{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:57:43Z","timestamp":1790927863443,"version":"4.1.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Institute for Healthcare Research Doctoral Clinical Academic Fellowship","award":["NIHR304095"],"award-info":[{"award-number":["NIHR304095"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Rehabil"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A qualitative study using uni-professional focus groups, forming the first stage of a multi-phase co-design project to develop a model of care for early sling removal after conservatively managed proximal humerus fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Focus groups were conducted online via Microsoft Teams with participants from a wide geographical spread across multiple United Kingdom National Health Service Trusts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Healthcare professionals (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200923), including orthopaedic surgeons, therapists (physio and occupational), and nurses, recruited through purposive sampling.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Three focus groups explored healthcare professionals\u2019 perspectives on early sling removal in the non-operative management of proximal humerus fractures. Patient and public involvement and engagement work informed study design, identifying the need to first understand professionals\u2019 viewpoints before engaging patients and progressing to consensus co-design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main measures<\/jats:title>\n                    <jats:p>Data were collected through focus groups supported by pre-session forms and analysed thematically following Braun and Clarke's framework using NVivo software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three overarching themes were identified:\n                      <jats:italic toggle=\"yes\">Navigating pain and fear<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">clinician confidence<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">early engagement<\/jats:italic>\n                      . Fear of patient harm and high pain levels in the early weeks were barriers to early sling removal. Confidence was influenced by experience, fracture severity and limited evidence, with hierarchical decision-making by surgeons. Participants considered enablers to be consistent messaging, early education, and reassurance to support both clinicians and patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Whilst healthcare professionals recognise benefits of earlier sling removal, implementation is limited by pain, uncertainty, and hierarchical decision-making. These findings highlight the need for multidisciplinary, co-designed pathways. There is a need next to explore patient perspectives to inform future co-designed pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02692155261437345","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T11:46:12Z","timestamp":1775130372000},"page":"1399-1408","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare professionals\u2019 perspectives on early sling removal following conservatively managed proximal humerus fractures: A qualitative study"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2637-488X","authenticated-orcid":false,"given":"Helen","family":"Tunnicliffe","sequence":"first","affiliation":[{"name":"School of Healthcare, University of Leicester"},{"name":"Orthopaedics, University Hospitals of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0904-1381","authenticated-orcid":false,"given":"Seth","family":"O\u2019Neill","sequence":"additional","affiliation":[{"name":"University of Leicester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sion","family":"Scott","sequence":"additional","affiliation":[{"name":"University of Leicester"},{"name":"University of East Anglia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8686-2802","authenticated-orcid":false,"given":"Harvinder","family":"Singh","sequence":"additional","affiliation":[{"name":"School of Healthcare, University of Leicester"},{"name":"Orthopaedics, University Hospitals of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3690-9593","authenticated-orcid":false,"given":"David","family":"Wright","sequence":"additional","affiliation":[{"name":"School of Healthcare, University of Leicester"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.04.130"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-006-0172-4"},{"key":"e_1_3_2_4_2","article-title":"Interventions for treating proximal humeral fractures in adults","volume":"6","author":"Handoll HH","year":"2022","unstructured":"Handoll HH, Elliott J, Thillemann TM, et al. 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Qualitative research practice a guide for social science students and researchers. 2003."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1080\/08870440903194015"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2007.04569.x"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/capr.12360"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.4324\/9780203864722"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-021-09697-5"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-025-08371-y"},{"key":"e_1_3_2_22_2","unstructured":"Ring D Bruinsma WE Goslings JC et al. 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