L. Osborn-Jenkins1,2, L. Roberts2, M. Al-Abbadey3,4, H. MacPherson5, B. Stuart6, D. Carnes7, C. Fawkes7, L. Yardley3,8, K. Bradbury3, F. Bishop3
1University Hospital Southampton NHS Foundation Trust, Musculoskeletal Physiotherapy Department, Southampton, United Kingdom, 2University of Southampton, Health Sciences, Southampton, United Kingdom, 3University of Southampton, Department of Psychology, Southampton, United Kingdom, 4University of Portsmouth, Department of Psychology, Portsmouth, United Kingdom, 5University of York, Health Sciences, York, United Kingdom, 6University of Southampton, Primary Care and Population Sciences, Southampton, United Kingdom, 7Queen Mary University of London, Blizard Institute, London, United Kingdom, 8University of Bristol, School of Psychological Science, Bristol, United Kingdom
Background: Low back pain (LBP) is a leading cause of disability worldwide. Best practice guidelines for managing back pain endorse advice-giving to enable people to self-manage and continue with normal activity. Little is known however, about the content of the advice, nor how it is delivered in practice in different healthcare sectors and by different professions.
Purpose: The aim of this study was to describe the advice offered to patients with back pain by physiotherapists, osteopaths and acupuncturists in the UK and explore whether the type of advice offered was associated with: profession; practitioner beliefs and attitudes about treating LBP; and patient characteristics.
Methods: A secondary analysis of data collected as part of a major longitudinal questionnaire-based research project titled Mechanisms in Orthodox and Complementary Alternative Medicine Management of Back Pain (MOCAM study), investigating contextual effects on treatment outcomes.
This prospective questionnaire-based cohort study used self-reported data, completed by practitioners and patients after the first consultation, during treatment (2 weeks post-baseline), and 3 months post-baseline.
Practitioners recorded any advice they offered on: diet, specific exercise, physical activity levels and rest. In addition, free-text was used to record all other advice offered. Meanwhile, patients were asked to report any advice they received and whether they adhered to it.
The free-text data were inductively categorised ensuring multi-professional agreement of advice terms used. All data were analysed using SPSS (version 26) and descriptive statistics were used to define the frequency of categories of advice reported, split by profession group and healthcare sector.
This prospective questionnaire-based cohort study used self-reported data, completed by practitioners and patients after the first consultation, during treatment (2 weeks post-baseline), and 3 months post-baseline.
Practitioners recorded any advice they offered on: diet, specific exercise, physical activity levels and rest. In addition, free-text was used to record all other advice offered. Meanwhile, patients were asked to report any advice they received and whether they adhered to it.
The free-text data were inductively categorised ensuring multi-professional agreement of advice terms used. All data were analysed using SPSS (version 26) and descriptive statistics were used to define the frequency of categories of advice reported, split by profession group and healthcare sector.
Results: A total of 157 practitioners (60 physiotherapists; 44 osteopaths; and 53 acupuncturists) recruited 960 patients with back pain and the data completion rate was 96.5%.
A wide variety of advice was offered to patients by all three professions but specific exercises (57.6%) and encouragement to increase activity (30.2%) were most frequently given. Messages to reduce activity (20.3%) or avoid movements (7.3%) was given to more than a quarter of all patients. Well-being advice was infrequently offered (3.2%), as was diet advice (4.4%), and advice about work was rare (1.1%).
Physiotherapists, osteopaths and acupuncturists showed different preferences for advice content, with more physiotherapists suggesting specific exercises (100%), activity promotion (78.3%), posture advice (33.3%) and pain education (25%), compared with osteopaths and acupuncturists. Osteopaths showed the highest preference for pain relief advice (38.6%) and rest (50%) whereas more acupuncturist advised on well-being (18.9%) and diet (26.45). There were discrepancies between the accounts of practitioners on the advice offered and patients’ perceptions of what they received.
A wide variety of advice was offered to patients by all three professions but specific exercises (57.6%) and encouragement to increase activity (30.2%) were most frequently given. Messages to reduce activity (20.3%) or avoid movements (7.3%) was given to more than a quarter of all patients. Well-being advice was infrequently offered (3.2%), as was diet advice (4.4%), and advice about work was rare (1.1%).
Physiotherapists, osteopaths and acupuncturists showed different preferences for advice content, with more physiotherapists suggesting specific exercises (100%), activity promotion (78.3%), posture advice (33.3%) and pain education (25%), compared with osteopaths and acupuncturists. Osteopaths showed the highest preference for pain relief advice (38.6%) and rest (50%) whereas more acupuncturist advised on well-being (18.9%) and diet (26.45). There were discrepancies between the accounts of practitioners on the advice offered and patients’ perceptions of what they received.
Conclusion(s): This study shows a lack of health promotion and well-being advice in the care of people with back pain. Further work is needed to identify patients’ preferences for receiving advice and to identify how clinicians can optimise advice-giving skills.
Implications: This novel study is the first to describe the different advice-giving practices of physiotherapists, osteopaths and acupuncturists in treating people with low back pain. The lack of health promotion and activity promotion among all practitioners must be addressed in clinical practice, to better meet the needs of people with back pain.
Funding, acknowledgements: Primary research: Arthritis Research UK Special Strategic Award.
Secondary analysis: as part of a HEE/NIHR Pre Doctoral Clinical Academic Fellowship
Secondary analysis: as part of a HEE/NIHR Pre Doctoral Clinical Academic Fellowship
Keywords: Back pain, Advice, Self-management
Topic: Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: University of Southampton (ref 19323)
Committee: NHS Health Research Authority East Midlands—Derby Research Ethics Committee
Ethics number: ref 14/EM/1113
All authors, affiliations and abstracts have been published as submitted.
