Use and perceived added value of patient-reported measurement instruments by physiotherapists treating acute low back pain: a survey study among Dutch physiotherapists

Abstract

Background: This study aims to explore (i) physiotherapists' current use in daily practice of patient-reported measurement instruments (screening tools and questionnaires) for patients with acute low back pain (LBP), (ii) the underlying reasons for using these instruments, (iii) their perceived influence on clinical decision-making, and (iv) the association with physiotherapist characteristics (gender, physiotherapy experience, LBP experience, overall ehealth affinity). Methods: Survey study among Dutch physiotherapists in a primary care setting. A sample of 650 physiotherapists recruited from LBP-related and regional primary care networks received the survey between November 2018 and January 2019, of which 85 (13%) completed it. Results: Nearly all responding physiotherapists (98%) reported using screening tools or other measurement instruments in cases of acute LBP; the Quebec Back Pain Disability Scale (64%) and the STarT Back Screening Tool (61%) are used most frequently. These instruments are primarily used to evaluate treatment effect (53%) or assess symptoms (51%); only 35% of the respondents mentioned a prognostic purpose. Almost three-quarters (72%) reported that the instrument only minimally impacted their clinical decision-making in cases of acute LBP. Conclusions: Our survey indicates that physiotherapists frequently use patient-reported measurement instruments in cases of acute LBP, but mostly for non-prognostic reasons. Moreover, physiotherapists seem to feel that current instruments have limited added value for clinical decision-making. Possibly, a new measurement instrument (e.g., screening tool) needs to be developed that does fit the physiotherapist's needs and preferences. Our findings also suggest that physiotherapist may need to be more critical about which measurement instrument they use and for which purpose.

Validation of the German version of the STarT-MSK-Tool: A cohort study with patients from physiotherapy clinics

“…The knowledge of the measurement properties of the STarT-MSK G strengthens its use for this purpose. Since practitioners have mixed ideas about how to best make use of prognostic tools [66,67], strategies on how to best implement them should be further developed and detailed studies to describe the added value should be conducted [6].…”

“…Typically, the majority of patients with these conditions are managed by general practitioners and physiotherapists [5]. Patient-reported measurement instruments are used by these clinicians to a varying degree, but there is a need for generic prognostic tools and risk stratification methods that are usable across a variety of body sites to facilitate targeted treatment decision-making [6,7]. A back-specific instrument, specifically designed to establish the prognosis of patients in primary care is the Keele STarT-Back-Tool (Subgrouping for Targeted Treatment).…”

Development and internal validation of a machine learning prediction model for low back pain non-recovery in patients with an acute episode consulting a physiotherapist in primary care

“…New research should therefore strive for better prognostic tools for acute LBP, which could be reached through including currently ignored predictors as well as repeated measurements over time (specifically in the first weeks to take into account the initial change [ 18 , 23 ]). For optimal adoption in daily practice of such a new prognostic tool, it is conditional that it consists of only a limited number of predictors in order to minimize the burden for patients and clinicians, is integrated within an online clinical decision support system and is easy to interpret [ 24 , 25 ]. The recently introduced artificial intelligence (AI)-based machine learning (ML) techniques have been suggested to be very promising and potentially able to result in a breakthrough in LBP (non-)recovery prediction [ 26 , 27 ].…”