Relevant treatment outcomes for individuals aged 60 and older with massive rotator cuff tears: a qualitative study with 16 patients

Abstract

Background and purpose: Qualitative research on individuals with massive rotator cuff tears (MRCT) is scarce. This study aims to identify the perceptions, concerns, and treatment outcomes relevant to individuals with MRCT of the shoulder, as expected before treatment or experienced afterward. Methods: A qualitative study was designed using a hermeneutic phenomenological methodology. Purposive sampling was employed to identify potentially eligible patients (diagnosed with MRCT and aged 60-85 years) in the trauma and orthopedic outpatient clinics of 3 hospitals in Spain. The study employed 2 segmentation criteria: type of treatment and timing (before/after treatment). 16 interviews were conducted to capture the patients' perspective: 9 were semi-structured and 7 were in-depth. Interpretative phenomenological analysis was used, and triangulation was performed by 3 researchers with diverse backgrounds. Results: The mean age of participants (10 women and 6 men) was 71 years, with most having their dominant limb affected. The analysis revealed 4 themes (13 subthemes): MRCT impact on daily living (shoulder-derived functional limitation, pain, and emotional disturbance); treatment outcomes (recovering independence, pain relief, and social participation); clinical management (communication with health professionals, duration of the diagnostic/therapeutic process, and participation in decision-making); and characteristics of the individual (sex, work, and comorbidity). Special unmet needs were identified for women, with more prolonged diagnostic and therapeutic processes while bearing most household responsibilities. Conclusion: Recovering independence and pain relief were the principal outcomes from the perspective of patients with MRCT, and social participation and emotional well-being were closely linked. Measuring these outcomes could improve shared decision-making, while addressing systemic barriers to enhance patient participation.