ARE WE DOING ENOUGH TO EDUCATE PATIENTS DURING HOME BASED THERAPEUTIC EXERCISES IN LOW BACK PAIN? - A QUALITATIVE STUDY

Z. Azeem¹, M. Jamkar², T. Palekar³

¹Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Kinesiotherapy & Movement Sciences, Pune, India, ²Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, India, ³Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Orthopedics, Pune, India

Background: Exercise adherence poses a challenge amongst Physiotherapists managing low back pain patients. Home based exercises are generally handwritten, published materials or verbal prescription, used by therapists to ensure reasonable adherence. However, it remains debatable if these methods improve adherence or not. In addition, the patient's perspectives on the suitability of exercises and the therapist's exercise prescription is a potential concern to bridge the gap between practice, research and achievement of desirable health outcomes.

Purpose: The purpose of our study was to build a consensus of patient’s expectations and Physiotherapists’ practice of prescribing home based exercises for patients with low back pain.

Methods: We conducted semi-structured interviews on 30 patients who took Physiotherapy consultation with a minimum follow-up of 2 weeks at discharge. Similarly, semi-structured interviews of 20 Clinical Physiotherapists with a maximum of 5 years of clinical practice were interviewed to understand their views and practice of prescribing home based exercises. As pre-interview preparation of the interviewees, 5 model sessions were conducted by the investigators by using an interview guide. Data saturation was obtained once ceiling effect was achieved during data synthesis. This was tailed with thematic analysis to identify categories and themes.

Results: All interviews were conducted as in-person mode and transcribed using audio-text transcription software (www.happyscribe.com). Interviews were coded followed thematic identification and finalization based on consensus driven by the investigators and experts in the field of Physiotherapy. Patient’s perspectives were based driven by responses like “what are their expectations with a home exercise plan.” Patients reported that home based exercises were difficult to remember given the nature, complexity and volume of exercises. The need to design “functional” exercises" was the priority as it would help in their ability to return to work. In contrast, Physiotherapists reported patient education as an important element of the post-discharge plan. However, these plans have not considered the functional aspect of the activity profile of the patients and emphasised on the prognostic factors of low back pain like ergonomic advice. There is disparity between patients’ expectations and Physiotherapists’ delivery of patient education while managing low back pain. Patient centeredness is one of the successful strategies for home based exercise plans. However, we found major practice gaps in this area. We believe that Physiotherapists are advantageously positioned to address the expectations of patients and provide a “patient-centric-therapist driven” education but this needs articulated attention in curriculum design at entry level Physiotherapy education.

Conclusions:“Patient participation” is a fulcrum for improving health outcomes in Physiotherapy. However, there are disparities in the way this concept is applied while designing home based exercises. We conclude that the gap between patient’s expectations on desirable outcomes and Physiotherapist’s process of delivering patient education needs attention.

Implications: For a better outcome on exercise adherence, patient education as an integral part of a rehabilitation program should be designed considering the expectations of the patient, encouraging education of causes, providing materials for retention of exercises and improving patient-doctor relationship in terms of better prognosis.

Funding acknowledgements: The study was self funded

Keywords:
Patient centredness
Curriculum design
Exercise adherance

Topics:
Education: continuing professional development
Education: clinical
Education: continuing professional development

Did this work require ethics approval? Yes

Institution: Dr. D.Y. Patil College of Physiotherapy, Pune

Committee: Institutional Sub-ethics Committee, Dr. D.Y. Patil College of Physiotherapy, Pune

Ethics number: DYPCPT/ISEC/35/2022