OET Physiotherapy Speaking: Respond to Hesitation After Shoulder Surgery

“I’m not sure…” is information, but it is not a complete explanation. A patient who hesitates before a rehabilitation activity may fear pain, misunderstand the instructions, need more time or have a practical difficulty that has not yet been discussed. If the physiotherapist supplies the reason immediately, the conversation can become a response to an imagined concern.

This OET Physiotherapy Speaking lesson uses an original case after rotator cuff repair to practise noticing hesitation, asking what it means and changing the next step. You will learn to offer reassurance that respects the surgical plan and the patient’s choice. A successful conversation does not require the patient to perform an exercise by the end.

The lesson develops the complete first role-play set from Speaking Pathways in OET Physiotherapy: Fifty Guided Practice Journeys, alongside its introduction and opening communication guidance. The wider course covers many conditions and communication situations; this article concentrates on one postoperative consultation. The new cards have five tasks each and are educational scenarios, not instructions for an individual patient’s rehabilitation.

The speaking skill: ask before interpreting hesitation

Imagine offering to review a movement already included in the patient’s rehabilitation plan. The patient looks down and says, “Maybe.” Continuing with “Good, lift your arm” treats uncertainty as consent. Replying “There’s nothing to be frightened of” assumes fear and makes an absolute claim about safety. Neither response discovers what the patient needs.

A more useful beginning is: “You sound unsure. What would you like us to clarify before we go any further?” Leave space for an answer. If the patient fears disrupting the repair, discuss protection and the individual plan. If the patient does not understand which arm provides assistance, clarify the instruction. If the patient cannot manage the setup at home, explore that practical barrier.

The words are only part of the skill. Your next action must also change. Asking an open question and then delivering the same prepared explanation regardless of the answer is still unresponsive communication. During practice, your partner should be able to identify which answer influenced your next sentence.

Paired role-play cards

The partner should speak naturally and reveal the main concern after a genuine invitation. The learner should not invent a successful movement, a normal examination or permission to remove the sling. A discussion about reviewing the prescribed activity can be completed without supplying a movement range or exercise dose that is absent from the card.

Understand the condition before task coaching

What the rotator cuff does

The rotator cuff is a group of muscles and tendons around the shoulder. Tendons connect muscle to bone, and this group helps control movement of the arm. A rotator cuff repair aims to reattach a torn tendon to bone. The operation and the strength and size of the repair vary, so the name of the procedure alone does not describe the whole rehabilitation plan.

A useful patient explanation is: “The surgery repaired a tendon around your shoulder. It needs protection while it heals, and the team has also planned which movements are appropriate at each stage.” Avoid telling the patient that the shoulder has been restored to its original strength. Repairing tissue surgically and completing rehabilitation are different parts of care.

Why protection and movement are not contradictory

A sling can protect and support the arm during the period specified by the treating team. Prescribed rehabilitation can include carefully selected activity within the restrictions for that repair. The patient may interpret the sling as a message to avoid every movement, or interpret an exercise sheet as permission to use the arm normally. Both interpretations need clarification through the actual instructions.

The key distinction is between the activity specifically allowed and unrestricted use of the shoulder. “An activity is on your plan” does not mean that lifting a kettle, reaching into a high cupboard or pushing up from a chair is allowed. Conversely, “protect the repair” does not automatically mean cancelling every prescribed activity. Check what the surgeon and physiotherapist have instructed for this patient.

Why the individual plan comes first

Postoperative guidance can vary with the procedure, repair and stage of recovery. Different hospital leaflets may describe different timeframes or activities. A general article cannot replace the patient’s own instructions. In the role-play, the learner should say what needs checking rather than choosing a generic programme from memory.

This has an important communication benefit. The explanation becomes specific and credible: “I want to confirm the restrictions in your operation plan before we try anything.” That is more trustworthy than “It’s only gentle, so it must be safe.” Small movements and low pain levels do not, by themselves, establish whether an activity is appropriate for a healing repair.

Pain deserves questions, not a slogan

Some pain can occur after surgery, but the patient’s current experience still needs assessment. Ask where it is, when it occurs, whether it has changed and what the patient has been advised to do. Do not use “pain is normal” to dismiss a new problem. Equally, do not confirm that the repair has failed merely because the patient is afraid of pain.

