Oral Presentation ARA-NSW 2020 - 42nd Annual NSW Branch Meeting

Do different diagnostic labels for rotator cuff disease influence management preferences? An online randomised controlled experiment (#30)

Joshua R Zadro 1 , Mary O'Keeffe 1 2 , Giovanni Ferreira 1 , Romi Haas 3 4 , Ian A Harris 1 5 , Rachelle Buchbinder 3 4 , Christopher G Maher 1
  1. Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Camperdown, NEW SOUTH WALES, Australia
  2. School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, Limerick, Ireland
  3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria , Australia
  4. Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
  5. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia, Sydney , NSW, Australia

Background: Different disease labels could influence management preferences for patients with rotator cuff disease and reduce unnecessary surgery. 

Objectives: To examine whether different labels for rotator cuff disease influence patients’ perceived need for surgery.

Methods: We conducted a six-arm, online randomised controlled experiment in participants with and without shoulder pain. Participants read a vignette describing a patient with rotator cuff disease and were randomised to one of six labels: subacromial impingement syndrome, rotator cuff tear, bursitis, rotator-cuff-related shoulder pain, shoulder sprain and episode of shoulder pain. Perceived need for surgery was the primary outcome. Secondary outcomes included perceived need for imaging, an injection, a second opinion and to see a specialist, perceived seriousness of the condition, recovery expectations, and perceived impact on work attendance. Using a Bonferroni correction, adjusted between-group mean differences (MD) and 99.67% confidence intervals (CI) were obtained using a one-way analysis of covariance, with significance set at p<0.0033.

Results: 1,308/1,626 (80%) responses were analysed. Participant mean age (standard deviation) was 40.3 (16.0) years, 59% were females. Mean perceived need for surgery (0-10 scale) was low and slightly higher among those labelled with a rotator cuff tear compared to bursitis (2.6 vs. 2.1, MD 0.7, 99.67% CI: 0.0-1.4). Mean perceived need for imaging (0-10 scale) was moderate and slightly higher among those labelled with a rotator cuff tear (4.7 vs. 3.7, MD 1.0, 99.67% CI: 0.1-1.9) and subacromial impingement syndrome (4.7 vs. 3.7, MD 1.0, 99.7% CI: 0.2-1.9) compared to bursitis. No other comparisons were significant.

Conclusions: There were small differences in perceived need for surgery and imaging between some labels. These differences may not be clinically important.