M.-O. Dubé1,2, P. Langevin1,2,3, H. Massé-Alarie1,2, J.-F. Esculier4,5, J.-S. Roy1,2
1Université Laval, Québec, Canada, 2Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada, 3Physio Interactive, Québec, Canada, 4University of British Columbia, Vancouver, Canada, 5The Running Clinic, Quebec, Canada
Background: Clinical practice guidelines (CPGs) provide clinicians with recommendations for optimal patient management. In the field of musculoskeletal disorders (MSKDs), physiotherapists tend to follow those guidelines very unevenly. One possible factor explaining this lack of adherence to CPGs is the discordance between interventions that patients value and what guidelines recommend. Those two represent fundamental aspects of evidence-based practice which is defined as “the integration of best research evidence with clinical expertise and patient values and preferences”. The identification and consideration of patients’ preferences is all the more important as patients’ expectations have been shown to predict treatment outcome. This potential disparity between CPGs recommendations and patients’ preferences could be problematic for the care of MSKDs and make it hard on physiotherapists to formulate an optimal treatment plan.
Purpose: The objectives of this study were 1) to assess patient preferences on the optimal rehabilitation interventions to manage their MSKD (non-traumatic neck, shoulder, low back or knee pain) and, 2) to establish the correspondence rate between patients’ preferences and CPGs recommendations.
Methods: Participants from all over Canada awaiting an initial physiotherapy assessment for a MSKD (non-traumatic neck, shoulder, low back or knee pain) were recruited through multiple private practice physiotherapy clinics. Eligible participants filled out a web-based survey (REDCap) on sociodemographic factors, preferences and expectations towards various interventions for optimal management of their MSKD, estimated cost of care and expected number of follow-up sessions. Descriptive statistics were extracted for each question. Patients’ preferences were compared to appropriate clinical guidelines to assess their concordance level.
Results: 97 participants (63 women and 34 men; mean age: 50.3 ± 16.6) with an average pain level of 4.7 ± 2.2 (median duration: 13 weeks; IQR: 101 weeks) answered the survey. 80% of responders believed that their MSKD would require 5 follow-up physiotherapy sessions or less and 58% of responders indicated that their level of involvement in their MSKD management would be equal to or less than that of the physiotherapist. The 3 interventions with the highest respondent preference were
1) mobilizations,
2) exercises,
3) education,
and the 3 with the lowest preference were
1) cryotherapy,
2) heat,
3) dry needling.
68% of respondents indicated that they expected to receive exercises while 65% expected to receive education about their MSKD.
1) mobilizations,
2) exercises,
3) education,
and the 3 with the lowest preference were
1) cryotherapy,
2) heat,
3) dry needling.
68% of respondents indicated that they expected to receive exercises while 65% expected to receive education about their MSKD.
Conclusions: Although the two most frequently recommended interventions from CPGs, education and exercises, were two of the most popular interventions in our survey, less than 70% of participants expected to receive these interventions. The majority of respondents indicated that their involvement should be equal to or less than that of the physiotherapist, which is partly in contradiction with the CPGs, which suggest active management (self-management).
Implications: Physiotherapists must continue to raise awareness among the public so that education and exercises are universally recognized as the cornerstone of MSKDs management. Clinicians should also be aware that patients like to receive mobilizations so they could consider including them in their interventions, without forgetting active management.
Funding acknowledgements: The authors reported there is no funding associated with the work featured in this abstract.
Keywords:
Patients’ expectations
Musculoskeletal disorders
Primary care
Patients’ expectations
Musculoskeletal disorders
Primary care
Topics:
Musculoskeletal
Primary health care
Musculoskeletal
Primary health care
Did this work require ethics approval? Yes
Institution: CIUSS-CN
Committee: Sectorial Rehabilitation and Social Integration Research Ethics Committee of the CIUSSS-CN
Ethics number: 2021-2155
All authors, affiliations and abstracts have been published as submitted.
