Patients’ experiences of the BetterBack model of care for low back pain in primary care – a qualitative interview study

Enthoven, Paul; Eddeborn, Fredrik; Abbott, Allan; Schröder, Karin; Fors, Maria; Öberg, Birgitta

doi:10.1080/17482631.2020.1861719

Cited by 5 publications

(11 citation statements)

References 46 publications

(72 reference statements)

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“…However, the larger number of treatments in the intervention group can be explained by the more often used group training that yields a higher number of treatment sessions. High satisfaction with LBP care has also been shown in a qualitative study that explored patients' experience of the BetterBack☺ MoC, where patients experienced better knowledge of their LBP and had received tools to better manage their health condition (137). Patient satisfaction with care has been seen to correlate with quality of life, and it has been suggested that although changes in treatment of patients might not lead to significant changes in patients' function and activities, clinicians can potentially affect patients' perception of LBP and improve coping with illness (160).…”

Section: Patient-reported Outcomesmentioning

confidence: 86%

“…This thesis has not evaluated which specific components of the clinical intervention that were effective in changing PROMs. However, according to a qualitative interview study not included in this thesis, the patients reported that the brochure, group education and exercise programme were helpful tools in developing selfmanagement strategies, and reducing fear avoidance and maladaptive illness beliefs (137).…”

Section: The Content Of the Betterback☺ Mocmentioning

confidence: 98%

“…By applying a hybrid type II design in the experimental studies, we evaluated the implementation of the BetterBack☺ MoC through its adoption on the PT level and the effects of clinical interventions delivered on a patient level. Moreover, patient interviews (137) and clinician interviews (unpublished data) have also been performed, but these are not included in this thesis. These evaluations can help determine whether the LBP care, after a multifaceted implementation of a best practice healthcare model, can improve in quality.…”

Section: Evaluation Of Guideline Implementationmentioning

confidence: 99%

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Implementing BetterBack – a Best Practice Physiotherapy Healthcare Model for Low Back Pain : Clinician and Patient Evaluation

Schröder

2021

Linköping University Medical Dissertations

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Background: Low back pain (LBP) occurs in all ages, and first-line treatment by physiotherapists (PTs) is common. However, national evidence-based LBP clinical guidelines are still lacking in Sweden. To facilitate guideline uptake, we developed and with a multifaceted strategy implemented a best practice physiotherapy healthcare model (BetterBack☺ MoC) with the aim of supporting management of LBP in primary care.The overall aim of this thesis was to evaluate a multifaceted implementation strategy and a best practice physiotherapy healthcare model for LBP.Methods: This thesis is based on one methodological study and three experimental trials with PTs and patients with LBP. In Paper I a mixed method design was used to translate, tailor, validate and feasibility-test the Determinants of Implementation Behaviour Questionnaire (DIBQ). This tailored DIBQ Questionnaire (DIBQ-t) was used to evaluate potential barriers/facilitators during the implementation process together with evaluation of PTs' confidence, attitudes and beliefs in managing LBP. In a stepped cluster randomised controlled trial, PTs and their patients in three clusters were allocated to intervention group (after implementation of BetterBack☺ MoC) or control group (routine physiotherapy care). The proportions of guideline-adherent care were compared between groups (Paper III). This evaluation was based on PTs' adherence to eight clinical practice recommendations and three clinical practice quality indices (CPQI). The overall CPQI containing the five most prioritised recommendations are: no referral to specialist care; no referral to medical imaging for benign LBP; use of educational interventions; use of exercise interventions; and no use of non-evidence-based physiotherapy. Finally, in Paper IV patient-reported outcome measures (PROMs) were compared between intervention (after the implementation of BetterBack☺ MoC) and routine care. In Paper IV an additional secondary analysis was performed, comparing PROMs based on whether or not PTs had delivered care that met all five criteria of the overall CPQI or not.

