NAVIGATING UNCERTAINTY IN LOW BACK PAIN CARE THROUGH AN ETHIC OF OPENNESS: LEARNINGS FROM A POST-CRITICAL ANALYSIS

N. Costa¹, R. Olson², M. Dillon¹, K. Mescouto¹, P. Butler¹, R. Forbes¹, J. Setchell¹

¹The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia, ²The University of Queensland, School of Social Science, Brisbane, Australia

Background: Uncertainty is inherent to, and ubiquitous in, low back pain (LBP) care. Despite the plethora of research on LBP, there has been little progress in reducing the impact of LBP on individuals and society. Many aspects of LBP are not fully understood, meaning that decisions in LBP care often rely on imperfect data, limited knowledge and unpredictable outcomes that are far from binary. Yet, theoretical and practical guidance on how to navigate uncertainties in LBP care specifically, and healthcare broadly, are scarce.

Purpose: This study draws from Barbara Gibson’s ethic of openness to explore how clinicians navigate uncertainty when working with people presenting with LBP and provide guidance on avenues for navigating uncertainty in LBP care.

Methods: We conducted 22 online one-on-one interviews with physiotherapists and other healthcare professionals who had experience working who present with LBP. During interviews, participants were asked to describe scenarios in which they navigated uncertainty with people who experienced LBP, the challenges they face when trying to navigate uncertainty in this context and what they thought helped them to do so. A subset of the interview data was analysed in two team analysis meetings, drawing from post-critical theory. NC, JS and RO then further explored the data with the concept of the ethic of openness in mind. The final step of (re)writing the results included all authors’ input.

Results: Our analysis suggests that clinicians draw from different philosophical commitments when providing care for individuals with LBP, with some of them implying a (post)positivist approach with pre-determined endpoints and others a post-critical approach, with no fixed endpoints and consideration of multiple options and perspectives. Based on our analysis, an ethic of openness (a position of uncertainty) may help to surface these philosophical commitments, creating space for possibilities other than denying uncertainty and oversimplifying (evidence-based) practice.

Conclusions: We argue that an ethic of openness may assist clinicians to navigate uncertainty in fruitful ways – embracing uncertainty, engaging in reflexivity and creativity, moving clinicians to directions that are likely to best meet the needs of patients.

Implications: Physiotherapists and other healthcare professionals who work with people who experience LBP may benefit from surfacing their philosophical commitments and challenging assumptions.

Funding acknowledgements: NC is supported by University of Queensland's Stimulus Fellowship and JS by the National Health and Medical Research of Australia.

Keywords:
Low back pain
Post-qualitative research
Ethic of opennes

Topics:
Musculoskeletal: spine
Professional practice: other
Pain & pain management

Did this work require ethics approval? Yes

Institution: The University of Queensland

Committee: University of Queensland's Human Ethics Research Committee

Ethics number: 2021/HE001723