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Osborn-Jenkins L1, Roberts L2
1University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, 2University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Background: Back pain 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 their normal activity. Little is known however, about the content of the advice that physiotherapists give or how it is delivered in clinical practice.
Purpose: The purpose of this project was to identify and categorise the advice given by physiotherapists to patients with back pain at their initial consultation in a primary care service.
Methods: This cross-sectional, observational study took place in a physiotherapy department in a city hospital in Southern England. Patients were referred to the outpatient service by their doctor and allocated an individual (45-minute) consultation with a clinician, with follow-up (30-minute) appointments as necessary. Twenty-five, initial clinical back pain encounters, involving 9 physiotherapists, were observed, audio-recorded, transcribed verbatim and thematically analysed using a Framework approach to identify the content of advice given.
Results: The mean duration of consultation was 38 minutes 59 seconds (range 26:21-53:16) and the total data set comprised 975 minutes. Advice was given in 88% (n=22/25) of consultations and 96% included additional exercise instruction.
The key topics of advice given were: activity promotion; advice about changing posture; practical advice regarding ways to sit; pain-management advice including medication and the use of heat; and healthy lifestyle advice. Gaps were identified in the specificity of advice given, especially relating to the frequency of recommended tasks and activities.
Cognitive reassurance was evident, focussing on active lifestyle changes and getting people confident to 'keep active' and 'move your back' despite pain. Beyond positive affirmations and discussion around patients' own identified management strategies, there was evidence that advice was used to encourage, reassure and enhance engagement. Additional explanations were given that included education about anatomical structures, biomechanics, pain science and healing timescales. Examples of both helpful, contradictory and unhelpful messages around advice given were evident in this dataset.
Conclusion(s): Physiotherapists use multi-faceted patient-centred, problem-solving approaches to encourage people with back pain to self-manage their pain levels and activities. Despite its importance in enabling people to self-manage their back pain, little is known about the advice offered by clinicians.
This is the first study to identify and categorise verbal advice given to patients with back pain in a physiotherapy setting and while there is evidence of helpful, practical recommendations for self-help and lifestyle changes, some of the content lacks specificity and at worse, is contradictory or unhelpful.
Implications: This novel, observational study identifies the topics of advice given by physiotherapists in back pain consultations and recognises the need for guidance to be patient-centred and specific. It also highlights the different strategies therapists use to enhance engagement and identifies examples of good practice. Further research is required to identify the most effective way to communicate advice to patients.
Keywords: Back pain, Advice, Reassurance
Funding acknowledgements: Lisa Roberts (NIHR Senior Clinical Lectureship) collected data (Arthritis Research UK academic fellowship [17830]). Secondary analysis was an unfunded project.
Purpose: The purpose of this project was to identify and categorise the advice given by physiotherapists to patients with back pain at their initial consultation in a primary care service.
Methods: This cross-sectional, observational study took place in a physiotherapy department in a city hospital in Southern England. Patients were referred to the outpatient service by their doctor and allocated an individual (45-minute) consultation with a clinician, with follow-up (30-minute) appointments as necessary. Twenty-five, initial clinical back pain encounters, involving 9 physiotherapists, were observed, audio-recorded, transcribed verbatim and thematically analysed using a Framework approach to identify the content of advice given.
Results: The mean duration of consultation was 38 minutes 59 seconds (range 26:21-53:16) and the total data set comprised 975 minutes. Advice was given in 88% (n=22/25) of consultations and 96% included additional exercise instruction.
The key topics of advice given were: activity promotion; advice about changing posture; practical advice regarding ways to sit; pain-management advice including medication and the use of heat; and healthy lifestyle advice. Gaps were identified in the specificity of advice given, especially relating to the frequency of recommended tasks and activities.
Cognitive reassurance was evident, focussing on active lifestyle changes and getting people confident to 'keep active' and 'move your back' despite pain. Beyond positive affirmations and discussion around patients' own identified management strategies, there was evidence that advice was used to encourage, reassure and enhance engagement. Additional explanations were given that included education about anatomical structures, biomechanics, pain science and healing timescales. Examples of both helpful, contradictory and unhelpful messages around advice given were evident in this dataset.
Conclusion(s): Physiotherapists use multi-faceted patient-centred, problem-solving approaches to encourage people with back pain to self-manage their pain levels and activities. Despite its importance in enabling people to self-manage their back pain, little is known about the advice offered by clinicians.
This is the first study to identify and categorise verbal advice given to patients with back pain in a physiotherapy setting and while there is evidence of helpful, practical recommendations for self-help and lifestyle changes, some of the content lacks specificity and at worse, is contradictory or unhelpful.
Implications: This novel, observational study identifies the topics of advice given by physiotherapists in back pain consultations and recognises the need for guidance to be patient-centred and specific. It also highlights the different strategies therapists use to enhance engagement and identifies examples of good practice. Further research is required to identify the most effective way to communicate advice to patients.
Keywords: Back pain, Advice, Reassurance
Funding acknowledgements: Lisa Roberts (NIHR Senior Clinical Lectureship) collected data (Arthritis Research UK academic fellowship [17830]). Secondary analysis was an unfunded project.
Topic: Musculoskeletal: spine; Musculoskeletal; Pain & pain management
Ethics approval required: Yes
Institution: University of Southampton
Ethics committee: Southampton and South West Hampshire Local Research Ethics Committee
Ethics number: 08/H0502/15
All authors, affiliations and abstracts have been published as submitted.
