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Best practice for patients with gluteal tendinopathy: A qualitative exploration of expert clinical reasoning and management

Year: 2025

Type: article

Abstract: Background Best management for the common, severe condition of Gluteal tendinopathy has not been determined, with exploration of expert clinical reasoning notably absent. We aimed to inform clinical care by exploring how experts manage GT. Methods An interview topic guide, iteratively developed with experts, was used alongside an online interview prompt with purposively sampled international inter-disciplinary experts during online, semi-structured interviews. Iterative framework and content analysis using a positivist stance was performed alongside recruitment until adequate information power was reached. Results Twenty participants including physiotherapists, physicians, and surgeons (14 males, 6 females) were interviewed for a mean (SD) of 52 (20) minutes yielding 5 main themes of: Therapeutic alliance: Developing a positive therapeutic alliance through emphatic engagement. "Give them a stack of reassurance and listen to their story"; Service Delivery and multidisciplinary team involvement: "Patients get 45 min…they get a package (of care) …"; Clinical reasoning : "I usually use three things in a patient's specific context. So, it's going to be about the quality of sleep. Yeah, their ability to walk, and their ability to sit and get up from sitting…." ; Exercise principles : "frontal plane control being priority for gluteal tendinopathy" ; Specific interventions "You need to further that education as you go along. But patients can only take in so much at once." Conclusion Expert reasoning prioritises personalised exercise and education as the core management approach in a reflexive therapeutic relationship incorporating individually staged interventions. Future work needs to focus on incorporating expert reasoning into clinical guidelines. Contribution of the Paper •Identifies five core themes underpinning expert clinical reasoning in the management of people with gluteal tendinopathy. •Demonstrates that personalised exercise and education form the core management approach, supported by staged adjunct interventions tailored to the individual. •Provides a framework to inform future clinical guidelines by incorporating multidisciplinary expert reasoning.

Source: Physiotherapy

DOI: 10.1016/j.physio.2025.101871

Authors: Tobias Bremer, Simon Lack, Angie Fearon, Dylan Morrissey

Institutions: Queen Mary University of London, William Harvey Research Institute, University of Canberra, Barts Health NHS Trust

Language: English

Topic: Tendon Structure and Treatment

Subfield: Orthopedics and Sports Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,480