Outpatient physiotherapists’ attitudes and beliefs toward patients with chronic pain: A qualitative study

Standardized screening of cognitive and affective tendencies in persons with low back pain: A knowledge translation project

BACKGROUND

The use of screening questionnaires (SQ) to evaluate affective or cognitive tendencies (CAT) in persons with low back pain (LBP) is recommended by clinical practice guidelines (CPG) yet few physical therapists (PTs) have adopted these recommendations.

OBJECTIVE

To develop and implement a tailored knowledge translation (KT) intervention in an outpatient rehabilitation practice to facilitate the uptake of SQ for CAT in persons with LBP.

METHODS

In a mixed-methods study, using the knowledge to action framework, PTs (n = 12) collaborated with research clinicians to improve the use of three SQ: 1) Primary Care Evaluation of Mental Disorders for Depressive Symptoms; 2) Fear-Avoidance Beliefs Questionnaire; and 3) Pain Catastrophizing Scale. Success of the intervention was measured through questionnaires, focus groups and chart audit.

RESULTS

A multimodal intervention to overcome specific identified barriers (i.e. time, forgetfulness, and lack of knowledge) was implemented. There was a 10% increase in the use of at least one SQ. PTs reported increased knowledge and use of the SQ but reported time and lack of confidence as barriers to implementation.

CONCLUSION

It was concluded that SQ for CAT can be successfully implemented; however, PTs felt unprepared to use the screening results to evaluate persons with CAT and more extensive training is recommended to change this practice pattern.

Exploring attitudes of healthcare professionals towards those with fibromyalgia: A Q-methodological approach

Fibromyalgia remains a difficult condition to diagnose and treat. Research suggests that this leads to frustrating experiences for service users and healthcare professionals. This has led to negative healthcare professional attitudes towards working with those with fibromyalgia. The research to date reports negative attitudes and predominantly investigates attitudes of primary care physicians. This study explores the attitudes of a range of healthcare professionals towards those diagnosed with fibromyalgia. Using Q-methodology, 27 healthcare professionals completed a sorting task and questionnaire to prioritise statements relating to a range of different attitudes towards service users. All participants significantly loaded onto three factors that explained a total of 64% of the data variance. Factor 1 reflected the attitude 'Service users with fibromyalgia are no different to other service users and I enjoy working with them'. Factor 2 reflected the attitude 'Service users with fibromyalgia are inaccurate informants of their own condition due to lack of understanding of their condition and are not likely to engage in treatments'. Factor 3 reflected the attitude 'Service users with fibromyalgia are trustworthy with a lot of clinical problems [but I lack confidence in specialist skills to support them]'. Contrary to the current literature, there appears to be supportive attitudes from healthcare professionals towards service users diagnosed with fibromyalgia. Increased specialised training, clinical exposure to working with fibromyalgia and reflective practice spaces were identified as elements that could improve healthcare professional attitudes.

Psychometric Properties of a Healthcare Provider Burden Scale: Preliminary Results

Measures are lacking of the clinical burden that healthcare providers perceive in treating chronic conditions. This study presents a preliminary psychometric evaluation of a novel self-report measure of provider burden in the treatment of chronic pain. Data for eight burden items were available from vignette studies examining the effects of patient pain severity and medical evidence on clinical burden and judgments for chronic pain. Participants (N = 922) were 109 physicians and 813 non-physicians, all acting in the role of physician (232 community members without chronic pain, 105 community members with chronic pain, and 476 American Chronic Pain Association members with chronic pain). Factor analyses of burden items yielded one-factor solutions in all samples, with high factor loadings and adequate explained variance. Internal consistency reliability was uniformly high (≥ .87). Burden scores were significantly higher among physicians compared to non-physicians; non-physician groups did not differ on any burden score. Significant correlations of burden score with indicators of psychosocial complications in patient care supported scale validity. Burden score was not associated with gender, age, or education. Results provide initial support for the psychometric properties of a Healthcare Provider Burden Scale (HPBS). Research utilizing larger and representative healthcare provider groups is needed.

Barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain: a systematic review and qualitative evidence synthesis

ABSTRACT

A substantial evidence-practice gap exists between healthcare professionals learning about the biopsychosocial model of pain and adopting this model in clinical practice. This review aimed to explore the barriers and enablers that influence the application of a biopsychosocial approach to musculoskeletal pain in practice, from the clinicians' perspective. Qualitative evidence synthesis was used. Four electronic databases (CINAHL, EMBASE, MEDLINE, and PsycINFO) were searched. Primary qualitative studies were included if they investigated the experiences of primary healthcare professionals using a biopsychosocial model of musculoskeletal pain care in outpatient settings or their perceptions towards biopsychosocial-oriented clinical practice guidelines. After screening 6571 abstracts, 77 full-text articles were retrieved. Twenty-five studies met the eligibility criteria, reporting the experiences of 413 healthcare professionals (including general practitioners, physiotherapists, and others) spanning 11 countries. Three metathemes were identified that impact the adoption of the biopsychosocial model across the whole of health: (1) at the microlevel, healthcare professionals' personal factors, knowledge and skills, and their misconceptions of clinical practice guidelines, perception of patients' factors, and time; (2) at the mesolevel, clinical practice guideline formulation, community factors, funding models, health service provision, resourcing issues, and workforce training issues; and (3) at the macrolevel, health policy, organizational, and social factors. Synthesized data revealed multilevel (whole-of-health) barriers and enablers to health professionals adopting a biopsychosocial model of pain into practice. Awareness of these multilevel factors may help inform preimplementation preparedness and support more effective implementation of the biopsychosocial model of musculoskeletal pain into clinical practice.

The suitability and utility of the pain and movement reasoning model for physiotherapy: A qualitative study

Introduction: The Pain and Movement Reasoning Model is a tool to assist clinical reasoning. It was created for physiotherapists to use in musculoskeletal outpatient clinics but may be appropriate in other clinical contexts. The Model has also been used in physiotherapy education.Objective: To determine physiotherapists' perceptions of the appropriateness (suitability) and benefit (utility) of the Pain and Movement Reasoning Model across clinical contexts in hospital and community practice. Methods Physiotherapists from two health networks in Melbourne, Australia, received training in using the Model and over 4-6 weeks applied it in their clinical interactions. Drawing on a deductive phenomenological approach, transcripts from focus groups and interviews were analysed to determine the suitability and utility of the Model across clinical areas.Results: Twenty-nine physiotherapists from 12 different clinical areas participated. Two themes represented the participants' comments: Suitability for Practice and Utility in Practice. Participants reported the approach to clinical reasoning, promoted by the Model, aligned with existing physiotherapy practice. Enhancements to practice included more comprehensive assessment, selection of broader management techniques and increased confidence with reasoning and explaining the complexity of pain to patients. Participants described using the Model for developing junior staff and training postgraduate students. They also saw potential in adapting the Model for other disciplines and for other multifactorial conditions.Conclusion: Physiotherapists working in a range of clinical contexts considered the Pain and Movement Reasoning Model appropriate and beneficial in clinical practice and in teaching. Further evaluation of the Model in wider settings is warranted.

Italian physiotherapists' knowledge of and adherence to osteoarthritis clinical practice guidelines: a cross-sectional study

INTRODUCTION

Implementation of clinical practice guidelines (CPGs) to manage musculoskeletal conditions among physiotherapists appears suboptimal. Osteoarthritis is one of the most disabling conditions worldwide and several studies showed a lack of knowledge of and adherence to osteoarthritis CPGs in physiotherapists' clinical practice. However, those studies are not conclusive, as they examine the knowledge of and adherence to CPGs only in isolation, or only by focussing on a single treatment. Thus, analysis of the knowledge of and adherence to CPGs in the same sample would allow for a better understanding of the evidence-to-practice gap, which, if unaddressed, can lead to suboptimal care for these patients. This study aims at assessing Italian physiotherapists' evidence-to-practice gap in osteoarthritis CPGs.

