Patients' prior perceptions and expectations of the Enhanced Transtheoretical Model Intervention for chronic low back pain: A qualitative study

Abstract

Background The Enhanced Transtheoretical Model Intervention (ETMI) is an approach for treating chronic low back pain (CLBP), which demonstrated clinical and cost‐effectiveness outcomes. ETMI highlights reassurance, return to normal activities and encouragement of recreational physical activity. In order to optimally implement ETMI, it is important to gain an understanding of the expectations and perceptions of patients before they engage with the intervention. Objectives To explore CLBP patients' perceptions and expectations of the ETMI method prior to their first consultation with physiotherapist. Methods Qualitative semi‐structured interviews were conducted with 30 CLBP patients. The interviews were audio‐recorded, transcribed, coded, and analysed thematically. Patients were first asked about their expectations of treatment, then they were asked to comment on the ETMI method. Results Three main themes emerged from the interviews: (1) Patient's perceptions of LBP; (2) patient's expectations from current physiotherapy and (3) Patient's expectations from ETMI method. The patients' perceptions of back pain centred on biomechanical causal factors, a desire for diagnostic tests and beliefs that rest cures the pain. Their expectations from current physiotherapy included pain reduction, passive treatment, a structured exercise program and clear information about LBP. In reference to the ETMI method, patients expected pain reduction, practical tools to self‐manage, and a combination of ETMI with passive treatment. Conclusion addressing issues around patient's perceptions and expectations of current physiotherapy and of the ETMI method, prior to their first consultation with physiotherapist, could be beneficial for understanding how to improve the ETMI implementation in the health care system.

Patients’ Perceptions and Outcome Measures after Undergoing the Enhanced Transtheoretical Model Intervention (ETMI) for Chronic Low Back Pain: A Mixed-Method Study

“…Our findings are consistent with those of studies that indicate that patients seek a confidence-based relationship with their caregivers [10,11,37,38]. Moreover, the findings regarding patients' perceptions of the ETMI method as a practical tool for the treatment of back pain are consistent with those of several studies addressing patients' perceptions of LBP clinical guidelines [15,39].…”

“…Recent studies address issues around patients' and physiotherapists (PTs') perceptions and expectations of current physiotherapy and of the ETMI method [9,10]. While the patient's primary purpose is to reduce their pain, they also expect to receive passive treatment, and information and knowledge regarding their back problem [9].…”

“…While the patient's primary purpose is to reduce their pain, they also expect to receive passive treatment, and information and knowledge regarding their back problem [9]. PTs have indicated that there are barriers to overcome, such as the PTs' communication and education, an individual's reluctance to change their daily routine, interprofessional collaboration, and healthcare complexity [10,11].…”

“…While a recent study shows that patients are beginning to perceive ETMI as an evidenced-based model for the treatment of CLBP [10], there is still a gap between patients' perceptions of a new method that they just heard about and a method that they receive in real life. Therefore, the goals of the current study were (1) to evaluate the outcome measures of patients with LBP (pain, fear avoidance, and function) and (2) to assess the perceptions of the interventions of patients with LBP, both after receiving physiotherapy based on the ETMI method.…”

Biomedical Dogmas Still Influence the Delivery of Exercise Therapy in Chronic Low Back Pain Management: Mixed-Methods Study

“… 27 Results of a qualitative study also suggest that LBP patients understand back pain as a biomedical condition as they believed that rest positively influences pain mechanisms. 28 From medical services, interviewed patients expected a reduction of pain, passive treatment approaches, specific exercise regimes and clear information on LBP courses and management options. 28 …”