POS0161-HPR BARRIERS AND FACILITATORS RELATED TO SELF-MANAGEMENT OF SHOULDER PAIN: A SYSTEMATIC REVIEW AND QUALITATIVE SYNTHESIS
Authors: A. O’shea, J. Drennan, C. Littlewood, H. Slater, J. Sim, J. Mcveigh
Journal: Annals of the Rheumatic Diseases (2021)

Background: Shoulder pain is a significant cause of pain and disability in the general population. 1 Current research suggests that shoulder pain can be resistant to treatment and is often recurrent. 2 Systematic review-level evidence shows modest short-term benefits for most current treatments. 3 Effective self-management strategies that equip patients with the necessary tools to self-manage their condition are urgently required. However, engagement with self-management is poor, potentially compromising treatment outcomes and contributing to ongoing disability. 4 Objectives: The objectives of this review were to: •Systematically identify and appraise relevant qualitative evidence on barriers and facilitators relating to self-management from the perspectives of people with shoulder pain and healthcare professionals. •Collate and synthesise this evidence, to gain an understanding of factors that influence self-management of shoulder pain. •Develop evidence-based recommendations to inform the implementation and delivery of self-management programmes for shoulder pain. Methods: A meta-aggregative approach to the synthesis of qualitative evidence was used. Twelve databases were searched, from inception to 13 July 2020, to identify studies exploring barriers and facilitators related to self-management of shoulder pain from the perspectives of people with shoulder pain and clinicians involved in the care of such patients. Two independent reviewers identified eligible articles, extracted the data and conducted 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: Sixteen studies were included in the review, exploring several shoulder conditions: shoulder instability; rotator cuff-related pain; dysfunction post rotator cuff surgery; and degenerative rotator cuff tears. 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 adherence to 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: Patients and clinicians identified several barriers and facilitators that influenced self-management of shoulder pain. Clinicians’ awareness of these factors could positively influence patient management, enhance patients’ ability to self-manage, and improve treatment outcomes. References: [1]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 and Rheumatism. 2004;51(4): 642-651. [2]Croft P, Pope D, Silman A. The clinical course of shoulder pain: prospective cohort study in primary care. Primary Care Rheumatology Society Shoulder Study Group. British Medical Journal. 1996;313(7057): 601-602. [3]Littlewood C, May S, Walters S. A review of systematic reviews of the effectiveness of conservative interventions for rotator cuff tendinopathy. Shoulder &amp; Elbow. 2013;5(3): 151-167. [4]Littlewood C, Malliaras P, Mawson S, May S, Walters S. Patients with rotator cuff tendinopathy can successfully self-manage, but with certain caveats: a qualitative study. Physiotherapy. 2014;100(1): 80-85. Disclosure of Interests: Aidan O’Shea: None declared, Jonathan Drennan: None declared, Chris Littlewood: None declared, Helen Slater Speakers bureau: AbbVie PTY LTD 2018, Julius Sim: None declared, Joseph McVeigh: None declared