{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:53Z","timestamp":1787017013962,"version":"build-2736575974"},"reference-count":33,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T00:00:00Z","timestamp":1623283200000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health Research (NIHR) Health Technology Assessment programme","award":["13\/26\/01"],"award-info":[{"award-number":["13\/26\/01"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,4,12]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore the experiences and perceptions of trial participants and healthcare professionals in the UK Frozen Shoulder Trial (UK FROST), a multicentre randomised controlled trial that compared manipulation under anaesthesia (MUA), arthroscopic capsular release (ACR) with a 12-week early structured physiotherapy programme (ESP) in people with unilateral frozen shoulder referred to secondary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Nested qualitative study with semistructured interviews. We used constant comparison method to develop our themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This qualitative study was nested within the UK FROST.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>44 trial participants (ESP: 14; MUA: 15; ACR: 15), and 8 surgeons and 8 physiotherapists who delivered the treatments in the trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Trial participants found UK FROST treatments acceptable and satisfactory in terms of content, delivery and treatment benefits. Participants in all arms experienced improvements in pain, shoulder movements, and function. Participants said they would choose the same treatment that they received in the trial.<\/jats:p>\n                    <jats:p>Surgeons and physiotherapists felt that the content and delivery of UK FROST treatments was not significantly different to their routine practice except for the additional number of physiotherapy sessions offered in the trial. They had mixed feelings about the effectiveness of UK FROST treatments. Both stressed the value of including hydrodilatation as a comparator of other treatment options. Physiotherapists raised concerns about the capacity to deliver the number of UK FROST physiotherapy sessions in routine clinical settings.<\/jats:p>\n                    <jats:p>Shared perceptions of trial participants, surgeons and physiotherapists were: (1) Pain relief and return of shoulder movements and function are important outcomes and (2) Adherence to exercises leads to better outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In general, our findings indicated that trial participants, and surgeons and physiotherapists who delivered the treatments had positive experiences and perceptions in the UK FROST. Early qualitative investigations to explore the feasibility of delivering treatments in real-world settings are suggested in future trials in the frozen shoulder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      International Standard Randomised Controlled Trial Register, ID:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"ISRCTN48804508\">ISRCTN48804508<\/jats:ext-link>\n                      . Registered on 25 July 2014; Results\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-040829","type":"journal-article","created":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T10:44:52Z","timestamp":1623408292000},"page":"e040829","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Experiences and perceptions of trial participants and healthcare professionals in the UK Frozen Shoulder Trial (UK FROST): a nested qualitative study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3540-8052","authenticated-orcid":false,"given":"Cynthia","family":"Srikesavan","sequence":"first","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francine","family":"Toye","sequence":"additional","affiliation":[{"name":"Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Brealey","sequence":"additional","affiliation":[{"name":"York Trials Unit, ARRC Building, Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorna","family":"Goodchild","sequence":"additional","affiliation":[{"name":"The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Northgraves","sequence":"additional","affiliation":[{"name":"Hull York Medical School, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalambos P","family":"Charalambous","sequence":"additional","affiliation":[{"name":"Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK"},{"name":"School of Medicine, University of Central Lancashire, Preston, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5452-8578","authenticated-orcid":false,"given":"Amar","family":"Rangan","sequence":"additional","affiliation":[{"name":"York Trials Unit, ARRC Building, Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Lamb","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK"},{"name":"College of Medicine and Health, University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,6,11]]},"reference":[{"key":"2025121403153768000_11.6.e040829.1","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1177\/1758573215601779","article-title":"Frozen shoulder","volume":"7","author":"Rangan","year":"2015","journal-title":"Shoulder Elbow"},{"key":"2025121403153768000_11.6.e040829.2","unstructured":"Mezian K , Chang KV , Shoulder F . Frozen shoulder. Treasure Island: StatPearls Publishing, 2020. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482162\/"},{"key":"2025121403153768000_11.6.e040829.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4162"},{"key":"2025121403153768000_11.6.e040829.4","doi-asserted-by":"crossref","first-page":"352","DOI":"10.2174\/1874325001307010352","article-title":"The frozen shoulder: myths and realities","volume":"7","author":"Nagy","year":"2013","journal-title":"Open Orthop J"},{"key":"2025121403153768000_11.6.e040829.5","doi-asserted-by":"crossref","DOI":"10.32098\/mltj.01.2020.04","article-title":"The effectiveness of physiotherapy in idiopathic or primary frozen shoulder: a systematic review and meta-analysis","volume":"10","author":"Cavalleri","year":"2020","journal-title":"Muscle Ligaments and Tendons J"},{"key":"2025121403153768000_11.6.e040829.6","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000002216"},{"key":"2025121403153768000_11.6.e040829.7","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1177\/1758573216676786","article-title":"Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments","volume":"9","author":"Le","year":"2017","journal-title":"Shoulder Elbow"},{"key":"2025121403153768000_11.6.e040829.