Best practice for patients with gluteal tendinopathy: A qualitative exploration of expert clinical reasoning and management.

BACKGROUND

Best management for the common, severe condition of Gluteal tendinopathy has not been determined, with exploration of expert clinical reasoning notably absent. We aimed to inform clinical care by exploring how experts manage GT.

METHODS

An interview topic guide, iteratively developed with experts, was used alongside an online interview prompt with purposively sampled international inter-disciplinary experts during online, semi-structured interviews. Iterative framework and content analysis using a positivist stance was performed alongside recruitment until adequate information power was reached.

RESULTS

Twenty participants including physiotherapists, physicians, and surgeons (14 males, 6 females) were interviewed for a mean (SD) of 52 (20) minutes yielding 5 main themes of: Therapeutic alliance: Developing a positive therapeutic alliance through emphatic engagement. "Give them a stack of reassurance and listen to their story";Service Delivery and multidisciplinary team involvement: "Patients get 45 min…they get a package (of care) …"; Clinical reasoning: "I usually use three things in a patient's specific context. So, it's going to be about the quality of sleep. Yeah, their ability to walk, and their ability to sit and get up from sitting…."; Exercise principles: "frontal plane control being priority for gluteal tendinopathy"; Specific interventions"You need to further that education as you go along. But patients can only take in so much at once."

CONCLUSION

Expert reasoning prioritises personalised exercise and education as the core management approach in a reflexive therapeutic relationship incorporating individually staged interventions. Future work needs to focus on incorporating expert reasoning into clinical guidelines. CONTRIBUTION OF THE PAPER.