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Supp G1, Schoch W1, Baumstark MW2,3, May S4
1PULZ im Rieselfeld, Freiburg, Germany, 2University of Freiburg, Institute for Exercise- und Occupational Medicine, Medical Center, Freiburg, Germany, 3University of Freiburg, Faculty of Medicine, Freiburg, Germany, 4Sheffield Hallam University, Sheffield, United Kingdom
Background: When physiotherapists prescribe exercises or provide education they may assume that this information is reaching the addressee, but we don´t know how successful physiotherapists are at getting this information across to patients.
Purpose: The aim of this study is to determine if the information physiotherapists think they provide is what patients treated due to low back pain actually hear and take away from the clinical encounter. Secondary aims are to determine which factors may influence the delivery of this information and to assess how relevant this information is rated by the patients.
Methods: The first component of the study used a questionnaire completed by the patient after the initial visit. Patients documented which exercises / information they had received and rated how relevant the advice was on a Likert scale. Therapists documented which instructions they gave to the patients and how successful they rated their delivery. The questionnaires were then compared and checked for differences. The second component of the study involved semi-structured interviews to evaluate the possible reasons for any discrepancies in communication.
Results: In total 90 pairs of questionnaires were completed. All patients were able to accurately document the first exercise / education provided. Of these patients 98 % rated this particular intervention as 'very relevant' or 'relevant'. When a second exercise / education was given 92 % of patients remembered this intervention and 97 % rated this particular intervention as 'very relevant' or 'relevant'. 67% remembered a possible third intervention and again 97 % rated this as 'very relevant' or 'relevant'. The analysis of 14 interviews eventuatetd in four themes which may have contributed to the successful results: 1) Type of assessment, 2) Exercises, 3) Worries about back pain, 4) Expectations.
Conclusion(s): In summary, patients understood what therapists thought to have told them and regarded the provided information as relevant. According to this study, patients seem to hear what therapists say if: 1) they are actively involved in the diagnostic process, 2) exercises are simple, suitable for daily use and effective, 3) patients´ concerns are addressed, 4) patients´ expectations are established.
Implications: This study offers implications for both clinical practice and for future research. Clinicians should be encouraged to actively involve patients in the initial evaluation to ensure the full potential of physical therapy is achieved.
Providing simple exercises that are applicable to patient´s daily lives may enhance the effective delivery of treatment strategies.
Clinicians should be aware of the influence of the total number of instructed exercises or the quantity of education provided on their successful delivery. According to the clinical situation it may be reasonable to limit both exercise prescription and education provided to insure patients successfully retain this information. Up to three exercises and educational points may be justified as still more than two third of patients were able to demonstrate good retention.
In further research the application of Shared Decision Making (SDM) to the diagnostic process should be evaluated to explore the full potential of SDM in musculoskeletal care.
Keywords: communication, low back pain, shared decision making
Funding acknowledgements: none
Purpose: The aim of this study is to determine if the information physiotherapists think they provide is what patients treated due to low back pain actually hear and take away from the clinical encounter. Secondary aims are to determine which factors may influence the delivery of this information and to assess how relevant this information is rated by the patients.
Methods: The first component of the study used a questionnaire completed by the patient after the initial visit. Patients documented which exercises / information they had received and rated how relevant the advice was on a Likert scale. Therapists documented which instructions they gave to the patients and how successful they rated their delivery. The questionnaires were then compared and checked for differences. The second component of the study involved semi-structured interviews to evaluate the possible reasons for any discrepancies in communication.
Results: In total 90 pairs of questionnaires were completed. All patients were able to accurately document the first exercise / education provided. Of these patients 98 % rated this particular intervention as 'very relevant' or 'relevant'. When a second exercise / education was given 92 % of patients remembered this intervention and 97 % rated this particular intervention as 'very relevant' or 'relevant'. 67% remembered a possible third intervention and again 97 % rated this as 'very relevant' or 'relevant'. The analysis of 14 interviews eventuatetd in four themes which may have contributed to the successful results: 1) Type of assessment, 2) Exercises, 3) Worries about back pain, 4) Expectations.
Conclusion(s): In summary, patients understood what therapists thought to have told them and regarded the provided information as relevant. According to this study, patients seem to hear what therapists say if: 1) they are actively involved in the diagnostic process, 2) exercises are simple, suitable for daily use and effective, 3) patients´ concerns are addressed, 4) patients´ expectations are established.
Implications: This study offers implications for both clinical practice and for future research. Clinicians should be encouraged to actively involve patients in the initial evaluation to ensure the full potential of physical therapy is achieved.
Providing simple exercises that are applicable to patient´s daily lives may enhance the effective delivery of treatment strategies.
Clinicians should be aware of the influence of the total number of instructed exercises or the quantity of education provided on their successful delivery. According to the clinical situation it may be reasonable to limit both exercise prescription and education provided to insure patients successfully retain this information. Up to three exercises and educational points may be justified as still more than two third of patients were able to demonstrate good retention.
In further research the application of Shared Decision Making (SDM) to the diagnostic process should be evaluated to explore the full potential of SDM in musculoskeletal care.
Keywords: communication, low back pain, shared decision making
Funding acknowledgements: none
Topic: Musculoskeletal
Ethics approval required: Yes
Institution: Physio Deutschland
Ethics committee: Ethikkommission an der Physio-Akademie des Deutschen Verbands für Physiotherapie
Ethics number: 2013-10
All authors, affiliations and abstracts have been published as submitted.