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1758-5740.2010.00095.x"},{"key":"2025121403153768000_11.6.e040829.9","doi-asserted-by":"crossref","DOI":"10.1308\/147870811X582080","article-title":"Management of frozen shoulder\u2013conservative vs surgical?","volume":"93","author":"Sharma","year":"2011","journal-title":"Ann R Coll Surg Engl"},{"key":"2025121403153768000_11.6.e040829.10","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-017-2352-2","article-title":"United Kingdom Frozen Shoulder Trial (UK FROST), multi-centre, randomised, 12 month, parallel group, superiority study to compare the clinical and cost-effectiveness of early structured physiotherapy versus manipulation under anaesthesia versus arthroscopic capsular release for patients referred to secondary care with a primary frozen shoulder: study protocol for a randomised controlled trial","volume":"18","author":"Brealey","year":"2017","journal-title":"Trials"},{"key":"2025121403153768000_11.6.e040829.11","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1054\/ctnm.2002.0645","article-title":"Clients\u2019 experiences of frozen shoulder and its treatment with Bowen technique","volume":"8","author":"Carter","year":"2002","journal-title":"Complement Ther Nurs Midwifery"},{"key":"2025121403153768000_11.6.e040829.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003452"},{"key":"2025121403153768000_11.6.e040829.13","unstructured":"Charmaz K . Constructing grounded theory \u2013 a practical guide through qualitative analysis. SAGE, 2006."},{"key":"2025121403153768000_11.6.e040829.14","doi-asserted-by":"publisher","DOI":"10.1080\/09593980902776613"},{"key":"2025121403153768000_11.6.e040829.15","unstructured":"NVivo qualitative data analysis software; QSR international Pty Ltd. version 11 2012."},{"key":"2025121403153768000_11.6.e040829.16","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"2025121403153768000_11.6.e040829.17","doi-asserted-by":"crossref","first-page":"2495","DOI":"10.1007\/s11136-014-0708-6","article-title":"Exploring the outcomes in studies of primary frozen shoulder: is there a need for a core outcome set?","volume":"23","author":"Rodgers","year":"2014","journal-title":"Qual Life Res"},{"key":"2025121403153768000_11.6.e040829.18","doi-asserted-by":"publisher","DOI":"10.3310\/hta16150"},{"key":"2025121403153768000_11.6.e040829.19","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1002\/acr.23254","article-title":"Outcome reporting in randomized trials for shoulder disorders: literature review to inform the development of a core outcome set","volume":"70","author":"Page","year":"2018","journal-title":"Arthritis Care Res"},{"key":"2025121403153768000_11.6.e040829.20","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1016\/j.jclinepi.2015.06.006","article-title":"Core domain and outcome measurement sets for shoulder pain trials are needed: systematic review of physical therapy trials","volume":"68","author":"Page","year":"2015","journal-title":"J Clin Epidemiol"},{"key":"2025121403153768000_11.6.e040829.21","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-098742"},{"key":"2025121403153768000_11.6.e040829.22","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096084"},{"key":"2025121403153768000_11.6.e040829.23","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jphys.2014.06.012","article-title":"Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review","volume":"60","author":"Picorelli","year":"2014","journal-title":"J Physiother"},{"key":"2025121403153768000_11.6.e040829.24","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5868-9-78"},{"key":"2025121403153768000_11.6.e040829.25","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20150229"},{"key":"2025121403153768000_11.6.e040829.26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1864"},{"key":"2025121403153768000_11.6.e040829.27","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-017-0304-x","article-title":"Estimation of treatment preference effects in clinical trials when some participants are indifferent to treatment choice","volume":"17","author":"Walter","year":"2017","journal-title":"BMC Med Res Methodol"},{"key":"2025121403153768000_11.6.e040829.28","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1179\/106698111X12899036752014","article-title":"Clinical equipoise and personal equipoise: two necessary ingredients for reducing bias in manual therapy trials","volume":"19","author":"Cook","year":"2011","journal-title":"J Man Manip Ther"},{"key":"2025121403153768000_11.6.e040829.29","doi-asserted-by":"crossref","first-page":"N9","DOI":"10.1227\/01.NEU.0000333288.21621.A9","article-title":"Clinical equipoise and the surgical randomized controlled trial","volume":"62","author":"Ghogawala","year":"2008","journal-title":"Neurosurgery"},{"key":"2025121403153768000_11.6.e040829.30","doi-asserted-by":"crossref","first-page":"420","DOI":"10.32098\/mltj.04.2014.05","article-title":"Surgical and non-surgical treatment of frozen shoulder. Survey on surgeons treatment preferences","volume":"4","author":"Kwaees","year":"2014","journal-title":"Muscles Ligaments Tendons J"},{"key":"2025121403153768000_11.6.e040829.31","unstructured":"Heire PBR , Mubashar M , Bhatti W . Ultrasound-guided hydrodilatation for adhesive capsulitis\u2013a step-by-step guide. European Congress of Radiology 2015."},{"key":"2025121403153768000_11.6.e040829.32","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.pmrj.2017.10.013","article-title":"Hydrodilatation with corticosteroid for the treatment of adhesive capsulitis: a systematic review","volume":"10","author":"Catapano","year":"2018","journal-title":"PM&R"},{"key":"2025121403153768000_11.6.e040829.33","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1177\/1457496918772367","article-title":"Effectiveness of Hydrodilatation in adhesive Capsulitis of shoulder: a systematic review and meta-analysis","volume":"107","author":"Saltychev","year":"2018","journal-title":"Scand J Surg"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-040829","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T11:15:45Z","timestamp":1765710945000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-040829"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":33,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,11]]},"published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1136\/bmjopen-2020-040829"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-040829","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6]]}}}