Clark Natalie Louise, Johnson Melissa, Kottam Lucksy, Brealey Stephen, Adamson Joy, Rangan Amar
South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom.
Department of Health Sciences, University of York, York, United Kingdom.
Health Res Policy Syst. 2025 May 30;23(1):73. doi: 10.1186/s12961-025-01335-7.
Frozen shoulder (FS) is a painful, stiff and disabling shoulder condition affecting adults of working age. A multi-centre randomised controlled trial (UK FROST) comparing three of the most common treatments provided by the National Health Service (NHS) in secondary care found all three treatments improved patient outcomes, with none being overall clinically superior. Each treatment had its advantages and disadvantages. This paper describes the use of the Consolidated Framework of Implementation Research (CFIR) as an exemplar of knowledge translation for the latest evidence from UK FROST in the management of FS. It describes using stakeholder feedback in the development of a FS pathway, considering the barriers and facilitators to implementation in relation to the UK FROST findings and current clinical practice.
Healthcare professionals, academics, policymakers and patient and public representatives were invited as stakeholders to three meetings held in November 2022 and January 2023. An overview of the United Kingdom Frozen Shoulder Trial (UK FROST) study, current pathways, referral processes and guidelines for FS in the context of the study results and the development of patient resources were discussed at the first meeting in November. Outcomes from this meeting informed the January meetings. The CFIR was used to guide analysis of the discussions from the stakeholder meetings.
Overall, 67 stakeholders attended across three meetings. From the meetings, we categorised the FS pathway into four components (1) presentation and assessment; (2) initial management; (3) treatment options - physiotherapy and steroid injection, secondary care referrals; and (4) enhanced recovery and follow-up, with shared decision-making emphasised throughout the pathway. Barriers and facilitators in each of the pathway components were identified using the five domains of the CFIR. A proposed evidence-based FS pathway was developed with stakeholders using an eight-step process.
This study has led to the development of an evidence-based FS care pathway, ready to be considered by policymakers for implementation, with considerations of barriers and facilitators. There was consensus that it is feasible to embed a modified physiotherapy intervention form UK FROST within current primary and community care settings to optimise service delivery and referral pathways. Trial Registration The trial registration is ISRCTN48804508.
肩周炎（FS）是一种影响工作年龄成年人的肩部疾病，会导致疼痛、僵硬和功能障碍。一项多中心随机对照试验（英国FROST）比较了英国国家医疗服务体系（NHS）二级医疗中三种最常见的治疗方法，发现这三种治疗方法均能改善患者预后，没有一种在临床上总体上更具优势。每种治疗方法都有其优缺点。本文描述了如何使用实施研究综合框架（CFIR）作为知识转化的范例，将英国FROST关于FS管理的最新证据应用其中。它描述了在制定FS治疗路径时如何利用利益相关者的反馈，考虑到与英国FROST研究结果和当前临床实践相关的实施障碍和促进因素。
邀请医疗保健专业人员、学者、政策制定者以及患者和公众代表作为利益相关者参加2022年11月和2023年1月举行的三次会议。在11月的第一次会议上，讨论了英国肩周炎试验（UK FROST）研究的概述、当前的治疗路径、转诊流程以及在研究结果背景下的FS指南和患者资源的开发。这次会议的结果为1月的会议提供了参考。CFIR被用于指导对利益相关者会议讨论内容的分析。
总体而言，三次会议共有67名利益相关者参加。通过这些会议，我们将FS治疗路径分为四个部分：（1）就诊与评估；（2）初始管理；（3）治疗选择——物理治疗和类固醇注射、二级医疗转诊；（4）强化康复与随访，并且在整个治疗路径中都强调共同决策。使用CFIR的五个领域确定了每个治疗路径部分中的障碍和促进因素。与利益相关者一起通过一个八步流程制定了一条基于证据的FS治疗路径。
本研究促成了一条基于证据的FS护理路径的制定，政策制定者可考虑实施该路径，并考虑到了障碍和促进因素。大家一致认为，在当前的初级和社区护理环境中嵌入英国FROST改良后的物理治疗干预措施以优化服务提供和转诊路径是可行的。试验注册 试验注册号为ISRCTN48804508。
