Introduction Rotator Cuff Related Shoulder Pain (RCRSP) represents a significant individual and societal burden. While conservative treatments are recommended, it is uncertain whether there are any factors that can affect the prognosis.

This study investigated variations in modifiable factors between responders and non-responders to conservative treatment. The study likewise investigated the patient perspectives on factors they considered important for their outcome following conservative care.

Materials and Methods This explanatory mixed-methods study included data from 201 RCRSP patients who had at least 3/5 non-modifiable factors (symptoms duration >3 months, Baseline pain > 50/100 NRS, multiple pain sites, previous sick leave, BMI >25). A reduction >9 points on QuickDASH at 3 months follow-up, constituted the responders. Modifiable factors collected at baseline were treatment expectations, treatment satisfaction, kinesiophobia, fear-avoidance behaviors, activity levels, and quality of life.

Twelve qualitative, semi-structured interviews with an inductive goal-free approach were conducted with responders and non-responders.

Results No statistically significant group differences were observed between any of the identified modifiable factors. The qualitative analysis revealed four overarching factors the patients considered important for their outcome:

• Improvement was attributed to cortisone injections

• The perceived lack of personalized treatment emerged as a potential factor influencing the lack of improvement.

• Identified structural changes when presence, were seen as a barrier for improvement

• Work-related issues

Conclusion Although no statistical group differences were found for modifiable factors, the qualitative analysis revealed elements that patients may consider important for recovery. Future studies can investigate whether addressing these systematically can improve outcome in RCRSP patients.