Margit Kooijman

Shoulder vignettes | 41 that a large proportion of patients still received treatment when no improvement was observed 5 . So, there is the already complex task of treating patients with shoulder patients combined with a potential evidence-practice gap in both general practitioner and physiotherapist care. Collaboration and integration are important but it may be expected that this only yields positive results when there is interdisciplinary consensus on the best management strategies. This was reason for us to investigate the current management for four common shoulder problems. By comparing general practitioner and physiotherapist care to each other, potential leads are established to improve management of patients with shoulder pain in primary care. Methods Design and participants A random sample of 500 GPs and 500 physiotherapists, recruited from the national register databases for general practitioners and physiotherapists of NIVEL (Netherlands Institute for Health Services Research), were sent a questionnaire to investigate the management of patients with shoulder pain in primary care practices in the Netherlands. The invitation to participate described that these complaints are common but known to have an unfavourable outcome in many patients and that the purpose of this study was to assess current management amongst the two main caregivers in primary care in an attempt to identify leads for improvement of care. Participating clinicians approved of the study by filling out the questionnaire, their participation did not influence treatment. According to the Dutch Medical Research Involving Human Subjects Act, this study did not require ethics approval. The study did follow the Declaration of Helsinki. Data collection The questionnaire consisted of four vignettes, adopted from the study of Buchbinder et al. (2013) on determining the pattern of care for shoulder pain in Australian general practice 15 . The vignettes presented a 77 year-old female with a six-week history of shoulder pain consistent with rotator cuff tendinopathy; a 45 year-old laborer with clinical features consistent with an acute rotator cuff tear; a 50 year-old female with a three week history compatible with adhesive capsulitis; and the same patient presenting three months later with persistent symptoms (appendix 1). Also following Buchbinder et al. (2013), response options were categorized into investigations, treatment and referrals, and general practitioners were asked to select the options they would normally apply. For physiotherapists, response options were modified according to their treatment possibilities. In addition, both general practitioners and physiotherapists were