Low Back Pain: Current Patterns of Canadian Physiotherapy Service Delivery

Abstract

Purpose: The aim of this study was to describe the current patterns of service delivery of Canadian physiotherapy (PT) professionals working in adult musculoskeletal (MSK) outpatient practice. Methods: A total of 846 Canadian PT professionals working with an adult MSK outpatient clientele participated in an online survey about how they would treat a patient with low back pain (LBP). After reading an online clinical vignette about a fictional patient with varying insurance status, participants answered questions about how they would treat the patient (e.g., wait time, frequency and duration of treatment, time allotted for initial evaluation and treatment), about their actual practice (e.g., number of patients seen per day), and about their work setting. Results: The vignette patients with LBP would typically be seen within 2 weeks, especially in private practice, and most would receive care 2-3 times per week for 1-3 months. Initial evaluations and subsequent treatments would take 31-60 minutes. Two-thirds of participants reported treating 6-15 patients a day in their current practice setting. Differences were found between provinces and territories (with the longest wait time in Quebec), practice settings (with a longer wait time in the public sector), and insurance status (patients covered by workers' compensation are seen more frequently). Conclusion: This study adds to our knowledge of the accessibility of outpatient MSK PT services for patients with LBP in Canada, and it points to potential areas for improvement.Key Words: Canada; health care services accessibility; low back pain; outpatients. RÉ SUMÉObjectif : dé crire les modè les actuels de prestation de services en physiothé rapie en clinique externe au Canada auprè s de patients adultes ayant des problè mes musculosquelettiques. Mé thodes : un total de 846 professionnels de la physiothé rapie canadiens travaillant en clinique externe auprè s de patients adultes ayant des problè mes musculosquelettiques ont ré pondu à un sondage en ligne à propos de leur maniè re de traiter un patient souffrant de douleur lombaire. Aprè s avoir lu une vignette clinique en ligne au sujet d'un patient fictif au ré gime d'assurance variable, les participants ont ré pondu à des questions au sujet de la maniè re dont ils traiteraient le patient (ex. : temps d'attente, fré quence et duré e des traitements, temps alloué à l'é valuation initiale et au traitement) ainsi que de leur pratique actuelle (ex. : nombre de patients vus par jour) et de leur cadre de travail. Ré sultats : les patients souffrant de douleur lombaire pré senté s dans la vignette clinique seraient normalement vus en deux semaines, particuliè rement en pratique privé e, et la plupart recevraient des soins de deux à trois fois par semaine pendant un à trois mois. Les é valuations initiales et les traitements subsé quents dureraient entre 31 et 60 minutes. Les deux tiers des participants ont ré pondu qu'ils traitent entre 6 et 15 patients par jour dans leur cadre de travail 49From the:

Appropriateness of exercise therapy delivery in chronic low back pain management: cross-sectional online survey of physiotherapy practice in Germany

“…In another vignette-based survey study of current PT practice patterns in LBP management, the authors identified that Canadian physiotherapists preferred to treat LBP patients two to three times per week, for 30 to 60 min per session, over a time period of one to three months [ 36 ]. These findings of Orozco and colleagues [ 36 ] are consistent with answers to the dose selection process of our study.…”

“…In another vignette-based survey study of current PT practice patterns in LBP management, the authors identified that Canadian physiotherapists preferred to treat LBP patients two to three times per week, for 30 to 60 min per session, over a time period of one to three months [ 36 ]. These findings of Orozco and colleagues [ 36 ] are consistent with answers to the dose selection process of our study. In comparison, a survey study conducted in New Zealand revealed that physiotherapists regularly provided between six to ten treatment sessions for NSCLBP patients and highlighted that this scope of therapy is not sufficient to support patients in self-managing their chronic conditions [ 37 ].…”

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

“…The study had other secondary objectives, which have been published elsewhere. 56 Study data were collected and managed using REDCap electronic data capture tools. 57…”

“…Such guidelines should provide evidence-based benchmarks for service provision to ensure that all people receive services according to their clinical needs, moving professionals beyond the implicitly biased practices identified in the survey. 56 The creation of national guidelines would obviously require consensus among key stakeholders, such as third-party payers, professional associations, and government Health Ministry delegates. National guidelines would also need to be enacted within provincial contexts by professional boards and associations, and tangible incentives would likely need to be offered to clinics to ensure participation.…”

How Much Physiotherapy, Chiropractic, and Osteopathy Care Do Compensated Australian Workers with Low Back Pain Receive? A Retrospective Cohort Study

“…While estimates of physical therapy patterns of care are available, these are either not specific to the workers' compensation sector or are from single Australian jurisdictions or outside Australia [13,14,[16][17][18][19][20][21]. Furthermore, the determinants of seeking physical therapy in compensated workers…”