Management of acute low back pain: the practices and perspectives of primary care clinicians in Australia

Measuring guideline adherence in physiotherapy: A scoping review of methodological approaches

RATIONALE

Clinical practice guidelines summarise the existing evidence on specific health conditions and aim to optimise quality of care by providing evidence-based recommendations. Studies have reported a gap between research findings and clinical practice in physiotherapy. Guideline adherence is often used as a measure of agreement between therapeutic care and guideline recommendations. However, there is currently no standardised methodological approach for measuring guideline adherence.

AIMS AND OBJECTIVE

The objective of this scoping review was to summarise the methods and results of studies that assessed guideline adherence in physiotherapy.

METHODS

MEDLINE, EMBASE, PEDro and CENTRAL databases were searched for relevant literature up to December 2022. Published reports of observational studies and controlled clinical trials that provided information on the assessment of guideline adherence in physiotherapists were included. The selection process was performed independently by two reviewers. The methodological quality of the identified reports was not assessed. Results were summarised narratively.

RESULTS

From a total of 2560 potentially relevant records, 53 reports were included in the analysis. Physiotherapists' adherence to guidelines was primarily assessed in the context of musculoskeletal conditions, such as low back pain (n = 25, 47.2%) and osteoarthritis (n = 8, 15.1%). A wide range of measurement approaches were used with the majority of reports using web-based surveys (n = 21, 39.6%), followed by chart reviews (n = 17, 32.1%). Most reports (n = 21, 39.6%) provided information on the level of adherence in terms of frequency dichotomising (self-reported) clinical practice as adherent or non-adherent. Adherence rates varied widely between included reports.

CONCLUSIONS

Although the large number of included reports indicates a high level of interest in the topic of guideline adherence, there is considerable heterogeneity between studies regarding the methodological approaches used to assess guideline adherence in physiotherapists. This reduces the comparability of the study results.

TRIAL REGISTRATION

INPLASY (registration no. 202250081). Registered on 12th May 2022.

The perceptions and knowledge of prognosis of physiotherapists in musculoskeletal practice: An exploratory qualitative study

QUESTION(S)

What are the perceptions and knowledge of physiotherapists who treat musculoskeletal disorders towards prognosis?

DESIGN

Exploratory phenomenological study.

PARTICIPANTS

15 physiotherapists involved in the treatment of musculoskeletal disorders.

DATA ANALYSIS

Data were collected through semi-structured interviews and analysed using inductive coding and thematic analysis.

RESULTS

Four themes were identified. First, participants perception of prognosis was influenced by how they defined prognosis. Participants often perceived that prognosis was the timeline to recovery related to function, tissue health, or pain. Second, some participants could not recall foundational knowledge about prognosis being taught during their entry-level physiotherapy program. Others recalled it being taught in relation to the tissue healing model. Third, participants described learning about prognosis through experience, professional development, or from peers. Finally, participants identified that a potential learning opportunity is to conceptualise prognosis as separate outcomes associated with function, tissue health, and pain. Each can impact upon prognosis, have a prognosis of their own, and can occur simultaneously.

CONCLUSION

How physiotherapists perceive and understand the concept of prognosis is influenced by their foundational knowledge. It appears for physiotherapists, prognosis may be conceptualised within the biomedical model of health. Indeed, physiotherapists may perceive that prognosis is the timeline for recovery determined by the tissue model of healing. Physiotherapists also rely on experiential knowledge gained from clinical practice, professional development, and their peers to enhance learning about prognosis. The understanding of prognosis may be enhanced if physiotherapists conceptualise prognosis in terms of the multifactorial outcomes associated with function, tissue health, and pain.

The perceptions of individuals with musculoskeletal disorders towards prognosis: An exploratory qualitative study

QUESTION(S)

How do individuals living with musculoskeletal disorders perceive the concept of prognosis?

DESIGN

Exploratory phenomenological study.

PARTICIPANTS

Individuals aged 18 years or older currently experiencing a musculoskeletal disorder.

DATA ANALYSIS

Single semi-structured one-on-one interviews were conducted. Data was analysed using inductive coding and thematic analysis.