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Section: Patient-reported Outcomesmentioning

confidence: 86%

Section: The Content Of the Betterback☺ Mocmentioning

confidence: 98%

Section: Evaluation Of Guideline Implementationmentioning

confidence: 99%

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Implementing BetterBack – a Best Practice Physiotherapy Healthcare Model for Low Back Pain : Clinician and Patient Evaluation

Schröder

2021

Linköping University Medical Dissertations

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“…However, this larger number can be explained by the more often use of group training intervention as part of the BetterBack MoC that yields a higher number of treatment sessions compared to the more often used home-based exercise in the control group. Other potential reasons for higher satisfaction in the intervention group have been shown in a qualitative study where patients in the BetterBack MoC group experienced better knowledge about their LBP and received tools to better manage their health condition [49]. Patient satisfaction with care has been seen to correlate with quality of life, but the directionality needs further investigation [50].…”

Section: Discussionmentioning

confidence: 98%

Effectiveness and Quality of Implementing a Best Practice Model of Care for Low Back Pain (BetterBack) Compared with Routine Care in Physiotherapy: A Hybrid Type 2 Trial

Schröder

Öberg

Enthoven

et al. 2021

JCM

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Low back pain (LBP) occurs in all ages and first-line treatment by physiotherapists is common. The main aim of the current study was to evaluate the effectiveness of implementing a best practice model of care for LBP (intervention group—BetterBack☺ MoC) compared to routine physiotherapy care (control group) regarding longitudinal patient reported outcomes. The BetterBack☺ MoC contains clinical guideline recommendations and support tools to facilitate clinician adherence to guidelines. A secondary exploratory aim was to compare patient outcomes based on the fidelity of fulfilling a clinical practice quality index regarding physiotherapist care. A stepped cluster randomized design nested patients with LBP in the three clusters which were allocated to control (n = 203) or intervention (n = 264). Patient reported measures were collected at baseline, 3, 6 and 12 months and analyzed with mixed model regression. The primary outcome was between-group changes from baseline to 3 months for pain intensity and disability. Implementation of the BetterBack☺ MoC did not show any between-group differences in the primary outcomes compared with routine care. However, the intervention group showed significantly higher satisfaction at 3 months and clinically meaningful greater improvement in LBP illness perception at 3 months and quality of life at 3 and 6 months but not in patient enablement and global impression of change compared with the control group. Physiotherapists’ care that adhered to all clinical practice quality indices resulted in an improvement of most patient reported outcomes with a clinically meaningful greater improved LBP illness perception at 3 month and quality of life at 3 and 6 months, significantly greater improvement in LBP illness perception, pain and satisfaction at 3 and 6 months and significantly better enablement at all time points as well as better global improvement outcomes at 3 months compared with non-adherent care. This highlights the importance of clinical guideline based primary care for improving patient reported LBP outcomes.

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“…A recent study assessing impacts of the BetterBack model found that it was very well received by patients, who felt it improved their knowledge and confidence, making it easier for them to self-manage their condition. 4 As the authors acknowledge, while this is promising, clinical trials and health economics evaluations are needed to support policy decisions about implementing BetterBack more widely.…”

mentioning

confidence: 99%

Yonder: Home visits, dentists’ wellbeing, child mental health, and BetterBack

Rashid¹

2021

Br J Gen Pract

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Patients’ experiences of the BetterBack model of care for low back pain in primary care – a qualitative interview study

Cited by 5 publications

References 46 publications

Implementing BetterBack – a Best Practice Physiotherapy Healthcare Model for Low Back Pain : Clinician and Patient Evaluation

Implementing BetterBack – a Best Practice Physiotherapy Healthcare Model for Low Back Pain : Clinician and Patient Evaluation

Effectiveness and Quality of Implementing a Best Practice Model of Care for Low Back Pain (BetterBack) Compared with Routine Care in Physiotherapy: A Hybrid Type 2 Trial

Yonder: Home visits, dentists’ wellbeing, child mental health, and BetterBack

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