Keep medication advice within the existing instructions. Ask whether the prescribed pain relief is helping and arrange advice if it is not, rather than inventing a drug or dose. Worsening pain, a red or hot wound, drainage or fever should prompt clinical advice through the appropriate postoperative or urgent route. Do not proceed with routine practice while a possible complication is being dismissed as anxiety.

Recovery includes everyday tasks

The purpose of rehabilitation is not just to complete an exercise sheet. A person may care about washing, dressing, sleeping, preparing food or returning to work. Ask which activity matters and what help is currently available. These details can reveal why an apparently simple home plan is difficult to use.

Mr Lewis’s interest in cooking is a meaningful goal. It is not evidence that he can currently lift pans or pour a kettle. You can acknowledge the goal while explaining that returning to particular tasks depends on the individual restrictions and review. Do not convert enthusiasm into clearance, or attach a promised date to a goal that has not been assessed.

Consent remains part of rehabilitation

A patient can want recovery and still decline a particular activity now. Ask permission for the specific proposal: discussing an exercise, watching a demonstration, attempting it and receiving physical assistance are different steps. Agreement to one does not automatically include the others. The patient should know what is proposed and have the opportunity to ask questions.

For speaking practice, this means leaving a real pause after an invitation. “Would you like to try?” followed immediately by an instruction is not much of a choice. If the patient declines, explore whether there is information they want, respect the decision and agree an appropriate next step. Avoid using the threat of a poor recovery to obtain cooperation.

Work through the five physiotherapist tasks

1. Hear the postoperative story

Start broadly: “How have things been since you went home?” Then clarify pain, changes, activities and the instructions. Ask the patient to describe what they understood, rather than testing whether they can recite the leaflet. “What were you told about using the sling and doing the planned movements?” invites a useful explanation.

Different answers require different responses. Missing instructions require clarification with the treating team. Increasing pain or a wound concern requires assessment. An understood plan that the patient fears requires a discussion of that fear. Do not move directly from the date of surgery to an exercise demonstration.

2. Make room for the reason behind hesitation

Notice without accusing: “You paused when I mentioned reviewing the movement.” Invite: “What is making you unsure?” Then reflect the answer: “You are worried that moving could undo the repair.” This sequence is more accurate than saying “You lack confidence”, which assigns an explanation before the patient has given one.

Ask enough to understand the belief. Does the patient think all movement is dangerous? Did a previous attempt hurt? Was a family member alarmed by the instruction? You do not need to interrogate every possibility. Begin with the patient’s explanation and follow the detail that affects what happens next.

3. Explain the reasoning in a short sequence

Start with the repair, then explain protection and planned activity, then relate the explanation to the question. “The sling and the prescribed activity have different purposes within the same plan” can resolve the apparent contradiction. Check whether the patient has heard that as permission for unrestricted use, and correct that misunderstanding if necessary.

Avoid suggesting that every hesitation is solved by more information. An explanation can address a belief about harm; it cannot create help at home or remove a patient’s pain. After the explanation, ask what remains uncertain. The answer may show that the next step needs to change again.

4. Offer a choice within the clinical plan

Offer something meaningful and appropriate: reviewing the written instructions together, discussing the purpose before any demonstration, or watching a permitted activity first. Do not offer an option outside the verified restrictions just because the patient prefers it. Shared decisions still need to be clinically suitable.

If hands-on assistance is proposed, explain what you would do and ask permission. If the patient prefers to wait, do not praise them only when they eventually agree. A calm response to refusal demonstrates that the choice was real. Discuss how the unresolved concern will be addressed and how the patient can contact the team.

5. Check the plan in the patient’s own words

Ask for an explanation back: “What will you follow at home, and what will you do if you are uncertain?” Listen for the difference between prescribed activity and unrestricted shoulder use. If the patient says, “I can use it normally as long as it doesn’t hurt”, clarify that pain alone does not determine the permitted activity after repair.

Finish with the next step that was actually agreed. If instructions still need confirmation, say so. If no movement was attempted, do not report that the patient practised successfully. The consultation can still have achieved something useful by identifying the concern, preventing an unsafe assumption and agreeing how to resolve it.

