Adherence to key domains in low back pain guidelines: A cross‐sectional study of Danish physiotherapists

Abstract

Objective: The aim of the study was threefold: Firstly, to investigate the adherence to clinical practice guidelines for low back pain (LBP) among Danish physiotherapists with regard to three key domains: (a) activity, (b) work and (c) psychosocial risk factors. Secondly, to investigate whether adherence differed between physiotherapists working in private clinics (private physiotherapists) and physiotherapists working at public healthcare centres (public physiotherapists). Thirdly, to describe the physiotherapists' treatment modalities for patients with LBP. Methods: A cross-sectional online survey was conducted with 817 physiotherapists working in the Central Denmark Region. Adherence to the guideline domains was assessed using two vignettes. The difference in adherence between the groups was assessed using the Chi-squared test. Treatment modalities were reported using descriptive statistics. Results: A total of 234 physiotherapists responded, hereof 163 private physiotherapists and 71 public physiotherapists (response rate 29%). The proportions of physiotherapists managing the patients strictly in line with the guideline domains were 32% (activity), 16% (work) and 82% (psychosocial risk factors) for Vignette 1 and 6% (activity), 53% (work) and 60% (psychosocial risk factors) for Vignette 2. Public physiotherapists were more likely to manage patients strictly in line with guidelines for assessing the psychosocial risk factors compared to private physiotherapist (Vignette 1: 92% vs. 77% p = .030; Vignette 2:70% vs. 55% p = .035). Regarding the other two domains, there was no significant difference between the two groups in terms of adherence (p > .05). Concerning treatment modalities, the majority of physiotherapists instructed the patients in adopting an exercise program or informed the patients about the benign nature and prognosis of LBP. Conclusion: Overall, the participating Danish physiotherapists strictly adhered to only one out of three key domains. This underlines the importance of bringing focus on implementing the current guidelines' recommendations in clinical practice.

Physical therapy for patients with low back pain in Germany: a survey of current practice

“…The overall high guideline adherence in the treatment section ( n = 973, 72 %) observed in our study was also found in a recent study of Danish physical therapists [ 29 ], where the vast majority of participants was strictly or partly in line with the CPG. In contrast to these results, de Souza et al [ 30 ] stated that among Brazilian physical therapists, only 5–24 % showed full LBP guideline adherence.…”

“…Differences in reported guideline-adherent behaviour appear to be dependent upon several factors, including study design and the definition of guideline adherence. Husted et al [ 29 ], de Souza et al [ 30 ] and Ladeira et al [ 31 ] evaluated guideline adherence using clinical vignettes. In contrast, participants of the current study ranked their application frequency of treatment modalities as recommended in the NVL and guideline adherence was determined using a scoring system.…”

“…In line with previous studies [ 13 , 36 – 38 ], survey participants reported inapplicability of guideline recommendations to individual patients ( n = 259, 54 %), time restrictions ( n = 180, 37 %) and lack of research skills ( n = 121, 25 %) as the most important factors inhibiting the use of guidelines in clinical practice. In a Danish study [ 29 ], the authors assumed an association between increased guideline adherence and more time spend on the first consultation (60 min or more). A typical physical therapy session in Germany lasts about 15–20 min for patients with musculoskeletal disorders, which poses an important structural barrier.…”

Ways to improve guideline adherence in the emergency department: an interview study on the management of traumatic brain injuries

“…However, the rate of guideline adherence is often low and varies widely [2][3][4]. Several barriers to guideline adherence have been identified, ranging from factors affecting individual physicians' knowledge about and attitude towards a certain guideline to external barriers.…”

Building therapeutic alliances with patients in treatment for low back pain: A focus group study

“…Within this model, management should include measures of possibly modifiable contributing factors like pain self‐efficacy, depression, anxiety, sleep quality, social functioning and work absenteeism (Tagliaferri et al., 2020). However, integration of the psychosocial domain in low back pain physiotherapy management is not optimal (Husted et al., 2020; Schaumberg, 2020). Physiotherapists have reported a lack of confidence to apply psychosocial strategies in their practice (Driver, Lovell, & Oprescu, 2019) and barely include psychosocially oriented illness perceptions in history taking (Roussel et al., 2016).…”