Adherence to low back pain clinical practice guidelines by Saudi physical therapists: a cross-sectional study

Electronic health record data extraction: Physical therapists' documentation of physical activity assessments and prescriptions for patients with chronic low back pain

BACKGROUND

Despite physical activity being a major component of managing chronic low back pain, < 50% of patients receive physical activity interventions. Electronic Health Records can deepen our understanding about this clinical gap.

OBJECTIVE

We aimed to: 1) develop and test a data abstraction form that captures physical activity documentation; and 2) explore physical therapists' documentation of physical activity assessments and interventions.

METHODS

We developed a data abstraction form using previously published practice guidelines. After identifying the forms' inter-rater reliability, we used it to explore physical therapists' documentation related to physical activity assessments and interventions for patients with chronic low back pain.

RESULTS

The final data abstraction form included information about physical activity history, assessments, interventions, general movement discussion, and plan. Our inter-rater reliability was high. Of the 18 patients, 66.7% had documentation about their PA history. Across the 56 encounters, 14 (25.0%) included an assessment, 18 (32.1%) an intervention, 18 (32.1%) a general movement discussion, and 12 (21.4%) included a plan.

CONCLUSION

Using our reliable data abstraction form we identified a lack of documentation about physical activity assessments and interventions among patients with chronic low back pain. A larger study is needed to examine the generalizability of these results.

A survey of Indian physiotherapists' clinical practice patterns and adherence to clinical guidelines in the management of patients with acute low back pain

INTRODUCTION

Clinical practice guidelines (CPG) exist for the management of non-specific low back pain (LBP). The objective of this study is to evaluate if Indian physiotherapists' follow CPGs when treating patients with acute LBP.

METHODS

A cross-sectional survey using an online questionnaire was used to collect demographic information, views, and opinion about acute LBP and CPGs, and management strategies of a clinical vignette presenting a patient with acute LBP.

RESULTS

Responses from 328 physiotherapists were included in this study. Eighty-one percent of respondents indicated familiarity with CPGs for LBP and 75.3% (n = 328) respondents indicated that their intervention choices aligned with guidelines to at least some extent. Participants with post-graduate and doctoral degrees were more accustomed to CPGs than those with bachelor's degrees (p < 0.01). There were significant differences in clinical practice (p < 0.01) between therapists who expressed familiarity with guidelines and those who were not, as well as those with and without post-graduate and doctoral degrees.

CONCLUSION

In general, the study showed adherence to guidelines; however, there were areas that did not align with established evidence, especially referral for radiology and use of electrical modalities.

Content analysis of the online information available about back pain

Background

Low back pain (LBP) is growing health concern that affects millions of people around the globe, and there are many misconceptions regarding causes, imaging, and appropriate treatment choices. Common people usually search Google seeking information regarding LBP from different websites. However, the content of these widely accessible websites have not be evaluated in the light of evidence. The present study aims to analyze the information presented by these websites, summarize the content, and evaluate it against the published literature.

Methods

We conducted a systematic search of Google using search terms “low back pain,” “back pain,” “backache. NVivo software was used to capture the content from the internet. Content analysis (CA) was used to analyze online consumer information concerning LBP on the included websites.

Results

A total of 53 websites were included in the study by screening the search pages. There were erroneous information present on majority of the websites. Almost all of the websites consisted of nocebic terms. The causes were more oriented towards biomedical model. Treatment options mentioned did not concur with the recent clinical practice guidelines.

Conclusion

The Online information retrieved from a Google search lacks representation of the current best research. The findings of the study suggest that future development of websites must include information that is more accurate, and evidence driven. Online LBP information should be based on criteria that are more sensitive to the psychosocial factors that contribute to pain.

Assessing Physical Therapy Knowledge amongst the New Graduates in Saudi Arabia: Competency Examination across the Nation

Given the increasing demand for more trained physical therapists in providing care to patients in Saudi Arabia, it has become vital to adequately assess individual physical therapy graduate academic learning and performance. Therefore, the present study aimed at evaluating the knowledge and skills of Saudi PT graduates. A competency examination adapted from a practice test that is commercially available and simulates the National Physical Therapy Examination (NPTE) was conducted. Out of 398 Saudi physical therapists that were approached with the examination link, 149 PT graduates consented to the study. Seventy questions were randomly selected by two individuals familiar with the content of PT programs in the United States and Saudi Arabia. The content outline of the selected questions followed the NPTE recommendations for body systems and non-systems. Each question was multiple choice with four answers. The examination was distributed electronically. Each participant was given 90 min to complete the examination. The passing score was set at 55%. Out of 149, only 6six (4.02%) participants passed the examination with an average passing score of 67% (range: 56–96%). In the primary domains of body systems, the score was highest in the endocrine domain (55.1%), followed by the integumentary (42.18%) and the neurology (40.9%) domains. In the non-system, participants had the highest score in the professionalism domain (89.8%). The highest mean knowledge score was obtained in the field of assessment (38.57%). PT graduates from Saudi Arabia performed poorly in the examination, demonstrating weak domain knowledge and skills.

Limited evidence exists on determinants of physiotherapists' adherence to high value interventions in nonspecific low back pain management: A scoping review

BACKGROUND

Examining the emerging body of evidence investigating what drives physiotherapist's clinical decisions in the management of low back pain can guide future research into identifying barriers and facilitators of their adherence to evidence recommended interventions.

OBJECTIVE

To establish the body of evidence regarding factors that improve or hinder physiotherapists' adherence to high-value interventions on the management of non-specific low back pain.

DESIGN

Scoping review.

METHODS

We conducted a Scoping review by searching MEDLINE, CINAHL, and SPORTDiscus databases on 13 February 2021. Two reviewers independently screened the retrieved literature and selected articles for inclusion. We included quantitative research that investigated an association between physiotherapists' personal characteristics or setting related characteristics with their clinical management of patients with non-specific low back pain.

RESULTS

Twelve studies reported in 13 publications were included. The majority of the studies were conducted in high-income countries including, the United States, Canada and UK. Twenty-six factors were investigated as potentially influencing physiotherapists' adherence to high value interventions in low back pain management. The most commonly examined physiotherapists' attributes were educational qualification that is postgraduate or certification course (58%, N = 7 studies), years of experience (41%, N = 5 studies), and beliefs and attitude about low back pain (41%, N = 5 studies). Work setting (N = 4) and workload (N = 3) were frequently investigated setting related factors.

CONCLUSION

Currently, there is limited evidence available to understand determinants controlling practice behaviours of physiotherapists' management of nonspecific low back pain. Future researches conceptualized within contemporary theories of clinician behaviour change and models of knowledge translation are needed.