Extended physiotherapist model with listening pauses

This is the professional’s side of a possible conversation. The pauses are essential. Your partner’s answers should influence the words that follow, and you should omit any statement that does not match what has been established.

“Hello, Mr Lewis. I’m the physiotherapist reviewing you today. Before we look at the rehabilitation instructions, could you tell me how you have been managing since you went home?”

Pause. Listen for the patient’s experience, including daily tasks and the help available.

“Thank you. Could you tell me more about the pain: when you notice it, whether it has changed and how the pain relief you were advised to use is working? Have you noticed a wound problem, felt feverish or had another change that is worrying you?”

Pause and respond to the answer. A new clinical concern needs assessment before routine exercise discussion continues.

“What were you told about the sling and the movements on your home plan? It would help to look at those instructions together, and I will need to confirm the restrictions for your particular repair before proposing any activity.”

Listen to the patient’s explanation. Do not pretend that the plan has been checked merely because it exists.

“You have been using the sling as instructed, but you have avoided the planned shoulder practice. Thank you for telling me. When you think about trying it, what is the main concern?”

Pause. If the patient hesitates again, give them time rather than answering for them.

“You are worried that moving could pull the repair apart. Is that right? Was there something in the advice, or something that happened at home, that made it seem especially risky?”

Listen. Use the specific concern to guide the explanation.

“I can see why a sling and an exercise sheet might seem to give different messages. Would it be helpful if I explained how protection and planned movement can fit together?”

Wait for permission and adjust the amount of detail to the patient’s response.

“The surgery repaired a tendon around your shoulder. That tissue needs protection while it heals. The rehabilitation plan identifies which activity is appropriate at each stage and which activity should still be avoided. The sling does not mean that every prescribed movement is forbidden, and an exercise on the plan does not mean you can use the arm freely.”

“I would not want to reassure you by saying that every gentle movement is harmless. We need to follow the instructions for your repair. Once those are confirmed, we can discuss the purpose and limits of the activity on your plan, and how you should respond if it causes a problem.”

Pause. Ask what the patient has understood and what remains uncertain.

“What would help you most before deciding whether to try anything? We could begin by going through the written instructions. If the activity is confirmed as appropriate, you could watch a demonstration before deciding whether you want to attempt it.”

Listen to the preference. Watching first is not consent to an assisted movement.

“You would prefer to understand it and watch first. That is fine. If we later consider physical assistance, I will explain what I am proposing and ask you before touching or moving your arm. Please tell me if you want to pause or if something does not feel clear.”

Before discussing home practice, ask about the practical situation.

“How would the plan fit into things at home? Is there any part of getting ready, managing the sling or following the instructions that you are unsure you can manage? What help is available, and is that likely to change?”

Listen carefully. A practical difficulty needs a practical assessment, not another reassurance about motivation.

“You also mentioned wanting to cook again. Which part of cooking are you most looking forward to? I would like to keep that goal in mind, while checking each activity against the restrictions for your repair. I cannot give you a reliable return date from this conversation, and being comfortable does not by itself mean that lifting or reaching is permitted.”

Pause. Acknowledge the chosen activity without giving clearance.

“Let me check what we have agreed. We will clarify the individual instructions before any new activity, and begin with an explanation and demonstration if that is suitable and you still want it. The existing restrictions remain in place. Could you tell me what you understand you should follow at home, and what you would do if a question or a new problem came up?”

Listen to the explanation back. Correct any misunderstanding about pain, sling use or unrestricted activity. Confirm the appropriate contact route and the actual next step.

Useful phrases and practical speaking tips

Notice neutrally: “I noticed you paused there.” This describes what happened without assigning an emotion. Follow it with an invitation such as “What would you like us to discuss before continuing?” Do not turn an observation into a diagnosis of anxiety.

Reflect the specific concern: “You are worried about the repair being pulled apart.” This is more informative than “You’re worried about everything.” Keep the patient’s wording where possible, and check whether it accurately captures the concern.

Explain a boundary: “The activity needs to fit the instructions for your operation.” This gives a reason for checking the plan. It also prevents the phrase “within comfort” from becoming the only rule governing postoperative activity.

