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New £2.7 million study to personalise care for people with shoulder pain

The Primary Care Clinical Trials Unit will recruit 500 Oxfordshire residents into the NIHR's jointly funded programme with Arthritis Research UK, representing their largest charity collaboration to date. © Shutterstock
Oxford University’s world-class infrastructure for carrying out clinical trials in community settings allows us to support such important national studies, and we’re keen for local GP surgeries to contact us to get involved in this particular project.
- Professor Carl Heneghan, University of Oxford.

An ambitious £2.7 million programme of research is seeking to personalise care for people with shoulder pain, to make sure that people receive the care that is best for them and avoid unnecessary investigations and treatments.

500 Oxfordshire residents will be invited to take part in the national study, co-ordinated locally by a team from Oxford University’s Primary Care Clinical Trials Unit.

The new programme of research, which is led nationally by Keele University with joint funding from the National Institute for Health Research (NIHR) and Arthritis Research UK, aims to develop a more effective way of ensuring that patients receive treatments they are most likely to benefit from.

The four different streams of the study represent one of the largest ever programmes of research that the NIHR has jointly funded with a charity.

Shoulder problems, such as shoulder impingement and frozen shoulder, affect one in five adults in the UK. The conditions can be very painful, affecting sleep, work, and day-to-day life.

In England, about 1.5 million people visit their GP for shoulder pain each year. However, 40% experience ongoing pain despite treatment.

Most patients with shoulder pain are treated with exercises, shoulder injection, or surgery. Although there is little evidence that surgery provides better results than non-surgical treatments, seven times more people are undergoing surgery than 10 years ago.

In this new NIHR programme of work, researchers at the Arthritis Research UK Primary Care Centre at Keele University, in collaboration with the University of Oxford, will review existing research to identify what factors influence whether patients are likely to benefit from specific treatments. They’ll then follow 1000 patients who have consulted their GP or a physiotherapist for shoulder pain to develop a screening and decision-making tool for treatment, which will be tested in a randomised trial. Half of these patients will be recruited in Oxfordshire.

The researchers hope that the tool will help to stratify how doctors assess the likely cause and future outcome of shoulder problems, so that patients can be offered personalised treatments that match their characteristics.

Principal investigator Professor Danielle van der Windt, Professor of Primary Care Epidemiology at Keele University, said: “Many patients with shoulder pain recover quickly, but in others the pain does not diminish and can affect sleep, work and everyday life for many months. At the moment, we don’t have good evidence that can help clinicians to identify patients at increased risk and make decisions about which treatment is likely to be best.

“This NIHR programme of research aims to provide such evidence. This means that, in future, patients who need it can be offered optimal treatment early on, whereas those who are likely to do well without treatment can be reassured and given good advice on how to manage their shoulder pain, so that unnecessary investigations or treatments can be avoided.”

Leading the study in Oxfordshire, Professor Carl Heneghan, Professor of Evidence-Based Medicine at the University of Oxford, said: “Shoulder pain is a debilitating condition that is mainly managed in primary care. In up to 40% of patients, the pain can last for as long as 12 months, yet there is little evidence to detect those most likely to benefit from interventions.

"This novel program of work aims to change this by identifying those who will gain the most from interventions such as surgery. Oxford University’s world-class infrastructure for carrying out clinical trials in community settings allows us to support such important national studies, and we’re keen for local GP surgeries to contact us to get involved in this particular project.”

The NIHR recognises the significant role that charities play in supporting health and care research and is currently developing an approach to support greater connectivity across the research landscape. The new approach aims to increase collaboration between charities and the NIHR, strengthen partnerships and align objectives among research funders, to deliver improvements in health and social care research to maximise patient benefit.

Dr Natalie Carter, Head of Research Liaison & Evaluation at Arthritis Research UK, said:  “We are very excited to announce this funding partnership. By working together, we can have a bigger impact on the one in five people in the UK who live with the agony of shoulder pain. 

“Everyone experiences arthritis differently, which is why making sure patients with shoulder pain are given treatments which will give the best results for them and their condition will make a huge difference on a person’s life.  If you are living with joint pain or arthritis and have questions about pain management, please visit the Arthritis Research UK website.”

The programme of research is currently being set-up, with participant recruitment opening later this year. GP surgeries interested in participating in the study should contact Dr Claire Madigan.


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