The Shoulder HD Pilot Trial: A qualitative study of patient and therapist experience, acceptability, tolerance and perception of a high and low load-volume intervention for rotator cuff tendinopathy.

OBJECTIVES

To explore the experiences of people, specifically the acceptability and tolerances of a high and low load-volume (intensity * X sets X repetitions) exercise programme for rotator cuff tendinopathy.

DESIGN

A nested qualitative study with individual in-depth semi-structured interviews.

METHODS

Twelve participants (6 high load-volume, 6 low load-volume) were recruited at the conclusion of a pilot and feasibility trial comparing high and low load-volume exercise for rotator cuff tendinopathy. Analysis followed an inductive thematic approach.

RESULTS

Three themes were identified: (1) Intensity: influenced by belief that the treatment will or won't work; (2) adherence: progress reinforced by a positive experience; and (3) education: reassurance and clear instruction regarding pain. Participants expressed initial doubt regarding the rationale behind both the high load-volume intervention and low load-volume intervention (i.e. either too easy or too hard). However, both groups surprised themselves with the improvement they made. Acceptability and tolerance of exercise intensity, either low or high, is are largely influenced by past exercise experience, expectations, attitudes and beliefs regarding the effectiveness of the exercise programme. Findings highlight the acceptability of both approaches for most people with rotator cuff tendinopathy, after some participants were initially apprehensive. Participants expressed the value of practical, informative, condition specific knowledge; the importance of tangible progress with their exercise programme; and appreciation for a low level of burden in adhering to their exercise.

CONCLUSIONS

Individualisation of exercise intensity is important, yet needs to consider individual preference, response to the load stimulus and the patients baseline physical capacity.