Co-design of a Treatment Algorithm for People With Large to Massive Rotator Cuff Tendon Tears: The CALMeR Cuff Pathway

OBJECTIVE: Using an experience-based codesign (EBCD) approach, to co-design a treatment algorithm to support and enhance assessment, diagnosis, and treatment of people presenting with large to massive rotator cuff tendon tears (for ease of reading, we will use the term “rotator cuff tears”) in primary health care settings. DESIGN: Mixed-methods study underpinned by EBCD with involvement of clinicians and people with rotator cuff tears. METHODS: Using an EBCD process, people with rotator cuff tears and clinicians participated in 3 workshops. Then, the data were analyzed, summarized, and refined until a group consensus was reached, and synthesized to produce the final treatment algorithm. RESULTS: Eleven people with rotator cuff tears and 12 clinicians participated. The co-design group identified 10 clinical action points to support the clinical assessment and surgical and nonsurgical management of rotator cuff tears. The clinical action points included clinicians speaking with 1 voice, adopting a consistent approach to education, setting realistic expectations, collecting sufficient and relevant outcome measures, and using a common approach to shared decision making. The collective outcome was a comprehensive approach for large to massive rotator cuff tears (“CALMeR Cuff”), which serves as a shoulder pain care pathway. CONCLUSION: Our co-design approach involved people with rotator cuff tears and ensured that the CALMeR Cuff pathway can provide consistent, evidence-based care for people with rotator cuff tears.