Diagnostic labels and advice for shoulder pain: How does this impact people’s perceived need for shoulder surgery?

The whole study will be conducted online. Participants will enter the survey by clicking a link to the study from their email. Once participants enter the survey, read the participant information sheet, provide consent (if eligible), and complete a baseline questionnaire, they will be directed to read a vignette describing a person with shoulder pain presenting to a health professional and imagine that they are the person being described in the vignette. This scenario was taken from our previous trial[1] which received input from clinicians that commonly manage patients with shoulder pain. Labels and messages After reading the hypothetical scenario, participants will be randomised (1:1:1:1 ratio) to receive one of four combinations of diagnostic labels and advice from a health professional. The interventions include: - Being labelled with a bursitis and given evidence based advice - Being labelled with a rotator cuff tear and given evidence based advice - Being labelled with a bursitis and given standard online advice The two labels are rotator cuff tear and bursitis. Both labels will be accompanied by a brief explanation of the label as per our previous trial: • “Rotator cuff tear. A rotator cuff tear is a tear in one of the shoulder tendons.” • “Bursitis. Bursitis is inflammation of a fluid-filled sac called a bursa in the shoulder.” The two messages of advice are: • Message #1 (evidence-based advice): “I am not worried that there is anything serious going on here because your pain is not related to severe trauma. I am also not worried that you have arthritis in your shoulder or a specific condition called frozen shoulder that causes severe pain and stiffness. Your pain should gradually improve over time by itself. It is recommended that you avoid activities that aggravate your pain but continue to use your arm so your shoulder does not stiffen up.” • Message #2 (standard online advice): “Without proper treatment, your symptoms can persist for months or years, and usually become worse over time. Most people with your symptoms respond to treatment within four to six weeks, especially if an injection is part of the treatment.” Message #1 was taken from our previous trial[1] and based on guideline recommendations for the management of rotator cuff disease[2]. For Message #2, we searched for examples of advice on webpages identified in a content analysis we recently conducted examining the quality of online information for shoulder surgery. We prioritised reputable sources (e.g. Government, University) that presented opposing advice to Message #1. Message #2 was adapted from a Harvard Medical School webpage titled ‘Rotator Cuff Injury’. We removed any reference to a diagnosis so the advice could be presented alongside the rotator cuff tear and bursitis labels. Both messages of advice will be delivered by a world-renowned orthopaedic surgeon via a pre-recorded video. This video will be embedded within the online survey. Participants will be required to press a 'play' button to watch the video. Participants will have access to the script and will be able to re-watch the video. To ensure participants watch the video (i.e. enoucrage adherence), participants will not be able to proceed to the next part of the survey until the whole video has been viewed. The next part of the survey will include the assessment of outcomes measures. The entire survey will take 10-15 minutes to complete. References 1. Zadro JR, O’Keeffe M, Ferreira GE, Haas R, Harris IA, Buchbinder R, et al. Diagnostic Labels for Rotator Cuff Disease Can Increase People’s Perceived Need for Shoulder Surgery: An Online Randomized Controlled Experiment. Journal of Orthopaedic & Sports Physical Therapy.0(0):1-45. 2. Kulkarni RN, Gibson JA, Brownson P, Thomas M, Rangan A, Carr AJ, Rees JL. Subacromial shoulder pain BESS / BOA Patient Care Pathways. Shoulder Elbow. 2015:0(0);1–9.