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

ObjectivesTo explore how people perceive different advice for rotator cuff disease in terms of words/feelings evoked by the advice and treatment needs.SettingWe performed a content analysis of qualitative data collected in a randomised experiment.Participants2028 people with shoulder pain read a vignette describing someone with rotator cuff disease and were randomised to:bursitis labelplusguideline-based advice, bursitis labelplustreatment recommendation, rotator cuff tear labelplusguideline-based adviceandrotator cuff tear labelplustreatment recommendation. Guideline-based adviceincluded encouragement to stay active and positive prognostic information.Treatment recommendationemphasised that treatment is needed for recovery.Primary and secondary outcomesParticipants answered questions about: (1) words/feelings evoked by the advice; (2) treatments they feel are needed. Two researchers developed coding frameworks to analyse responses.Results1981 (97% of 2039 randomised) responses for each question were analysed.Guideline-based advice(vstreatment recommendation) 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.Treatment recommendation(vsguideline-based advice) 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.ConclusionsWords/feelings evoked by advice for rotator cuff disease and perceived treatment needs may explain whyguideline-based advicereduces perceived need for unnecessary care compared to atreatment recommendation.