Previous research suggests that general practitioners find handling patients with shoulder pain difficult and that the current care for shoulder pain is not in line with the best available evidence (1).This project aims to assess the effectiveness, costs and implementation of an evidence-based guideline for shoulder pain in general practice.
A simplified and evidence-based algorithm for examination and treatment of patients with shoulder pain will be developed and implemented in general practice. The purpose is to improve quality of care and provide GPs with a simplified and efficient tool to handle patients with common shoulder- related pain. The study is a stepped-wedge, cluster-randomized trial with a hybrid design including a effectiveness, cost and implementation assessment of a guideline-based intervention in clinical practice (2). General practitioners in Norway will be recruited and the GP offices will be randomized to the time of crossover from current treatment as usual (TAU) to the implementation of the intervention. The intervention is a tailored strategy that includes workshops for general practitioners covering information and access to a decision support tool, an education program where the general practitioner learn an evidence-based approach to shoulder pain and access to patient information materials. Outcomes will be measured at patient and GP levels, using self-report questionnaires, focus group interviews and register based data.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
250
Evidence-based clinical examination and treatment plan
GPs will in cooperation with the patients tailor a information package targeted to the patients needs regarding their clinical shoulder diagnosis and individual implications and needs (Pain, sleep, exercises etc.).
Usual care as provided by the GP
Department of Research and innovation, Helse Fonna, Norway
Haugesund, Vestland, Norway
RECRUITINGDepartment of General Practice, University of Oslo
Oslo, Norway
RECRUITINGChange in Shoulder Pain and Disability Index (SPADI)
13 item patient reported questionnaire on shoulder pain and disability. (0 = no pain or shoulder disability, 100 = worst pain and disability).
Time frame: Change from 0 to 12 weeks
the EuroQol quality of life measure (EQ5D-5L)
Health related quality of life ((0 (death) - 1.0 (perfect health))
Time frame: Change from 0 weeks to 52 weeks
Patient reported quality of care index (treatment according to the guideline intervention)
Patient reported content of treatment measured on six items according to treatment prescribed by the GP measured on 5-item Likert scales. Sum score above 18 points regarded as consultation of high quality according to guideline intervention.
Time frame: 0 week (after 1. visit to general practitioner)
Global patient perceived effect of treatment outcome (GPE)
1 item (7-point) ( 0 = worse than ever, 7 =I have become completely well)
Time frame: Measured at 6,12 and 52 weeks. Primary analysis of interest is at 12 weeks.
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