RESULTS

Five themes were identified. First, participants defined prognosis as the likely outcome associated with their diagnosis. Their prognosis was often associated with outcomes related to pain, tissue health, and function. Second, participants perceived pain as having a negative impact on their prognosis by limiting their function and having a psychological impact. Third, participants held biomedical views in that tissue health was perceived as a cause for their pain and that tissue healing was essential for pain cessation. It was also difficult for participants to distinguish between pain related to tissue damage, and pain that was not. Fourth, participants use their ability to complete leisure and functional activities to determine the success of their recovery. Finally, participants perceived receiving individual prognoses for pain, tissue health, and function that may be simultaneously occurring as both important and beneficial.

CONCLUSION

Overall, participants viewed receiving prognostic information as important and beneficial. When constructing their views on prognosis participants perceived that pain, tissue health, and functional ability could all impact upon prognosis, whilst having a prognosis of their own. Physiotherapists should consider conceptualising and discussing prognosis in terms of pain, tissue health, and function when managing musculoskeletal disorders.

Characterization of the procedures and professional practices of primary care physiotherapists in Brazil

BACKGROUND: Physiotherapy interventions are well known and established in secondary and tertiary care. However, within the Brazilian primary health care (PHC), the role of physiotherapists is still under development, and there is a lack of representative data showing how and what is being implemented by these professionals. OBJECTIVE: The aim was to characterize the professional practices of physiotherapists working at PHC in Brazil. METHODS: This is an exploratory study that adopted a descriptive analysis based on the records of physiotherapists, considering assistance and sociodemographic aspects, in the period from 2016 to 2017. The following variables were extracted: region, federative unit and municipality, age group and sex of the attended user, condition/problem, procedure and place of attendance. RESULTS: A total of 318,780 procedures were recorded, concentrated in the South and southeast regions, with a predominance of clinical-assistance procedures and a higher frequency of attendance in Basic Health Units. Among the assisted users, the female gender prevailed in the age group of 20 to 59 years. Low back pain was the most frequently treated condition. CONCLUSION: The professional practices of physiotherapists working at PHC in Brazil were characterized by healthcare, clinical-assistance, preventive and health promotion activities, with emphasis on clinical-assistance practices focused on musculoskeletal conditions, especially low back pain.

Feasibility of delivering and evaluating stratified care integrated with telehealth ('Rapid Stratified Telehealth') for patients with low back pain: protocol for a feasibility and pilot randomised controlled trial

INTRODUCTION

Long waiting time is an important barrier to accessing recommended care for low back pain (LBP) in Australia's public health system. This study describes the protocol for a randomised controlled trial (RCT) that aims to establish the feasibility of delivering and evaluating stratified care integrated with telehealth ('Rapid Stratified Telehealth'), which aims to reduce waiting times for LBP.

METHODS AND ANALYSIS

We will conduct a single-centre feasibility and pilot RCT with nested qualitative interviews. Sixty participants with LBP newly referred to a hospital outpatient clinic will be randomised to receive Rapid Stratified Telehealth or usual care. Rapid Stratified Telehealth involves matching the mode and type of care to participants' risk of persistent disabling pain (using the Keele STarT MSK Tool) and presence of potential radiculopathy. 'Low risk' patients are matched to one session of advice over the telephone, 'medium risk' to telehealth physiotherapy plus App-based exercises, 'high risk' to telehealth physiotherapy, App-based exercises, and an online pain education programme, and 'potential radiculopathy' fast tracked to usual in-person care. Primary outcomes include the feasibility of delivering Rapid Stratified Telehealth (ie, acceptability assessed through interviews with clinicians and patients, intervention fidelity, appointment duration, App useability and online pain education programme usage) and evaluating Rapid Stratified Telehealth in a future trial (ie, recruitment rates, consent rates, lost to follow-up and missing data). Secondary outcomes include waiting times, number of appointments, intervention and healthcare costs, clinical outcomes (pain, function, quality of life, satisfaction), healthcare use and adverse events (AEs). Quantitative analyses will be descriptive and inform a future adequately-powered RCT. Interview data will be analysed using thematic analysis.

ETHICS AND DISSEMINATION

This study has received approval from the Ethics Review Committee (RPAH Zone: X21-0221). Results will be published in peer-reviewed journals and presented at conferences.

TRIAL REGISTRATION NUMBER

ACTRN12621001104842.