Triage models for surgical decision-making in patients with shoulder pain: an integrative review

Shoulder pain is a major cause of work absenteeism, affecting 1 in 3 adults. Although nonsurgical treatments like physical therapy are recommended as the first line of management, 40% of patients are referred for surgery before exploring these options. This review aimed to identify existing triage models used for shoulder pain referrals for surgery, guidelines for shoulder pain management that include criteria for surgical referral, and indications for surgery. An integrative review approach was used to comprehensively search major databases (Medline, PubMed, Embase, CINAHL Plus) and gray literature. Articles on triage models, referral processes, or surgery candidacy for shoulder pain were included. The searches retrieved 4510 articles, with 480 selected for full review and 71 articles included in this synthesis. Thirty-seven articles described various triage models and clinical decision-making processes for managing shoulder pain, including determining when to refer for surgical consultation and the indications for surgery. Seventeen articles compared surgical and nonsurgical treatments to identify surgical indicators, 10 articles examined factors affecting decision-making, and 7 articles explored predictor models for surgical outcomes. The findings underscore the need for a multifactorial decision-making process that acknowledges the complexity of pain within a biopsychosocial framework and incorporates patients' personal preferences into the triage decision-making process. These triage models should work across different contexts, eg, conservative, primary, and speciality care, to facilitate better patient experience across the continuum.