DETERMINANTS OF INDIAN PHYSIOTHERAPISTS’ ADHERENCE TO HIGH VALUE INTERVENTIONS IN THE MANAGEMENT OF LOW BACK PAIN: A CROSS SECTIONAL STUDY

S. Shah¹, V Prakash¹

¹Charotar University of Science and Technology (CHARUSAT), Ashok & Rita Patel Institute of Physiotherapy, Anand, Gujarat, India

Background: Evidence suggests physiotherapists around the world often provide costly, ineffective, unnecessary, even harmful care for managing low back pain (LBP) despite multiple guidelines recommending best practices.

Purpose: To investigate the relationship between physiotherapists’ adherence to evidence recommended interventions and their professional characteristics and practice setting in the management of acute and subacute non-specific low back pain.

Methods: We conducted a cross-sectional survey among Indian Physiotherapists managing musculoskeletal conditions working in academic clinic, hospitals and private clinics. The survey questionnaire collected data on physiotherapists’ demographic characteristics, practice setting related information and perceived barriers and facilitators to implementing evidence in practice. Physiotherapists adherence to evidence recommended interventions in terms of clinical decisions and advice to patients were assessed based on a previously validated clinical vignette. We measured physiotherapists’ attitudes and beliefs about pain using the 19 items Pain Attitudes and Beliefs Scale for Physiotherapists. Data were collected from July to December 2022.

Results: We conducted a cross sectional survey using an online platform (www.qualtrics.com) among Indian physiotherapists. A total of 215 questionnaires were accessed, 52 of which were left blank and 13 of which were incomplete. As a result, 150 physiotherapists were included in the study. The majority of participants were classified as non-adherent to the evidence-recommended interventions and indicated that they would recommend bed rest (79%) and do not recommend exercise as the primary intervention (83%). A positive association was found (medium strength) between the biopsychosocial orientation subscale of the PABS-PT score with clinical decisions total scores (r = 0.33, p < 0.001) suggesting that physiotherapists who consider psychosocial factors to be potential causes of LBP tend to promote activity and use exercise as a primary intervention more often. Clinical decisions regarding delivery of exercise as a primary intervention and advice to avoid bedrest were significantly associated with total barrier scores (p < 0.05) and specific domain scores for professional autonomy and patient expectations (p < 0.05). Clinical decisions to deliver exercise as a primary intervention were associated with previous training in low back pain and education in evidence based practice. There was no significant association of years of experience, highest degree obtained, type of practice and clinical setting with adherence to evidence recommended interventions.

Conclusions: The use of evidence-based interventions is significantly low among Indian physiotherapists. Physiotherapist's adherence with evidence-based interventions is related to their beliefs about low back pain. It is possible that professional education, experience, and clinical settings do not fully explain differences in these belief systems and clinical decisions.

Implications: Result of this study can guide development of a context-specific knowledge translation interventions that address local barriers specific to Indian physiotherapists who routinely manage patients with non-specific low back pain.

Funding acknowledgements: This work was supported by CHARUSAT Seed grant for research (AR1/21), Charotar University of Science and Technology (CHARUSAT), Anand, Gujarat.

Keywords:
Clinical decisions
High‐value care
Low back pain

Topics:
Research methodology, knowledge translation & implementation science
Musculoskeletal: spine
Professional issues

Did this work require ethics approval? Yes

Institution: Charotar University of Science and Technology (CHARUSAT)

Committee: Institutional Ethics Committee-CHARUSAT

Ethics number: CHA/IEC/ADM/21/07/723