Evidence has surfaced that supports the value of loaded exercises for rotator cuff tendinopathy but there are barriers that might prevent implementation of this intervention in the real-world. The aim of this study was to explore these possible barriers with participants involved in a pilot randomised controlled trial (RCT) investigating a self-managed loaded exercise intervention. Data were collected using individual interviews and analysed using the framework method. The study was conduceted at one private physiotherapy clinic in northern England. Six patients and two physiotherapists were purposively sampled from those allocated to the self-managed exercise group within the RCT. Three themes were created: (1) Expectations and preferences, (2) characteristics of an unsuccessful outcome, (3) characteristics of a successful outcome. The majority of patients expressed expectations contrary to the philosophy of a self-managed approach. But this did not act as a barrier when the intervention was offered within a positive and supporting environment where patients understood the reasons for undertaking the exercise, effectively self-monitored and engaged with pro-active follow-up. An early and appreciable response to therapy was also a key factor influencing ongoing engagement with the exercise programme.
With certain caveats including the necessity of recognising and responding to individual characteristics, implementing effective knowledge translation strategies and the need to engage with properly timed pro-active follow-up, the potential to implement programmes of self-managed loaded exercise for patients with rotator cuff tendinopathy in the real-world and in further research studies appears feasible but challenging.