Separate invitations: “Would you like to watch first?” and “Would you like to try it?” are different questions. Ask the question that matches the next proposed step and wait. A polite phrase spoken without a pause can still function as pressure.

Make a correction openly: If you say “You can do this safely” before checking the plan, repair it: “I should first confirm that this is appropriate for your repair. Let’s check the instructions before proceeding.” The correction demonstrates attention to the information available.

Use manageable questions: Avoid combining pain, medication, sleep, exercises and work in one long question. Ask one topic, listen and follow up. This makes the conversation easier for the patient and gives you more usable information.

Allow an unresolved answer: The patient may still feel uncertain after an explanation. Ask what remains unclear and agree how to address it. Do not demand “So you’re happy now?” or treat continuing concern as a failure of cooperation.

Common mistakes and better responses

“You must try, or you won’t recover.” This uses a feared outcome to pressure the patient and oversimplifies recovery. Explain the purpose of the prescribed plan, explore the barrier and discuss an appropriate next step. Cooperation obtained through a threat is not the aim of the role-play.

“It cannot damage anything because it is gentle.” Gentle is not a substitute for permitted. Say that you will check the operation-specific instructions and assess suitability. Do not guarantee that an activity carries no risk.

“If it doesn’t hurt, you can use the arm.” This ignores restrictions intended to protect healing tissue. Clarify that comfort and permission are different questions after surgery. The patient should follow the individual plan, not a rule invented during the conversation.

“Your wife can help you with that.” This assumes both availability and ability. Ask what support exists and what the patient wants. If help is needed, discuss how the task and support can be assessed rather than assigning a relative an unagreed responsibility.

“Excellent, you’ve done it correctly.” Do not invent an observed performance in a spoken model. If a demonstration or attempt has not taken place, keep the language prospective: “We would check how you manage it before agreeing home practice.”

“The surgery was two weeks ago, so you should be ready.” The date alone does not establish readiness for a particular movement. Ask about the specific repair, restrictions and current findings. Avoid comparing the patient unfavourably with another person’s recovery.

Second attempt: the hesitation has a practical reason

Keep the operation, stage of recovery and clinical boundaries. Change the reason for the pause. Mr Lewis now understands why prescribed activity matters and is not mainly afraid of damaging the repair. His wife returns to work tomorrow, and he is unsure how he will manage the setup and his sling without help. He says, “I can follow you here, but I’m not sure about doing it at home.”

The learner should ask which part is difficult and what support is available. Do not repeat the whole explanation of tendon healing as though that solves the problem. Do not tell him to remove the sling unaided or improvise a new activity. Review the practical task and the individual restrictions, and discuss appropriate support or clarification with the treating team.

A responsive sentence is: “So the question is how you would manage the setup when you are alone, rather than whether the prescribed activity has a purpose. Could you show or explain which part you are unsure about, within the restrictions we have confirmed?” If physical demonstration is not appropriate yet, an explanation of the difficulty is enough to guide the discussion.

The home plan should be usable, not merely understandable in the clinic. A patient can accurately repeat an instruction and still be unable to carry it out in their environment. The second attempt tests whether the learner distinguishes those two issues and avoids treating a practical barrier as unwillingness.

Practice exercise: let the answer change the response

Record two short exchanges beginning with “You sound unsure. What is making you hesitate?” In the first, the patient fears damaging the repair. In the second, the patient cannot manage the setup alone. Give a different follow-up question and a different proposed next step for each answer, while preserving the same surgical restrictions.

Then identify the weakness in this response: “Don’t worry; everyone is nervous. Let’s get the exercise done, and your wife can help you later.” Repair it without assuming the patient’s emotion, consent or home support.

Clinical reading and further practice

Clinical boundaries were checked against University Hospital Southampton’s rotator cuff repair overview, its after-surgery care information, and Guy’s and St Thomas’ guidance on sling care and seeking advice. Local protocols are not interchangeable individual prescriptions. Use the linked course for further communication practice, and follow the treating team’s plan in clinical care.

Source: OET PHY SP 109.epub, Jobins Training. Examples labelled original or illustrative were written for this article. Independent exam preparation; no affiliation with or endorsement by the examining body. Practice does not predict an official score.