (RCRSP) is a common and disabling cause of shoulder pain contributing to great socio-economic costs. Conservative management is recommended as first-line treatment, with studies performed in the United Kingdom, Belgium, the Netherlands and Australia finding practice generally consistent with guideline recommendations. Current French guidelines for management of RCRSP were published more than a decade ago, and it is unknown if French physiotherapists manage RCRSP in line with the current guideline recommendations. The aim of this survey is to evaluate if management delivered by French physiotherapists for RCRSP is in line with the current evidence. Methods:A cross-sectional online survey was conducted and disseminated through various social media platforms and a mailing list from December 2018 to March 2019.Results: Two hundred and six French physiotherapists completed the survey. The results demonstrated that the majority of physiotherapists provide care consistent with recommended guideline management, through the delivery of exercise and education. Ideology and specific parameters of treatment delivery, particularly exercise treatment, were highly variable among the cohort, but comparable to findings among physiotherapists in the United Kingdom, Belgium, the Netherlands and Australia. Conclusion:French physiotherapists are broadly consistent with providing guideline recommended care of RCRSP; however, heterogeneity exists in the ideals and practice of specific treatment delivery, particularly within exercise management.

Physiotherapy management of rotator cuff-related shoulder pain in Germany is broadly consistent with recommended practice: An observational study

“…Overall, German physiotherapists are broadly consistent with providing guideline recommended care for RCRSP, almost all respondents recommending some form of education and exercise as management., though high levels of uncertainty exist regarding indication for interventionalist care (imaging, injection, surgery) and heterogeneity is apparent in speci c exercise paradigms. Findings are comparable to those found internationally (11)(12)(13)25), though in German physiotherapists there are signi cant differences in the reported management of RCRSP when comparing academically trained versus non-academically trained physiotherapists.…”

“…In comparison to other countries German physiotherapists were much less consistent in recommending injection management considering guideline recommendations (42.9%) compared to France and Australia with over 70% (12,13). Referral rate for imaging by German physiotherapists (39.9%, 76/192) is higher than those in Australia (6.4%), the United Kingdom (9.0%), France (12.6%), and Belgium/the Netherlands (31.0%), but slightly lower than in Italy (42.0%) (11-13, 25, 26).…”

“…Referral rate for imaging by German physiotherapists (39.9%, 76/192) is higher than those in Australia (6.4%), the United Kingdom (9.0%), France (12.6%), and Belgium/the Netherlands (31.0%), but slightly lower than in Italy (42.0%) (11-13, 25, 26). No indication for surgery was stated in 74.0% (142/192) of German respondents compared to Australia (90.0%), France (89.3%), Italy (62.0%), and Belgium and the Netherlands (70.0%) (12,13,25,26).…”

“…Researchers in the United Kingdom, Australia and France investigated common physiotherapy practice for shoulder pain (11-13). They found most physiotherapists are compliant with current recommendations, but use of adjunctive therapies (dry needling, electrotherapy) with limited supportive evidence is common (11)(12)(13). Discrepancies between research evidence and practice (evidence-practice-gap) could highlight a lack of effective knowledge translation (11).…”

“…It is recommended to trial conservative management for at least six weeks before considering imaging and twelve weeks before considering interventionalist care (injection/surgery) (7-10).Researchers in the United Kingdom, Australia and France investigated common physiotherapy practice for shoulder pain (11-13). They found most physiotherapists are compliant with current recommendations, but use of adjunctive therapies (dry needling, electrotherapy) with limited supportive evidence is common (11)(12)(13). Discrepancies between research evidence and practice (evidence-practice-gap) could highlight a lack of effective knowledge translation (11).Under the premise of needs-based health care, bene ts and effectiveness of physiotherapeutic examination and treatment strategies are increasingly being researched in Germany, with research outcomes justifying the cost of care and resource utilisation (14).…”