Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada
Abstract Background Shoulder pain is difficult to diagnose and treat with half of those affected still symptomatic six months after initial consultation. This may be explained by primary care management not conforming to evidence-based practice. This survey evaluated physiotherapists (PTs) and famil...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Primary Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12875-023-01999-6 |
| _version_ | 1797863923217596416 |
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| author | Véronique Lowry Patrick Lavigne Diana Zidarov Kadija Perreault Jean-Sébastien Roy François Desmeules |
| author_facet | Véronique Lowry Patrick Lavigne Diana Zidarov Kadija Perreault Jean-Sébastien Roy François Desmeules |
| author_sort | Véronique Lowry |
| collection | DOAJ |
| description | Abstract Background Shoulder pain is difficult to diagnose and treat with half of those affected still symptomatic six months after initial consultation. This may be explained by primary care management not conforming to evidence-based practice. This survey evaluated physiotherapists (PTs) and family physicians' (FPs) knowledge and appropriateness of care in shoulder pain management. Methods A survey sent to PTs and FPs in the province of Quebec, Canada presented four clinical vignettes with cases of rotator cuff (RC) tendinopathy, acute full-thickness RC tear, adhesive capsulitis and traumatic anterior glenohumeral instability. Respondents indicated diagnosis, indications for imaging, specialists’ referrals, and choice of treatments. Answers were compared to recommendations from clinical practice guidelines (CPGs). Participants’ responses were compared between types of providers with Fisher’s exact test. Results Respondents (PTs = 175, FPs = 76) were mostly women with less than ten years of experience. More than 80% of PTs and 84% of FPs correctly diagnosed cases presented. Despite this practice not being recommended, more FPs than PTs recommended an imaging test in the initial management of RC tendinopathy (30% compared to 13%, p = 0.001) and adhesive capsulitis (51% compared to 22%, p = 0.02). For full-thickness RC tear and shoulder instability, up to 72% of FPs and 67% of PTs did not refer to a specialist for a surgical opinion, although recommended by CPGs. For RC tendinopathy, 26% of FPs and 2% of PTs (p < 0.001) would have prescribed a corticosteroid infiltration, which is not recommended in the initial management of this disorder. For adhesive capsulitis, significantly more FPs (76%) than PTs (62%) (p < 0.001) suggested an intra-articular corticosteroid infiltration, as recommended by CPGs. For all presented vignettes, up to 95% of family physicians adequately indicated they would refer patients for physiotherapy. In prioritizing rehabilitation interventions, up to 42% of PTs did not consider active exercises as a priority and up to 65% selected passive modalities that are not recommended for all shoulder pain vignettes. Conclusions Most FPs and PTs were able to make adequate diagnoses and select appropriate treatments for shoulder pain, but practices opposed to evidence-based recommendations were chosen by several respondents. Further training of FPs and PTs may be needed to optimize primary care management of different shoulder disorders. |
| first_indexed | 2024-04-09T22:44:30Z |
| format | Article |
| id | doaj.art-1a80148254144d109edfc0673b0138d4 |
| institution | Directory Open Access Journal |
| issn | 2731-4553 |
| language | English |
| last_indexed | 2024-04-09T22:44:30Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj.art-1a80148254144d109edfc0673b0138d42023-03-22T11:57:29ZengBMCBMC Primary Care2731-45532023-02-0124111910.1186/s12875-023-01999-6Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, CanadaVéronique Lowry0Patrick Lavigne1Diana Zidarov2Kadija Perreault3Jean-Sébastien Roy4François Desmeules5School of Rehabilitation, Faculty of Medicine, University of MontrealOrthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research CenterSchool of Rehabilitation, Faculty of Medicine, University of MontrealDepartment of Rehabilitation, Faculty of Medicine, Laval UniversityDepartment of Rehabilitation, Faculty of Medicine, Laval UniversitySchool of Rehabilitation, Faculty of Medicine, University of MontrealAbstract Background Shoulder pain is difficult to diagnose and treat with half of those affected still symptomatic six months after initial consultation. This may be explained by primary care management not conforming to evidence-based practice. This survey evaluated physiotherapists (PTs) and family physicians' (FPs) knowledge and appropriateness of care in shoulder pain management. Methods A survey sent to PTs and FPs in the province of Quebec, Canada presented four clinical vignettes with cases of rotator cuff (RC) tendinopathy, acute full-thickness RC tear, adhesive capsulitis and traumatic anterior glenohumeral instability. Respondents indicated diagnosis, indications for imaging, specialists’ referrals, and choice of treatments. Answers were compared to recommendations from clinical practice guidelines (CPGs). Participants’ responses were compared between types of providers with Fisher’s exact test. Results Respondents (PTs = 175, FPs = 76) were mostly women with less than ten years of experience. More than 80% of PTs and 84% of FPs correctly diagnosed cases presented. Despite this practice not being recommended, more FPs than PTs recommended an imaging test in the initial management of RC tendinopathy (30% compared to 13%, p = 0.001) and adhesive capsulitis (51% compared to 22%, p = 0.02). For full-thickness RC tear and shoulder instability, up to 72% of FPs and 67% of PTs did not refer to a specialist for a surgical opinion, although recommended by CPGs. For RC tendinopathy, 26% of FPs and 2% of PTs (p < 0.001) would have prescribed a corticosteroid infiltration, which is not recommended in the initial management of this disorder. For adhesive capsulitis, significantly more FPs (76%) than PTs (62%) (p < 0.001) suggested an intra-articular corticosteroid infiltration, as recommended by CPGs. For all presented vignettes, up to 95% of family physicians adequately indicated they would refer patients for physiotherapy. In prioritizing rehabilitation interventions, up to 42% of PTs did not consider active exercises as a priority and up to 65% selected passive modalities that are not recommended for all shoulder pain vignettes. Conclusions Most FPs and PTs were able to make adequate diagnoses and select appropriate treatments for shoulder pain, but practices opposed to evidence-based recommendations were chosen by several respondents. Further training of FPs and PTs may be needed to optimize primary care management of different shoulder disorders.https://doi.org/10.1186/s12875-023-01999-6ShoulderSurveyClinical Practice GuidelinesEvidence-based practiceFamily PhysiciansPhysiotherapists |
| spellingShingle | Véronique Lowry Patrick Lavigne Diana Zidarov Kadija Perreault Jean-Sébastien Roy François Desmeules Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada BMC Primary Care Shoulder Survey Clinical Practice Guidelines Evidence-based practice Family Physicians Physiotherapists |
| title | Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada |
| title_full | Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada |
| title_fullStr | Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada |
| title_full_unstemmed | Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada |
| title_short | Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada |
| title_sort | knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain a survey study in the province of quebec canada |
| topic | Shoulder Survey Clinical Practice Guidelines Evidence-based practice Family Physicians Physiotherapists |
| url | https://doi.org/10.1186/s12875-023-01999-6 |
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