'Thinking about pain in a different way': Patient perspectives of a neuroscience-informed physiotherapy programme for rotator cuff-related shoulder pain.

BACKGROUND: Rotator cuff-related shoulder pain (RCRSP) is a common musculoskeletal problem. The multi-factorial contributors to persistent pain are often overlooked during treatment. Pain neuroscience education (PNE) contributes to a holistic approach for patients with persistent pain but has not yet been researched for patients with RCRSP. OBJECTIVE: To explore the perspectives and experiences of participants with RCRSP who had completed a programme of PNE-informed pragmatic physiotherapy. DESIGN: A qualitative study using semi-structured interviews. METHODS: We included a sub-group of five males and five females, aged 46-75 years, with persistent RCRSP of at least three months. They had undertaken a three-month pragmatic physiotherapy integrated with PNE. Individual semi-structured interviews were recorded, transcribed verbatim, and analysed using the General Inductive Approach. RESULTS: Four themes emanated from the interviews. The first two themes were named 'Patient Beliefs' and overall 'Rapport and Relationship'. Another theme, 'Perspective and Understanding of the Resources', indicated diverse uptake of the resource information. The participants reported developing self-management skills, active coping strategies and a reduction in fear of pain described by the theme: 'Empowerment: My Shoulder into the Future'. CONCLUSIONS: Participants experienced a change in their beliefs, which were enhanced by an individualised delivery and a strong therapeutic relationship through the course of the physiotherapy care. The participants appeared to value when the physiotherapist listened to and understood their beliefs. This required a shift in the patient-therapist relationship from the physiotherapist being the 'expert' to facilitating the patient's ability to take control of their shoulder health.

A qualitative study of pain experiences in patients requiring hip and knee arthroplasty.

The aim of this study was to conduct an in-depth investigation of experiences with pain before knee and hip replacement surgery. A total of 20 patients were interviewed, and interpretative phenomenological analysis was used to identify themes. These were as follows: living with pain, pain conceptualised, pain treatments and healthcare system. Pre-surgical pain is very disabling and is viewed as biological. There was an associated loss of independence. Pharmaceutical management is used by all but not entirely effective, psychological therapies are underutilised. Patients were frustrated, angry, and confused about qualifying for surgery. Many areas of care could be improved to help these pre-surgical patients.

First-time mothers' perspectives on relationships with and between midwives and doctors: insights from a qualitative study of giving birth in New Zealand.

OBJECTIVE: to explore the experience of giving birth for first-time New Zealand mothers. DESIGN: qualitative methodology was employed to obtain an in-depth insight into the birth experience using semi-structured interviews conducted face-to-face 11 days to 16 weeks (median 13.5 weeks) after giving birth were audio-recorded and transcribed verbatim. SETTING: the interviews were of a small group of New Zealand mothers. PARTICIPANTS: ten first-time mothers aged 24-38 years (median 31.5 years) participated. MEASUREMENTS: transcripts were analysed using a phenomenological form of thematic analysis. FINDINGS: a core theme was relationship issues. Two subthemes were delineated: lack of relationship between mothers and midwives and doctors; and the conflict between midwives and doctors. KEY CONCLUSIONS: personal, caring and co-operative relationships with all maternity care professionals were basic to New Zealand mothers feeling good about their birth experience. IMPLICATIONS FOR PRACTISE: relationships, with and between, all maternity care professionals merit further investigation in an effort to optimise birth satisfaction.