Table 2Stakeholder ranking of scientific research questions

Scientific Research QuestionWeightedUnweightedRelated PICO Elements
Overarching Questions
Which patients do best with nonoperative treatment?9 7 P
Which tears require surgery?6 5 P
What is the threshold for surgery, given the rotator cuff tear severity/grade?22
How does concomitant pathology or patient age modify a surgical threshold?5 3
How long should a good outcome persist after operative or nonoperative intervention and should these recovery duration expectations differ by treatment approach?11
How should recovery duration expectations differ in older patients?00
What is the overall value of rehabilitation/adjunctive care?43
How should rehabilitation (operative and nonoperative) strategies, timing, and intensity, differ by the tear characteristics, patient age, mechanism of injury, type of repair and work issues/worker’s compensation?8 6 P
How does the timing of passive/active/resistive exercise impact tissue healing in post-operative rehabilitation?44
What is the impact of range of motion and strength on outcomes?11
What is the natural history of rotator cuff tears? What variables (risk factors) are associated with progression of fatty atrophy and tear size?7 5 P
Which patient and cuff tear factor(s) most strongly predict poor outcomes after surgery?6 5 P
Which patient subgroups (age, tear-based, functional limitation-based) should be identified in RCTs/clinical studies, and which are too heterogeneous to combine for outcomes comparisons?00
What patient demographics and clinical profiles are important? (Age, health habits/smoking, hand dominance, worker’s compensation, specific comorbidities).33
How do tear characteristics affect outcomes: size, age/duration of pathology, pre-existing/chronic changes, mechanism of injury?44
How do psychosocial factors such as depression, socioeconomic status, motivation/self-efficacy, fear-avoidance, and coping mechanisms modify outcomes?44
Nonoperative Questions
Which nonoperative interventions and which comparisons should be studied? (Physical therapy, exercise (supervised vs. home-based), cortisone injections, massage therapy, acupuncture, other).44
Nonoperative vs. Operative Questions
Which nonoperative vs. operative treatment comparisons are most important among patients whose condition may benefit from either approach? (Which patients do equally well when treated nonoperatively or operatively?)21
Operative Questions
Given surgery is indicated, when is early (vs. delayed) surgery indicated?22
Does cuff integrity predict patient-centered outcomes? Is a “successful” (intact) rotator cuff repair necessary?22
Why does surgery often result in improved outcomes, even with evidence of repair failure?00
What is the effectiveness or comparative effectiveness of different surgical decisions, such as approach, technique, or associated procedures?5 4 I/C
Who benefits from repeat procedures and when should revision repair be attempted?11
What is the effectiveness of adjunctive/biologic technologies such as protein-rich plasma, growth factors, stem cells, reinforcement meshes or patches?33
Which surgical procedures (tenotomy, muscle transfer, reverse total shoulder replacement, other) should be considered for irreparable rotator cuff tears?33
What information will best help a patient choose a provider and treatment path?43

PICO = population, intervention, comparison, outcome; RCT = randomized controlled trial

Item was ranked in the top quartile. Each stakeholder had 9 stars to assign to questions deemed high priority. Up to 3 stars could be assigned to any one issue.

From: Results

Cover of Nonoperative and Operative Treatments for Rotator Cuff Tears: Future Research Needs
Nonoperative and Operative Treatments for Rotator Cuff Tears: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 22 [Internet].
Future Research Needs Papers, No. 39.
Butler M, Forte M, Braman J, et al.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.