Low Back Pain: Investigation of Biases in Outpatient Canadian Physical Therapy

Laliberté, Maude; Mazer, Barbara; Orozco, Tatiana; Chilingaryan, Gevorg; Williams‐Jones, Bryn; Hunt, Matthew; Feldman, Debbie Ehrmann

doi:10.1093/ptj/pzx055

Cited by 9 publications

(4 citation statements)

References 80 publications

(107 reference statements)

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“…Recruitment. Considering that response rates of physiotherapists to online surveys range from approximately 9% (Laliberté et al, 2017) Respondents were excluded from the study if they (a) reported working exclusively in neurological, cardiorespiratory, or paediatric rehabilitation; or (b) failed to meet any of the inclusion criteria described above.…”

Section: Methodsmentioning

confidence: 99%

Evidence-Based Practice for Non-Specific Low Back Pain: Canadian Physiotherapists’ Adherence, Beliefs, and Perspectives

Prado

Parsons

Ripat

2022

Physiotherapy Canada

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Purpose: Physiotherapists are key providers of care for patients with low back pain (LBP); however, information on Canadian physiotherapists’ use of evidence-based clinical practice guidelines (EBCPGs) for LBP is lacking. We aimed to (1) describe Canadian physiotherapists’ adherence to EBCPGs for LBP; (2) compare beliefs and attitudes of physiotherapists with higher and lower adherence; (3) identify predictors of adherence; and (4) gather physiotherapists’ perceptions about the care provided to patients with LBP. Method: This mixed methods study involved two phases: (1) a survey containing a LBP clinical scenario and (2) qualitative semi-structured interviews with physiotherapists. Results: A total of 406 (77%) of the 525 survey respondents demonstrated higher adherence (score of 3 or 4) to EBCPGs; however, only 29.5% chose interventions to address psychosocial issues. Postgraduate training was the strongest predictor of higher adherence. Interviewed physiotherapists reported being highly satisfied with the care provided to patients with LBP even when psychosocial issues are present, despite low confidence in addressing those issues. Conclusions:Although overall adherence was high, Canadian physiotherapists do not frequently address psychosocial issues with LBP patients, and often do not feel confident or competent in that aspect of practice. This suggests an opportunity for developing additional training for addressing psychosocial issues in LBP patients.

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Section: Methodsmentioning

confidence: 99%

Evidence-Based Practice for Non-Specific Low Back Pain: Canadian Physiotherapists’ Adherence, Beliefs, and Perspectives

Prado

Parsons

Ripat

2022

Physiotherapy Canada

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“…Regions with a greater number of independent MRI sites had higher rates of early MRI due to potential clinician 'self-referral' [33]. Evidence from simulated scenarios demonstrated private clinicians are more likely to see workers with LBP more often if their healthcare was funded by an income support system (an employer liability system) than by private insurance or out of their own pocket [56]. In clinical scenarios, physiotherapists treat compensated patients similarly to other patients, but were more likely to suggest ongoing physiotherapy for treatment [57].…”

Section: Cmo Configuration 1 (N=3 Pieces Of Literature)mentioning

confidence: 99%

The Impact of Income Support Systems on Healthcare Quality and Functional Capacity in Workers with Low Back Pain: A Realist Review

Donato

Iles

Lane

et al. 2020

Preprint

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Background: Low back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers' compensation or social security. Current evidence suggests that income support systems can influence recovery from LBP, but provides little insight as to why and how these effects occur. This study examines how and in what contexts income support systems impact the healthcare quality for people with work disability and LBP and their functional capacity. Methods: We performed a realist review, a type of literature review that seeks to explain how social interventions and phenomena in certain contexts generate outcomes, rather than simply whether they do. Five initial theories about the relationship between income support systems and outcomes were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented with grey literature searches for policy documents and legislative summaries, and semi-structured interviews with experts in income support, healthcare and LBP. Results: Income support systems influence healthcare quality through funding restrictions, healthcare provider administrative burden, and allowing employers to select providers. They also influence worker functional capacity through the level of participation and financial incentives for employers, measures to prove the validity of the worker's LBP, and certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition. Discussion: Income support systems impact the healthcare quality and functional capacity of people with work disability and LBP through context-dependent financial control, regulatory and administrative mechanisms. Research and policy design should consider how income support systems may indirectly influence workers with LBP via the workplace.

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“…Prioritization processes may also involve rationing of services, that is denying access to patients based on specified eligibility criteria [10]. Not surprisingly, prioritization processes and limited access to healthcare services raise issues regarding equity in access [7,[11][12][13][14][15]. These issues are challenging for clinicians, managers and decision makers, knowing that "in a resource-constrained system, giving additional weight to something or someone implies that something or someone else will lose out."…”

Section: Introductionmentioning

confidence: 99%

Prioritization of Referrals in Outpatient Physiotherapy Departments in Québec and Implications for Equity in Access

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Low Back Pain: Investigation of Biases in Outpatient Canadian Physical Therapy

Cited by 9 publications

References 80 publications

Evidence-Based Practice for Non-Specific Low Back Pain: Canadian Physiotherapists’ Adherence, Beliefs, and Perspectives

Evidence-Based Practice for Non-Specific Low Back Pain: Canadian Physiotherapists’ Adherence, Beliefs, and Perspectives

The Impact of Income Support Systems on Healthcare Quality and Functional Capacity in Workers with Low Back Pain: A Realist Review

Prioritization of Referrals in Outpatient Physiotherapy Departments in Québec and Implications for Equity in Access

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