Background Persistent musculoskeletal pain is a multi-factorial entity, influenced by biological, genetic and psychosocial factors. Psychosocial factors, such as individuals' beliefs and experiences, need to be considered in the management of such pain. While extensive research has explored beliefs of individuals with spinal pain, less is known about individuals' beliefs regarding shoulder pain. Objectives To explore beliefs about the cause of pain in individuals with persistent rotator cuff-related pain, as well as the experiences of the effect of pain on their daily lives. Design A mixed methods design, using semi-structured interviews and validated outcome questionnaires. Method Five men and five women, aged 47–68 years, with shoulder pain for at least three months were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim and analysed using the general inductive approach. Results/findings Four key themes emerged. The cause of pain, ‘Understanding the pain’, was described in terms of anatomical factors within the context of the participants' lives. The pain impacted all areas of life, creating another theme, ‘It affects everything’. Participants responded to their pain by adopting certain, ‘Pain-associated behaviours’ and sought information for diagnosis, general management and exercise prescription, ‘Emotional responses and the future’. Conclusions The participants with rotator cuff-related pain believed the cause of their pain to be local to the shoulder region. However, they also described various stressors in their work-, sports- and family-related lives. Rehabilitation may need to include educating the individual, expanding their understanding regarding pain mechanisms and appropriate interventions, based on individual goal-setting.

Purpose: To explore perceptions and initial outcomes of patients with rotator cuff-related pain to a pain education session. Materials and Methods: Ten individuals with persistent rotator cuff-related pain (≥3 months duration) attended an individual pain education session. They completed patient-reported outcomes measures on a weekly basis, three weeks prior and three weeks following the session. Individual semi-structured interviews were conducted three weeks following the pain education. Interviews were recorded, transcribed verbatim, and analyzed using the General Inductive Approach. Results: There were two over-arching key themes: firstly, ‘Participants’ Perspectives’ of the session generated four themes: Improved understanding of ‘the whole’; Mindful self-awareness; Taking charge; “The pain is still there”. Their understanding of pain was reconceptualised, evident by their ability to describe the role of neurophysiological mechanisms, stress and general well-being towards their pain. The second over-arching key theme, ‘Participants’ Recommendations’, had two themes: Integrating neuroscience with pathoanatomical knowledge and Educating other health professionals. Pain levels decreased post-pain education compared to pre-pain education. Conclusions: Following the pain education session, participants had greater understanding of factors influencing their shoulder pain. Pain education, in addition to pathoanatomical information may be useful as part of treatment for persistent rotator cuff-related pain.

Hintergrund: Das subacromiale Schmerzsyndrom (SAPS) ist ein häufiges muskuloskelettales Krankheitsbild. Patienten haben eine eingeschränkte schmerzhafte Schulterbeweglichkeit. Der Pathomechanismus ist noch nicht ganz geklärt. Umliegende Gelenke können durch Bewegungseinschränkungen das SAPS beeinflussen. Die vorliegende Bachelorthesis soll eine Literaturübersicht über osteopathische Behandlungsmöglichkeiten beim SAPS geben. Methodik: Sieben medizinische Datenbanken wurden auf zwischen 2010 und 2023 veröffentlichte relevante Artikel durchsucht. Eingeschlossen wurden randomisierte klinische Studien (RCT), in deutscher und englischer Sprache, in denen osteopathische Techniken, bei menschlichen Probanden mit einem SAPS, eingesetzt wurden. Die Ergebnisse wurden mit einer Kontrollgruppe oder anderen Interventionen verglichen. Ergebnisse: Die Suche ergab 782 einzelne Artikel. 