Corticosteroid injections in the management of subacromial pain: Experiences and decision making of physiotherapists

Background: Despite ongoing debate in the literature regarding their efficacy, corticosteroid injections remain a common treatment intervention for physiotherapists to consider for patients with subacromial pain. Very little is known about what factors and how clinician's experiences inform decision making in this area. Objectives: To investigate the experiences and decision making of physiotherapists in relation to the use of corticosteroid injections for subacromial pain. Design: A qualitative study using semi-structured interviews, which were then analysed using thematic analysis. Setting: A social enterprise organisation delivering NHS primary care musculo-skeletal physiotherapy services. Participants: Nine physiotherapists. Results: Three broad codes were identified: (1) initial management; (2) patient factors; (3) therapist beliefs. Within these three codes, seven sub-themes were identified. Confidence in diagnosis and satisfaction that conservative management had been attempted was important. Features of a patient's presentation were key to decision making, i.e. pain severity, function and effect on sleep. Patient engagement with rehabilitation was also considered important, as was consideration of the effect of psychosocial factors. Therapist beliefs and experiences around the efficacy of corticosteroid injections was also considered influential on decision making. Some dissuasive factors were also discussed. Conclusion: Some of the key factors in the decision making of physiotherapists in relation to the use of corticostemid injections for subacromial pain have been identified, such as patient presentation and engagement, clinician experience and consideration of current literature. Further research is indicated to explore this subject further to enable better understanding around clinical decision making and the use of corticosteroid injections.