How do people perceive different advice for rotator cuff disease? A content analysis of qualitative data collected in a randomised experiment.

Abstract

To explore how people perceive different advice for rotator cuff disease in terms of words/feelings evoked by the advice and treatment needs. We performed a content analysis of qualitative data collected in a randomised experiment. 2028 people with shoulder pain read a vignette describing someone with rotator cuff disease and were randomised to: <i>bursitis label</i> plus <i>guideline-based advice, bursitis label</i> plus <i>treatment recommendation, rotator cuff tear label</i> plus <i>guideline-based advice</i> and <i>rotator cuff tear label</i> plus <i>treatment recommendation. Guideline-based advice</i> included encouragement to stay active and positive prognostic information. <i>Treatment recommendation</i> emphasised that treatment is needed for recovery. Participants answered questions about: (1) words/feelings evoked by the advice; (2) treatments they feel are needed. Two researchers developed coding frameworks to analyse responses. 1981 (97% of 2039 randomised) responses for each question were analysed. <i>Guideline-based advice</i> (vs <i>treatment recommendation</i>) more often elicited words/feelings of reassurance, having a minor issue, trust in expertise and feeling dismissed, and treatment needs of rest, activity modification, medication, wait and see, exercise and normal movements. <i>Treatment recommendation</i> (vs <i>guideline-based advice</i>) more often elicited words/feelings of needing treatment/investigation, psychological distress and having a serious issue, and treatment needs of injections, surgery, investigations, and to see a doctor. Words/feelings evoked by advice for rotator cuff disease and perceived treatment needs may explain why <i>guideline-based advice</i> reduces perceived need for unnecessary care compared to a <i>treatment recommendation</i>.