METHODS

An online survey divided into two sections investigating knowledge of and adherence to CPGs was developed based on three high-quality, recent and relevant CPGs. In the first section, participants had to express their agreement with 24 CPG statements through a 1 (completely disagree) to 5 (completely agree) scale. We defined a ≥ 70% agreement with a statement as consensus. In the second section, participants were shown a clinical case, with different interventions to choose from. Participants were classified as 'Delivering' (all recommended interventions selected), 'Partially Delivering' (some recommended interventions missing) and 'Non-Delivering' (at least one non-recommended interventions selected) the recommended intervention, depending on chosen interventions.

RESULTS

822 physiotherapists (mean age (SD): 35.8 (13.3); female 47%) completed the survey between June and July 2020. In the first section, consensus was achieved for 13/24 statements. In the second section, 25% of the participants were classified as 'Delivering', 22% as 'Partially Delivering' and 53% as 'Non-Delivering'.

CONCLUSIONS

Our findings revealed an adequate level of knowledge of osteoarthritis CPGs regarding the importance of exercise and education. However, an adequate level of adherence has yet to be reached, since many physiotherapists did not advise weight reduction, but rest from physical activity, and often included secondary treatments (e.g. manual therapy) supported by low-level evidence. These results identify an evidence-to-practice gap, which may lead to non-evidence based practice behaviours for the management of patients with osteoarthritis.

Correlation of sleep quality with sleep belief and attitude in 120 elderly patients with chronic functional constipation

BACKGROUND

The change of living standard has changed the life style of the elderly. Chronic functional constipation (FC) seriously affects the health of the elderly and their sleep quality. The proposal of the brain-gut axis theory has attracted much attention from medical researchers. This study investigated the correlation between sleep quality and sleep cognition in elderly FC patients, with an aim to provide an objective basis for clinical use of targeted and precise cognitive behavioral intervention measures.

AIM

To explore the correlation of sleep quality with sleep belief and attitude in elderly patients with chronic FC.

METHODS

One hundred and twenty chronic FC elderly patients treated from July 2017 to July 2019 at the Second Hospital of Jinhua City, Zhejiang Province were selected as study subjects. The Pittsburgh sleep quality index (PSQI) scale and the dysfunctional beliefs and attitudes about sleep scale-16 (DBAS-16) were used to assess the sleep quality and sleep belief and attitude, respectively. Pearson correlation analysis was performed to assess the correlation of sleep quality with sleep belief and attitude.

RESULTS

Compared with normal people, the sleep latency, sleep time, sleep efficiency, sleep disorder, daytime function, and total PSQI score of elderly FC patients all increased significantly (P < 0.05), while the scores of sleep quality and use of hypnotic drugs were all significantly lower (P < 0.05). The total DBAS-16 score of elderly FC patients was 48.12 ± 8.69, and the scores of the consequences of insomnia, sleep anxiety, sleep expectation, and drugs were 12.96 ± 4.98, 18.95 ± 5.12, 4.49 ± 2.36, and 10.36 ± 3.12, respectively. The consequences of insomnia were negatively correlated with sleep disorders and daytime function (r = -0.131 and -0.135, respectively). Sleep anxiety was negatively correlated with sleep quality, sleep latency, sleep time, sleep efficiency, hypnotic drugs, daytime function, and total PSQI score (r = -0.359, -0.228, -0.312, -0.224, -0.152, -0.221, and -0.376, respectively). Sleep expectation was negatively correlated with sleep efficiency and daytime function (r = -0.103 and -0.153, respectively). There was a negative correlation between drugs and sleep quality, sleep latency, sleep time, hypnotic drugs, and PSQI total score (r = -0.167, -0.142, -0.119, -0.434, and -0.211, respectively). The total DBAS-16 score was negatively correlated with the seven dimensions of sleep disorders and the total score of PSQI.

CONCLUSION

The sleep quality of elderly patients with chronic FC is correlated with their sleep belief and attitude. Medical workers should enhance the awareness of sleep belief and attitude among elderly FC patients to improve sleep cognition and quality.