Karstens S1,2, Saunders B3, Schneider S4, Joos S2
1Trier University of applied Science, Department of Computer Science; Therapeutic Sciences, Trier, Germany, 2University of Tuebingen, Department of General Practice, Tuebingen, Germany, 3Keele University, Institute of Primary Care and Health Sciences, Keele, Stoke-on-Trent, United Kingdom, 4German Sport University Cologne, M.Sc. Sport Physiotherapy, Cologne, Germany
Background: Integration of physical and psychological approaches in physiotherapy, aiming to reduce modifiable obstacles to recovery such as unhelpful beliefs and illness behaviours, has become accepted internationally as a treatment approach for patients with low back pain (LBP). An evidence-based approach that has been implemented in several countries is the STarT-Back (Subgrouping for Targeted Treatment) stratified care approach. This involves subgrouping patients based on their prognostic risk of persistent disabling pain using the STarT Back self-report tool. Each of the three subgroups: low-, medium- and high-risk is matched to appropriate early treatment options. Patients in the high-risk group receive 'psychologically informed physiotherapy'. At present, such an approach is not implemented in the German healthcare system.
Purpose: To explore the perceptions of German patients with LBP towards the STarT-Back approach, focusing in particular on perceived barriers and facilitators to the use of 'psychologically informed physiotherapy' for patients at high-risk.
Methods: Semi-structured interviews were carried out with 12 patients with LBP recruited from physiotherapy clinics (median age-category 50-59 y, 50% female). At the beginning of each interview, the STarT-Back approach and its evidence base were presented; following which, patients' views about the approach were explored. Interviews were audio-recorded, transcribed and coded, leading to the development of higher-order themes, in line with a Grounded Theory approach.
Results: Trust was developed as key theme from the data. Subthemes were confidentiality, the patient-therapist relationship and the qualification of the therapist. When discussing psychological topics, confidentiality was highlighted as being a salient issue. Some patients were unsure about whether conversations within the consultation would be kept between themselves and the physiotherapist. In contrast, other patients reported positive views about discussing psychological topics with their physiotherapist. Patients reported feeling more comfortable discussing such issues if the treating physiotherapist had undergone specific training in the management of psychological factors. A positive therapist-patient relationship was also highlighted as an important factor in building trust; the stronger the therapeutic alliance, the more comfortable patients reported they would feel disclosing psychological concerns. Some patients described feeling more open to discussing psychological topics with a physiotherapist than with a psychologist, due to concerns that a psychologist might over interpret information.
Conclusion(s): Patients can feel hesitant discussing psychological concerns in clinical consultations. However, our findings suggest that some patients may feel more comfortable discussing these issues with a physiotherapist than with clinicians from other disciplines, such as psychologists. This is in part due to the positive relationships patients reported having with the physiotherapists, which may be a facilitator for the adoption of a psychologically informed therapy approach in clinical practice. A further facilitator may be making patients aware that the physiotherapist is specifically trained in dealing with psychological issues, so as to establish trust in their expertise. However, a lack of trust concerning confidentiality could be a possible barrier.
Implications: The findings suggest that implementation of the psychologically informed physiotherapy approach in Germany is acceptable to patients, if the identified barriers are addressed.
Keywords: Implementation research, psychologically informed physiotherapy, patient perceptions
Funding acknowledgements: The study was unfunded
Purpose: To explore the perceptions of German patients with LBP towards the STarT-Back approach, focusing in particular on perceived barriers and facilitators to the use of 'psychologically informed physiotherapy' for patients at high-risk.
Methods: Semi-structured interviews were carried out with 12 patients with LBP recruited from physiotherapy clinics (median age-category 50-59 y, 50% female). At the beginning of each interview, the STarT-Back approach and its evidence base were presented; following which, patients' views about the approach were explored. Interviews were audio-recorded, transcribed and coded, leading to the development of higher-order themes, in line with a Grounded Theory approach.
Results: Trust was developed as key theme from the data. Subthemes were confidentiality, the patient-therapist relationship and the qualification of the therapist. When discussing psychological topics, confidentiality was highlighted as being a salient issue. Some patients were unsure about whether conversations within the consultation would be kept between themselves and the physiotherapist. In contrast, other patients reported positive views about discussing psychological topics with their physiotherapist. Patients reported feeling more comfortable discussing such issues if the treating physiotherapist had undergone specific training in the management of psychological factors. A positive therapist-patient relationship was also highlighted as an important factor in building trust; the stronger the therapeutic alliance, the more comfortable patients reported they would feel disclosing psychological concerns. Some patients described feeling more open to discussing psychological topics with a physiotherapist than with a psychologist, due to concerns that a psychologist might over interpret information.
Conclusion(s): Patients can feel hesitant discussing psychological concerns in clinical consultations. However, our findings suggest that some patients may feel more comfortable discussing these issues with a physiotherapist than with clinicians from other disciplines, such as psychologists. This is in part due to the positive relationships patients reported having with the physiotherapists, which may be a facilitator for the adoption of a psychologically informed therapy approach in clinical practice. A further facilitator may be making patients aware that the physiotherapist is specifically trained in dealing with psychological issues, so as to establish trust in their expertise. However, a lack of trust concerning confidentiality could be a possible barrier.
Implications: The findings suggest that implementation of the psychologically informed physiotherapy approach in Germany is acceptable to patients, if the identified barriers are addressed.
Keywords: Implementation research, psychologically informed physiotherapy, patient perceptions
Funding acknowledgements: The study was unfunded
Topic: Musculoskeletal: spine; Pain & pain management; Service delivery/emerging roles
Ethics approval required: Yes
Institution: University of Heidelberg
Ethics committee: Ethics Committee
Ethics number: S-414/2013
All authors, affiliations and abstracts have been published as submitted.
