Diagnosis and management of shoulder pain by New Zealand physiotherapists: a national survey

Background

Physiotherapists commonly manage patients with shoulder disorders. The primary aims of this study were to (1) determine current assessment and management of patients with shoulder disorders by physiotherapists in New Zealand and compare it to evidence-based recommendations; and (2) assess their confidence in making a diagnosis.

Methods

We performed a cross-sectional online survey of New Zealand registered physiotherapists who self-report that they treat patients with shoulder disorders. The survey was distributed electronically via professional physiotherapy networks and social media. Physiotherapists were asked about four common shoulder disorders (rotator cuff tendinopathy, acute rotator cuff tear, early and later presentation of adhesive capsulitis) presented as vignettes.

Results

234 physiotherapists completed the survey. Most (78%) work in private practice and 73% have a shoulder caseload of $\ge$5 patients per week. Participants commonly included physical examination of shoulder and cervical joints. Investigations and referral to other healthcare professionals varied between vignettes. Advice, education about exercise, manual therapy and activity/work modification were the most prevalent interventions. Electrotherapy was a common intervention for rotator cuff tendinopathy. Most physiotherapists were moderately or extremely confident in their diagnosis across all vignettes. There was no difference in correct diagnosis between physiotherapists with a high versus low shoulder caseload for 3 vignettes, with a slight difference favouring those with a high shoulder caseload for acute rotator cuff tear (90% vs 80%, Fisher's p = 0.047).

Conclusions

Physiotherapists self-reported management of patients with shoulder disorders partially accord with evidence-based recommendations. They have confidence in their diagnoses which are mostly correct.

Contribution of the Paper

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  Physiotherapists in New Zealand managed patients with shoulder disorders partially accord with evidence-based recommendations.
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  Physiotherapists in New Zealand have confidence in their diagnoses, which are mostly correct.
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  For 3 out of 4 clinical vignettes, we found no differences in correct diagnosis between participants with low and high shoulder caseload.
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  A greater proportion of clinicians with low shoulder caseload would request MRI for a clinical vignette describing an early presentation of adhesive capsulitis.