Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada

Lowry, Véronique; Lavigne, Patrick; Zidarov, Diana; Perreault, Kadija; Roy, Jean-Sébastien; Desmeules, François

doi:10.1186/s12875-023-01999-6

Table 4 Diagnosis and initial management of shoulder pain indicated by physiotherapists and family physician

From: Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada

	RC tendinopathy					Acute full-thickness RC tear					Adhesive capsulitis					Traumatic glenohumeral anterior instability
	PT (n = 175)		FP (n = 76)		p-value	PT (n = 161)		FP (n = 74)		p-value	PT (n = 149)		FP (n = 74)		p-value	PT (n = 147)		FP (n = 74)		p-value
	n	(%)	n	(%)	p-value	N	(%)	n	(%)	p-value	n	(%)	n	(%)	p-value	n	(%)	n	(%)	p-value
Adequate diagnosis
Yes	140	80	64	84	0.54	144	89	71	96	0.16	147	99	70	95	0.10	145	99	74	100	0.55
No	35	20	12	16	0.54	17	11	3	4	0.16	2	1	4	5	0.10	2	1	0	0.0	0.55
Recommendation of investigation
Yes	22	13	23	30	0.001^a	107	67	65	88	0.001^a	33	22	38	51	0.02^a	60	41	56	76	< 0.001^a
None	153	87	53	70	0.001^a	54	34	9	12	0.001^a	116	78	36	49	0.02^a	87	59	18	24	< 0.001^a
Type of recommended investigation^b
	PT (n = 22)		FP (n = 23)			PT (n = 107)		FP (n = 65)			PT (n = 34)		FP (n = 38)			PT (n = 60)		(n = 56)
Blood tests	1	4	1	4	1.00	0	0.0	0	0.0	1.00	1	3	7	18	0.06	0	0.0	1	1	0.48
X-Rays	13	59	21	91	0.02^a	4	3	4	5	0.48	17	50	31	82	0.006^a	23	16	41	55	0.01^a
Diagnostic MSK US	10	46	5	22	0.12	79	49	44	60	0.39	13	38	8	21	0.13	6	4	9	12	0.41
MRI	1	5	0	0.0	0.49	47	29	25	34	0.53	2	6	1	3	0.60	19	13	11	15	0.20
MRA	1	5	0	0.0	0.49	10	6	2	3	0.14	4	12	0	0.0	0.05	21	14	11	15	0.10
Other	1	5	0	0.0		0	0.0	0	0.0		0	0.0	1	3		0	0.0	1	1
Reason(s) for recommending an investigation^b
	PT (n = 22)		FP (n = 23)			PT (n = 107)		FP (n = 65)			PT (n = 34)		FP (n = 38)			PT (n = 60)		(n = 56)
To confirm diagnosis	8	36	7	30	0.75	81	76	55	74	0.23	13	38	8	21	0.12	27	45	22	39	0.57
To exclude another diagnosis	14	64	17	74	0.53	24	22	11	15	0.43	15	44	33	87	< 0.001^a	33	55	38	68	0.18
To guide treatment	8	36	4	17	0.18	32	30	23	31	0.50	10	29	10	26	0.80	12	20	15	27	0.51
To refer the patient to a medical MSK specialist	3	14	0	0.0	0.11	74	69	39	53	0.25	7	21	2	5	0.07	29	48	25	45	0.83
Other	1	5	0	0.0		4	4	3	4		1	3	3	8		2	3	3	5
Recommendation of referral to a medical MSK specialist^b
	PT (n = 175)		FP (n = 76)			PT (n = 159)		FP (n = 74)			PT (n = 149)		FP (n = 74)			PT (n = 147)		FP (n = 74)
None	173	99	75	99	1.00	88	55	53	72	0.01^a	120	81	69	93	0.02^a	99	67	37	50	0.02^a
Orthopaedic surgeon	0	0.0	0	0.0	1.00	59	37	20	27	0.18	12	8	0	0.0	0.01^a	44	30	34	46	0.03^a
Other^c	3	2	1	1	1.00	12	8	1	1	0.06	19	13	5	7	0.25	15	10	5	7	0.46

Proportion indicated in bold represent management that is recommended
RC Rotator cuff, FP Family physicians, PT Physiotherapists, MSK Musculoskeletal, US Ultrasound, MRI Magnetic resonance imaging, MRA Magnetic resonance arthrography
^aStatistically significant difference between PT and FP as determined by a Fisher’s test (p < 0.05)
^bParticipants could select more than one option. The total of answer can exceed 100%
^cRheumatologist, physiatrist, sport physician or other medical specialist

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