14 Studien erfüllten die Einschlusskriterien und wurden in der PICO Übersicht eingeschlossen. Zehn Studien verwendeten Manipulationstechniken und vier Studien Weichteiltechniken mit Heimübungen. Die Ergebnisse zeigen, dass die Techniken sich positiv auf das SAPS auswirken. Eine Signifikanz zwischen den Gruppen ist häufig nicht vorhanden. Schlussfolgerung: Alle Studien zeigen nach osteopathischen Behandlungen eine Verbesserung der Beschwerden mit SAPS. Manipulation reicht als alleinige Behandlung nicht aus, um einen Langzeiteffekt zu erzeugen. Eine individualisierte Kombinationstherapie mit verschiedenen Behandlungstechniken und Heimübungen, ist für die effektive, klinische, Patientenbehandlung besser geeignet. Zukünftige Untersuchungen sollten vermehrt osteopathische Techniken untersuchen, um das positive Bild der osteopathischen Behandlung zu festigen und das mögliche Ausmaß der Verbesserungen zu ermitteln. / Background: Subacromial pain syndrome (SAPS) is a common musculoskeletal condition. Patients have limited painful shoulder mobility. The pathomechanism has not yet been fully elucidated. Surrounding joints can affect the SAPS through movement restrictions. This bachelor thesis is intended to provide a literature review on osteopathic treatment options for SAPS. Methods: Seven medical databases were searched for relevant articles published between 2010 and 2023. Included were randomized clinical trials (RCT), in German and English, in which osteopathic techniques were used on human subjects with SAPS. The results were compared to a control group or other interven-tions. Results: The search returned 782 individual articles. 14 studies met the inclusion criteria and were included in the PICO review. Ten studies used manipulation techniques and four studies used soft-tissue techniques with home exercises. The results show that the techniques have a positive effect on the SAPS. Significance between groups is often absent. Conclusion: All studies show an improvement in symptoms with SAPS after osteopathic treatments. Manipulation alone is not enough to produce a long-term effect. An individualized combination therapy with different treatment techniques and home exercises is more suitable for the effective, clinical, patient treatment. Future investigations should examine more osteopathic techniques in order to consolidate the positive image of osteopathic treatment and to determine the pos-sible extent of the improvements.

La douleur, fréquemment rencontrée lors d’atteintes musculosquelettiques, est un phénomène complexe influencé par une combinaison multifactorielle de déterminants biopsychosociaux. Elle présente un important taux de chronicité avec près de huit millions de personnes au Canada atteintes de douleur chronique (douleur qui perdure plus de trois mois), c’est-à-dire un Canadien sur cinq. Les troubles musculosquelettiques incluent le syndrome de conflit sous-acromial (SCSA), une atteinte fréquente à l’épaule, qui a une forte tendance à se chroniciser. Un an après le début des symptômes, environ la moitié des personnes avec ce syndrome présentent de la douleur et une limitation de la fonction persistantes. Des facteurs psychosociaux seraient prédictifs de la chronicité pour le SCSA. Toutefois, dans les guides de pratique qui orientent la prise en charge de cette atteinte, les interventions ciblant ces facteurs sont limitées et parfois même manquantes. En physiothérapie, une discipline fréquemment impliquée dans la réadaptation de cette atteinte, des approches englobant les facteurs biopsychosociaux seraient à privilégier. L’enseignement au patient, une modalité faisant partie intégrante de la physiothérapie, mais pour laquelle les recommandations sont limitées pour en guider la réalisation, serait une avenue pertinente. Cette thèse vise à développer des recommandations qui soutiennent l'enseignement structuré auprès des patients ciblant l’autonomisation (implication active pour la prise de décision et la gestion de la condition) de la personne dans le suivi du SCSA en physiothérapie. Elles intègrent les données scientifiques, expérientielles et contextuelles et les composantes de la Classification internationale du fonctionnement, du handicap et de la santé. La première phase de cette thèse contient une revue systématique de la portée qui visait à répertorier l’étendue de la littérature sur les interventions d’enseignement au patient lors de la prise charge du SCSA. Cette revue a permis d’identifier des cibles initiales d’enseignement au patient issues de la littérature, utilisées pour orienter la phase suivante du projet. La deuxième phase a utilisé une consultation d’experts par des groupes de discussion focalisée intégrant des professionnels de la réadaptation et des patients-partenaires pour explorer les cibles et décrire les stratégies d’enseignement (plan pour atteindre un objectif d’enseignement visé). Cette consultation a été analysée de manière qualitative en vue de faire ressortir les thématiques principales d’enseignement au patient émergeant des discussions. Cette étape a mené au développement de recommandations préliminaires. La