Clinical challenges of classification based targeted therapies for non-specific low back pain: What do physiotherapy practitioners and managers think?

Abstract

BackgroundClassification of non-specific low back pain (NSLBP) was recommended to better target care and so maximise treatment potential. This study investigated physiotherapy practitioners' (PPs) and managers' (PMs) views, experiences and perceptions of barriers and enablers for using classification systems (CSs) to better target treatment for NSLBP in the NHS primary care setting.DesignQualitative focus group and interviews.MethodsData from semi-structured interviews of three PMs and a focus group with five PPs, considered local opinion leaders in physiotherapy, was thematically analysed.ResultsFive themes emerged (i) CS knowledge: PPs and PMs were aware of CSs and agreed with its usefulness. PPs were mostly aware of CSs informing specific treatments whilst PMs were aware of prognosis based CSs. (ii) Using CSs: PPs classify by experience and clinical reasoning skills, shifting between multiple CSs. PMs were confident that evidence-based practice takes place but believed CSs may not be always used. (iii) Advantages/disadvantages of CSs: Effective targeting of treatments to patients was perceived as advantageous; but the amount of training required was perceived as disadvantageous. (iv) Barriers: Patients' expectations, clinicians' perceptions, insufficiently complex CSs, lack of training resources. (v) Enablers: Development of sufficiently complex CSs, placed within the clinical reasoning process, mentoring, positive engagement with stakeholders and patients.ConclusionsPPs and PMs were aware of CSs and agreed with its usefulness. The current classification process was perceived to be largely influenced by individual practitioner knowledge and clinical reasoning skills rather than being based on one CS alone. Barriers and enablers were identified for future research.

Clinical assessment and patient-reported outcome measures in low-back pain – a survey among primary health care physiotherapists

“…Even so, previous findings report diverse results how physiotherapists use PROMs when targeting treatment [19,[24][25][26][27][28]. Studies surveying physiotherapists on their use of PROMs in clinical practice imply both facilitators and barriers, and report a low percentage of the use of PROMs in clinical practice [24][25][26][27][28]. Hitherto, there is insufficient knowledge on to what extent physiotherapists in primary health care, in Sweden, use clinical tests and PROMs in their management of patients suffering from LBP [12].…”

Fascial manipulation vs. standard physical therapy practice for low back pain diagnoses: A pragmatic study

“…Incorporating a few minutes of FM ® treatment into the plan of care has the potential to dramatically reduce the perception of pain and improve quality of life outcomes for those with low back pain. Attempting to classify LBP signs and symptoms using a common clinical paradigm is debatable (Brennan et al, 1976;Sheeran et al, 2015;Apeldoorn et al, 1976). The primary clinical classification systems used presently include responses to repetitive movements (i.e.…”

“…ODI has excellent reliability and validity for assessing low back pain (Frost et al, 1976;Miekisiak et al, 2013). A single agreed-upon MCID cutpoint score for the ODI is not yet established, but 10% and 50% are commonly utilized (Alrwaily et al, 2016;Brennan et al, 1976;Fritz et al, 1976Fritz et al, , 2005Sheeran et al, 2015). Therefore, the ODI MCID was evaluated as a change in at least one disability category, at a 10% change, and at a 50% change.…”

Response to Letter to the Editor re: ‘Movement-based subgrouping in low back pain: synergy and divergence in approaches’

“…As highlighted by Sheeran et al [3], some of the barriers to adoption of classification schemes are the many hours of advanced training required (but not readily available) by certain schemes, and the perceived threat to therapeutic diversity by use of a single classification system. A survey of US-based physiotherapists illustrated that use of classification schemes is diverse, and that diagnosis often occurs across multiple levels or systems [4].…”