Physiotherapy management of rotator cuff-related shoulder pain in Germany is broadly consistent with recommended practice: An observational study

Background : Rotator cuff-related shoulder pain (RCRSP) is a disabling cause of shoulder pain commonly encountered by physiotherapists internationally. Current clinical practice guidelines recommend conservative management (education, exercise, activity modification, analgesia) prior to consideration of imaging and interventional care (injections/surgery). Previous research from the United Kingdom, Belgium, and the Netherlands, Italy, Australia, and France show that current physiotherapy practice is broadly consistent with guideline recommendations, with some key differences in practice between nations. In contrast to these countries, primary qualification of physiotherapists in Germany is not academically based, but a three-year program of vocational training. It is unknown to what extent German physiotherapists are consistent with providing recommended management for RCRSP, and if this differs from practice shown in other countries. The aim of this study was to investigate the adherence to recommended management for RCRSP in German physiotherapists and compare the findings to practice in other countries. Methods : An English case vignette-based questionnaire, which had been applied in other studies, was translated, and adapted into German context. An online cross-sectional survey was conducted from January 2022 to March 2022. Relationships between different data were analysed using a Chi-square test or Fisher's exact test. A qualitative content analysis was conducted for the open-ended questions. Results : One hundred and ninety-two German physiotherapists responded to the survey. Results showed that most physiotherapists would use exercise therapy (99,0%;190/192) and education (99,0%;190/192) as part of management of RCRSP, consistent with guideline recommendations. Non-academically trained physiotherapists were more likely to use interventions with insufficient evidence (i.e., electrotherapy, taping) (73.0%;111/152), (Pearson-Chi-square = 6.88, p = 0.011). Views on the design of specific parameters of exercise therapy (i.e., type of exercise, dosage etc.) varied widely within the cohort, but were comparable with findings from the other nations. Conclusions : German physiotherapy management for RCRSP is broadly consistent with recommendations of current evidence, but heterogeneity exists in the specific recommendations when considering exercise type and dosage. Compared to similar international studies, German physiotherapists provided less research based clinical reasoning to their management choices and non-academically trained German physiotherapists were significantly more likely to recommend interventions with unclear or missing evidence. Trial Registration: German Clinical Trials Register (DRKS00030955). Retrospectively registered 05 January 2023.