Musculoskeletal practitioners’ perceptions of contextual factors that may influence chronic low back pain outcomes: a modified Delphi study

Abstract

Background Optimal shaping of contextual factors (CFs) during clinical encounters may be associated with analgesic responses in treatments for musculoskeletal pain. These CFs (i.e., the patient-practitioner relationship, patient’s and practitioner’s beliefs/characteristics, treatment characteristics, and environment) have not been widely evaluated by musculoskeletal practitioners. Understanding their views has the potential to improve treatment quality and effectiveness. Drawing on a panel of United Kingdom practitioners’ expertise, this study aimed to investigate their perceptions of CFs during the management of patients presenting with chronic low back pain (LBP). Methods A modified two-round online Delphi-consensus survey was conducted to measure the extent of panel agreement regarding the perceived acceptability and influence of five main types of CFs during clinical management of patients with chronic LBP. Qualified musculoskeletal practitioners in the United Kingdom providing regular treatment for patients with chronic LBP were invited to take part. Results The successive Delphi rounds included 39 and 23 panellists with an average of 19.9 and 21.3 years of clinical experience respectively. The panel demonstrated a high degree of consensus regarding approaches to enhance the patient-practitioner relationship (18/19 statements); leverage their own characteristics/beliefs (10/11 statements); modify the patient’s beliefs and consider patient’s characteristics (21/25 statements) to influence patient outcomes during chronic LBP rehabilitation. There was a lower degree of consensus regarding the influence and use of approaches related to the treatment characteristics (6/12 statements) and treatment environment (3/7 statements), and these CFs were viewed as the least important. The patient-practitioner relationship was rated as the most important CF, although the panel were not entirely confident in managing a range of patients’ cognitive and emotional needs. Conclusion This Delphi study provides initial insights regarding a panel of musculoskeletal practitioners’ attitudes towards CFs during chronic LBP rehabilitation in the United Kingdom. All five CF domains were perceived as capable of influencing patient outcomes, with the patient-practitioner relationship being perceived as the most important CF during routine clinical practice. Musculoskeletal practitioners may require further training to enhance their proficiency and confidence in applying essential psychosocial skills to address the complex needs of patients with chronic LBP.

The chiropractors’ dilemma in caring for older patients with musculoskeletal complaints: Collaborate, integrate, coexist, or separate?

“…Chiropractic has a long history of a holistic (framed contemporality as biopsychosocial) approach to patient care [ 31 , 32 ], an approach also appreciated by care recipients [ 7 , 33 ]. Besides manual therapy, contemporary chiropractors often use several other modalities to care for and manage MSK complaints [ 20 , 32 ], including providing health promotion advice [ 33 ], adapting the treatment to patient preferences and needs and taking into account the whole therapeutic encounter as a complex web of mental as well as physical processes that impact MSK pain [ 34 ], which aligns well with recommendations by the WHO [ 12 ]. However, there are several complicating factors in the care and management of older adults, such as co-morbidities and chronic underlying diseases, i.e., cardiovascular disease, diabetes, neurological disease, and osteoporosis [ 32 ].…”

Spielt es eine Rolle, ob das ISG als Schmerzquelle diagnostiziert wird?

“…It is also one of the expectations of pa tients [45]. This has the potential to improve patient sat isfaction and the therapeutic relationship, which is sug gested to favorably influence core outcomes [46,47].…”

The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic

“…A recent modified two-round online Delphi-consensus survey was conducted with musculoskeletal practitioners to measure the extent of panel agreement on the perceived acceptability and influence of five main types of contextual factors during clinical management of patients with chronic low back pain [20]. The contextual factors of interest were (1) the patient-practitioner relationship; (2) patient's characteristics/beliefs; (3) practitioner's characteristics/beliefs; (4) the treatment characteristics; and (5) the treatment environment/setting [20]. The panel consisted of 23 chiropractors, 10 physiotherapists, one individual who was a qualified chiropractor and physiotherapist, and one clinical functional neurologist [20].…”

“…The contextual factors of interest were (1) the patient-practitioner relationship; (2) patient's characteristics/beliefs; (3) practitioner's characteristics/beliefs; (4) the treatment characteristics; and (5) the treatment environment/setting [20]. The panel consisted of 23 chiropractors, 10 physiotherapists, one individual who was a qualified chiropractor and physiotherapist, and one clinical functional neurologist [20]. The findings suggest that the patient-practitioner relationship was rated as the most important contextual factor [20].…”

“…The panel consisted of 23 chiropractors, 10 physiotherapists, one individual who was a qualified chiropractor and physiotherapist, and one clinical functional neurologist [20]. The findings suggest that the patient-practitioner relationship was rated as the most important contextual factor [20]. However, less than 70% of the panel reported being confident about their non-verbal communication skills and less than 70% of the panellists were confident about developing WA, expressing genuine empathy, engaging in collaborative decision-making, or requesting the patient's opinion [20].…”