My shoulder has a brain': physiotherapy for persistent shoulder pain: taking control of your shoulder pain

Participants will receive pragmatic individualised physiotherapy treatment, based on their baseline assessment. Following the baseline assessment, they will have up to 7 sessions, expected to last one hour for the first two sessions, and thereafter ½ hr. The frequency of the sessions will be based on the individual patient-specific context, over a maximum time period of 3 months. Thus, a total of 8 sessions (including the baseline assessment) will be provided over 3 months. The intervention will be based on a symptom-modification and cognitive therapy approach using 5 phases. For Phase 1, symptom-modification will focus on reduction of pain and/or stiffness using manual therapy, active movements of the shoulder and low-intensity shoulder exercises. Cognitive training (Phase 2) will be adapted from approaches used for patients with chronic low back pain, and informed by our previous study. The cognitive training will be supported by patient resources (online video clips) developed during Stage 1 and 2 of our research. These will include knowledge regarding shoulder anatomy; interpretation of imaging findings; pain physiology; cognitive/psychologically-informed exercises; and the role of specific and general physical exercises, relaxation and general health. The explicit inclusion of Phase 2 ‘Cognitive training’ and Phase 5 ‘Physical activity’ are the main points of differences to current regular physiotherapy for rotator cuff syndrome and constitute, specifically, the ‘neuroscience’-informed approach. Phases 3 to 5 will be progressive exercises to increase loading ability of the shoulder, muscle strength and graded general physical activity. Specific exercises will be based on the patient’s individual goals, functional level and requirements in terms of daily life, occupation-related tasks, recreation and sports. Cognitive training will underpin all 5 phases, and the phases may be concurrent, rather than strictly sequential. There will be emphasis on reflective communication, goal orientation, functional enhancement and self-management throughout the treatment series. Participants will complete a daily online exercise diary of their (1) shoulder-specific exercises and (2) general physical activities. Participants will also be asked to complete a diary of costs related to the shoulder pain during the course of the physiotherapy programme. All treatments will be provided by physiotherapists.