Patient reported priorities for treatment of frozen shoulder Susan Jones Dr Nigel Hanchard Dr Sharon Hamilton. RCN Research Conference 2013

Transcription

1 Patient reported priorities for treatment of frozen shoulder Susan Jones Dr Nigel Hanchard Dr Sharon Hamilton RCN Research Conference 2013

2 BACKGROUND - What it is - Frozen shoulder - Primary adhesive capsulitis A condition affecting the capsule of the shoulder joint Characterised by inflammation and contracture Capsule becomes fixed May occur for no identifiable reason Difficulty in diagnosis Phasic nature; typically lasts from months

3 BACKGROUND Prevalence 2 5% of the population seek help Present in up to 10% of the population Treatment options watchful waiting physical therapy steroid injection surgery

4 RATIONALE and AIM of the study Rationale The perceptions and treatment priorities of people experiencing frozen shoulder have been neglected in previous research Aim To elucidate patients perceptions of frozen shoulder and their treatment priorities.

5 DESIGN A qualitative study using semi-structured interviews Recruitment occurred in community and hospital clinics by clinical members of the research team Participants were selected to reflect the phases in the trajectory of the condition

6 DATA ANALYSIS Inductive, using a constant comparative method Independently analysed by two researchers Six stage thematic approach outlined by Braun and Clarke (2006)

7 PARTICIPANTS (n=11) Group 1 (pain predominant) n=5 Group 2 (stiffness predominant) n=4 Group 3 (stiffness predominant) n=2 Contexts of participant journeys 10 waited 6 8 weeks to present 2 diagnosed and referred on appropriately 2 as above but already treated or being treated for other shoulder 7 delay in diagnosis / referral

8 vi Figure 1: Thematic map PAIN INCONVENIENCE CONFUSION Extreme, nauseating, Limiting, long lasting What is causing this? GGG intense Active people disabled CONFUSION Extreme, nauseating, intense Limiting, long lasting Active people disabled What is causing this? TREATMENT BY GP REFERRED TO A SPECIALIST Delay going to GP or occupational health Confusion continues Pain becomes so severe eventually seek help Diagnosis uncertain Relief health Patient priorities pain identified becomes as: TREATMENT BY GP Confusion continues so severe eventually seek help PAIN Clarity Questions answered Gradual improvement Regaining of function Diagnosis uncertain symptoms REFERRED TO A SPECIALIST Hope Earlier for the diagnosis future Patient priorities identified as: Regaining Raising function awareness Earlier amongst diagnosis health staff Raising awareness amongst health care staff More information More information Figure 1: Thematic map Relief Clarity Questions answered Gradual improvement of symptoms Hope for the future

9 THEME 1: PAIN FINDINGS Sudden onset, notice it on reaching, worsens, typically sleep loss The amount of pain that I was in, I didn t believe that it was just a frozen shoulder. Participant 12

10 FINDINGS THEME 2: INCONVENIENCE/DISABILITY Active people, ended up unable to complete activities of daily living and keep working Try getting out the bath cause you can t find a way up. You just cannot find a way to get out the bath! We ve got bars on the side of the bath anyway but I couldn t find a way. I just had to snake over the side sometimes. Participant 7

11 FINDINGS THEME 3: CONFUSION Patients were often confused by their symptoms So painful but without apparent cause GPs, occupational therapists and even generalist physiotherapists were confused too

12 FINDINGS: Confusion With the shoulder, I was saying, it s still hurting and they [GP] were saying we ll look to see what else it is then. Every time something came back as no, it s negative, have you got any neck problem, shoulder problem, anything like that, no arthritis, no swelling in it but every time it come back no, you are thinking, now what? Participant 7 [first-affected shoulder, 2004]

13 Anxiety Denial FINDINGS: Confusion Unexplained 24/7 pain Without a diagnosis they had no understanding of what was happening to them Uncertainty how long would it last; would it ever get better?

14 FINDINGS THEME 4: TREATMENT No standard care pathway Referral to specialist physiotherapist required 4 referred immediately 7 delayed referral

15 FINDINGS: Treatment Confusion allayed once saw specialist physio you want to know where the final outcome is going to be rather than you suffering week in week out thinking when is it going to end. Fed up with this. Whereas when you know it is going to last 3 or 4 years down the line, I know it is not going to be forever. Whereas you don t know anything, God, is this ever going to go away? I think I would like to know from the start. Participant 11

16 PATIENTS PRIORITIES Overcoming pain and stiffness Recovering functional capacity Understanding the cause, condition trajectory and likely outcome Reducing delay in diagnosis Increasing speed of referral to MSK specialist Written as well as verbal info on the condition

17 CONCLUSIONS Awareness raising / training Prioritise what patients think is important when deciding on treatment Standardised, consistent, evidence-based sources of info for patients which take their views into account Available in multiple formats

18 QUESTIONS? References on last slides for information

19 REFERENCES 1. Hanchard N, Goodchild L, Thompson J, et al. Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder. Version 1.7: standard physiotherapy. Endorsed by the Chartered Society of Physiotherapy. 2011:157p. Available at: 2. Hand GCR, Athanasou NA, Matthews T, Carr AJ. The pathology of frozen shoulder. J Bone Joint Surg Br. 2007;89(7):

20 3. Kelley MJ, McClure PW, Leggin BG. Frozen shoulder: evidence and a proposed model guiding rehabilitation. J Orthop Sport Phys. 2009;39(2): Milgrom C, Novack V, Weil Y, et al. Risk factors for idiopathic frozen shoulder. Isr Med Assoc J: IMAJ. 2008;10(5): Boyle-Walker KL, Gabard DL, Bietsch E, Masek-VanArsdale DM, Robinson BL. A profile of patients with adhesive capsulitis. J Hand Ther. 1997;10:

21 6. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum. 2004;51(4): Maund E, Craig D, Suekarran S, et al. Management of frozen shoulder: a systematic review and cost-effectiveness analysis.health Technol Asses (Winchester, England). 2012;16(11):1 243.

22 8. Hand C, Clipsham K, Rees JL, Carr AJ. Longterm outcome of frozen shoulder. J Shoulder Elb Surg. 2008;17(2): Braun, V. & Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology, 3 (2):