troisième phase visait à obtenir un consensus sur la pertinence et la formulation de recommandations détaillées encadrant les interventions d’enseignement au patient en physiothérapie pour le SCSA à l’aide d’une consultation par approche Delphi. À la suite de ces trois phases, sept recommandations générales encadrant les stratégies d’enseignement au patient et six recommandations touchant des cibles d’interventions spécifiques d’enseignement ont été développées. Un outil d’aide à la décision guidant l’utilisation de ces recommandations d’enseignement structuré lors du suivi des personnes atteintes d’un SCSA a aussi été élaboré. Ces recommandations sont les premières existantes pouvant soutenir l’enseignement structuré au patient lors du suivi du SCSA. Celles-ci sont pertinentes pour guider l’enseignement prodigué basé sur la littérature et un consensus d’experts. Les cibles d’autogestion et d’engagement actif de la personne sont pertinentes pour intervenir sur les facteurs psychosociaux et ainsi potentiellement réduire la chronicité de cette atteinte. / Pain, frequently encountered in musculoskeletal injuries, is a complex phenomenon influenced by a multifactorial combination of biopsychosocial determinants. It has a high rate of chronicity with nearly eight million people in Canada suffering from chronic pain (pain lasting more than three months), i.e., one in five Canadians. Among musculoskeletal disorders, subacromial pain syndrome (SAPS), a frequently encoutered shoulder disorder, has a high propensity to become chronic. One year after the onset of symptoms, about half of individuals with SAPS have persistent pain and functional limitations. Psychosocial factors are predictive of SAPS chronicity, however, in the clinical practice guidelines that guide the management of this condition, interventions targeting these factors are limited and sometimes absent. Approaches that target biopsychosocial factors should be favoured, among others, in physiotherapy, a discipline frequently involved in the rehabilitation of this condition. Patient education, a modality that is an integral part of physiotherapy, but for which there is limited evidence and recommendations to guide its implementation, would be a relevant avenue. Therefore, this thesis aims to develop recommendations that support structured patient education. These recommendations focus on the person's empowerment and self-management during the follow-up of SAPS in physical therapy. They are based on scientific, experiential and contextual data as well as components of the International Classification of Functioning, Disability and Health. The first phase of this thesis contains a systematic scoping review that aimed to map the extent of the literature on patient education interventions in the management of SAPS. This review identified the initial patient education targets from the literature that were used to guide the next phase. The second phase used expert consultation through focus groups involving rehabilitation professionals and patient-partners to explore targets and outline strategies for structured patient education interventions in physical therapy for the follow-up of individuals with SAPS. The development of the interview guide and the analysis of these discussions were based on the initial educational targets and strategies (plan to conduct the educational intervention) extracted from the previous phase. This consultation was qualitatively analyzed to identify the main patient education themes resulting from the discussions. The main themes led to the development of preliminary recommendations. The third phase aimed to reach consensus on the relevance and formulation of detailed recommendations framing patient education interventions in physical therapy for the follow-up of individuals with SAPS using a Delphi consultation approach. As a result of these three phases, seven general recommendations framing patient teaching strategies and six recommendations for specific teaching interventions targets were developed. A decision support tool guiding the use of these structured patient education recommendations in the follow-up of people with SAPS has also been developed. These recommendations are the first that can comprehensively support structured patient education intervention during the follow-up of individuals with SAPS. They are relevant to guide patient education interventions that are based on the literature and expert consensus. The goals of self-management and active engagement of the person are relevant to intervene on psychosocial factors and thus potentially reduce the chronicity of this condition.