Shouldering Our Way Into a More Meaningful Research Agenda for Atraumatic Shoulder Pain: A Priority Setting Study

  1. Kristian Damgaard Lyng
  2. Torben Krejberg Børsting
  3. Mikkel Bek Clausen
  4. Annelene Houen Larsen
  5. Behnam Liaghat
  6. Kim Gordon Ingwersen
  7. Marcus Bateman
  8. Amar Rangan
  9. Karen Toftdahl Bjørnholdt
  10. David Høyrup Christiansen
  11. Steen Lund Jensen
  12. Janus Laust Thomsen
  13. Kristian Thorborg
  14. Connie Ziegler
  15. Jens Lykkegaard Olesen
  16. Michael Skovdal Rathleff

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Abstract

OBJECTIVE: To amplify the voices of people living with atraumatic shoulder pain, their relatives, and health care practitioners, and to establish research questions.

DESIGN: A priority-setting study using a modified approach originally formulated by the James Lind Alliance (JLA).

METHODS: The process consisted of 6 phases (initiation, consultation, collation, prioritization, validation, and reporting), and included 2 e-surveys and 2 separate virtual workshops. We included people with atraumatic shoulder pain, relatives, health care practitioners managing shoulder pain, and researchers conducting research within the field.

RESULTS: Six hundred and eight people participated (n = 383 [63%] patients, n = 213 [35%] health care practitioners, and n = 12 [2%] carers). In the first survey, 297 participants submitted 1080 potential research questions, which were collated into 16 main themes and 94 subthemes and transformed into research questions. These research questions were featured in the second survey, where 290 participants prioritized the questions, resulting in a compilation of the top 25 questions. Based on discussions from 2 separate online workshops with a total of 21 participants, a top-10 list was created.

CONCLUSION: In the final priority list, the 3 research questions with the highest ranking were, first, “how can we improve the translation of research into clinical practice?”; second, “how can we prevent atraumatic shoulder pain?”; and third, “who benefits from surgery, and who does not?” J Orthop Sports Phys Ther 2025;55(3):206-217. Epub 12 February 2025. doi:10.2519/jospt.2025.13059

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  1. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/19198837.

    Short Summary of Main Findings In this 2024 priority-setting study (preprint August 2024; now published in Journal of Orthopaedic & Sports Physical Therapy 2025), researchers used a modified James Lind Alliance approach involving 297 stakeholders (mostly people with atraumatic shoulder pain, plus healthcare practitioners and a few relatives). Participants submitted 1,080 research questions, which were prioritized through surveys and workshops. The final top 10 research priorities for atraumatic shoulder pain (also called subacromial pain syndrome/rotator cuff-related pain) were established. The highest-ranked questions focused on:

    1. Translating best available evidence into clinical practice,

    2. Preventing shoulder pain,

    3. Identifying which patients benefit from surgery. Other priorities likely included optimal exercise/rehabilitation strategies, long-term outcomes, and patient-centered care.

    How This Work Has Moved the Field Forward It is one of the first large-scale, patient- and stakeholder-driven priority-setting partnerships specifically for atraumatic shoulder pain in a Danish context (with international collaborators). By centering the voices of people living with the condition, it shifts the research agenda away from researcher-driven topics toward more meaningful, clinically relevant, and implementation-focused questions, guiding future funding, trials, and guidelines in shoulder rehabilitation and orthopedics.

    Major Issues

    • Still listed as a preprint on medRxiv (though now fully peer-reviewed and published in JOSPT in 2025).

    • Primarily Danish participants; generalizability to other countries/healthcare systems may be limited.

    • Priority-setting is inherently subjective and consensus-based; no new empirical data on treatments or outcomes.

    Minor Issues

    • Title is creative/punny but somewhat informal for a scientific paper.

    • Detailed top-10 list and exact ranking beyond the top 3 not fully elaborated in all summaries.

    • Workshops conducted virtually, which may have influenced participation dynamics.

    Competing interests

    The author declares that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The author declares that they did not use generative AI to come up with new ideas for their review.

  2. Version published to 10.2519/jospt.2025.13059
  3. Version published to 10.1101/2024.08.22.24312355 on medRxiv