Physical Therapists' Perceptions and Use of Exercise in the Management of Subacromial Shoulder Impingement Syndrome: Focus Group Study

Catherine E Hanratty, Daniel P Kerr, Iseult M Wilson, Martin McCracken, Julius Sim, Jeffrey R Basford, Joseph G McVeigh

Shoulder pain resulting from subacromial impingement syndrome (SAIS) is a common problem with a relatively poor outcome. There is little research exploring physical therapists' perspectives on the management of the syndrome. To investigate physical therapists' perceptions and experiences regarding the use of exercise in the treatment of patients with SAIS. Qualitative focus group study. Three 60-90 minute focus group sessions containing 6-8 experienced musculoskeletal physical therapists (total n=20) were conducted. Thematic content analysis was used to analyse transcripts and develop core themes and categories. Exercise was seen as key in the treatment of SAIS. The overarching theme was the need to "gain buy-in to exercise" at an early stage. The main subtheme was patient education i.e. the use of "patient education" appeared to be how therapists achieved buy-in to exercise. Therapists identified the need to use education about SAIS etiology to foster buy-in and "sell" self-management through exercise to the patient. They consistently mentioned achieving buy-in and education using visual tools, postural advice and sometimes a "quick fix" of pain control. Furthermore, experienced practitioners included educational interventions much earlier in treatment than when they first qualified. Therapists emphasized the need for individually tailored exercises including: scapular stabilization; rotator cuff, lower trapezius and serratus anterior strengthening; and anterior shoulder and pectoralis minor stretching. Quality of exercise performance was deemed more important than the number of repetitions that the patient performed. Experienced musculoskeletal physical therapists believe that exercise is central in managing patients with SAIS, and that gaining patient buy-in to exercise, patient education, promoting self-management, and postural advice are important for the successful management of people with SAIS.