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Kopkow C1, Bahns C1, Happe L1, Thiel C1
1Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
Background: Low back pain (LBP) is one of the most common musculoskeletal disorders worldwide, causing considerable health impairments for patients and enormous economic burden for health care systems. The National Disease Management Guideline (NVL) "Non-specific LBP" intends to be a practical decision-making aid for both physicians and non-medical professionals in Germany to improve quality of healthcare. Although LBP is the most frequent diagnosis resulting in physical therapy treatment, there is limited information available relating to current physical therapy practice regarding management of patients with LBP and guideline adherence.
Purpose: The objective of this study was to evaluate current physical therapy practice regarding management of patients with LBP.
Methods: The study was a priori registered with the German Clinical Trials Register (protocol number: DRKS00012607). Ethical approval was obtained from the ethics committee of the German association of physiotherapists (ethics committee number: 2017-08).
To evaluate current physical therapy practice of patients with LBP, an online-survey among physical therapist working in Germany based on the recommendations given in the NVL “Non-specific LBP” was performed.
Guideline adherence was evaluated by comparing the survey findings with the recommendations of the NVL, and in addition with recommendations from the clinical practice guidelines for LBP published by the Royal Dutch Society for Physical Therapy (KNGF) for physical therapists.
Exploratory univariate and multivariate regression analyses were performed to examine the data and identify predictors for guideline adherence.
All statistical analyses were performed using R (The R Project for Statistical Computing, Vienna, Austria).
Results: In total, 1377 physical therapists completed the questionnaire (n female/male: 850/527) with an average age of 40.5 years (± 11.4) and a mean clinical experience of 15.8 years (± 10.4). Most therapists received professional education at vocational schools (83%, n=1143).
Guideline adherence for the management of LBP was 38% (n=512) and varied between examination (49%, n=677) and treatment (72%, n=972). Although 1334 (97%) participants reported to perform a clinical examination at first contact, screening of recommended red flags was performed by only 22% (n=256). In accordance with the NVL, most respondents applied active therapy in the management of LBP, e.g. strength training (acute: 53%, n=726/chronic: 82%, n=1109). However, massage (acute: 46%, n=628/chronic: 45%, n=615) and Kinesio Taping (acute: 29%, n=393/chronic: 31%, n=417) were frequently used despite being not recommended.
The only predictor for guideline adherence, which could be identified, was the independent variable "educational level". Guideline adherence of physical therapists with an academic background was significantly higher as without (p 0.05).
Conclusion(s): The results of this study show deficits in guideline-adherent management of LBP by German physical therapists. To facilitate the transfer of scientific evidence into clinical practice and to optimize quality of health care, the improvement of implementation strategies and the removal of existing barriers in the application of evidence-based practice seem necessary.
Implications: Overuse, underuse and misuse in relation to physical therapy management of LBP in Germany need to be discussed. In addition, future research should identify factors influencing guideline adherence and promote improvements in guideline implementation.
Keywords: Low back pain, Guideline, Germany
Funding acknowledgements: None
Purpose: The objective of this study was to evaluate current physical therapy practice regarding management of patients with LBP.
Methods: The study was a priori registered with the German Clinical Trials Register (protocol number: DRKS00012607). Ethical approval was obtained from the ethics committee of the German association of physiotherapists (ethics committee number: 2017-08).
To evaluate current physical therapy practice of patients with LBP, an online-survey among physical therapist working in Germany based on the recommendations given in the NVL “Non-specific LBP” was performed.
Guideline adherence was evaluated by comparing the survey findings with the recommendations of the NVL, and in addition with recommendations from the clinical practice guidelines for LBP published by the Royal Dutch Society for Physical Therapy (KNGF) for physical therapists.
Exploratory univariate and multivariate regression analyses were performed to examine the data and identify predictors for guideline adherence.
All statistical analyses were performed using R (The R Project for Statistical Computing, Vienna, Austria).
Results: In total, 1377 physical therapists completed the questionnaire (n female/male: 850/527) with an average age of 40.5 years (± 11.4) and a mean clinical experience of 15.8 years (± 10.4). Most therapists received professional education at vocational schools (83%, n=1143).
Guideline adherence for the management of LBP was 38% (n=512) and varied between examination (49%, n=677) and treatment (72%, n=972). Although 1334 (97%) participants reported to perform a clinical examination at first contact, screening of recommended red flags was performed by only 22% (n=256). In accordance with the NVL, most respondents applied active therapy in the management of LBP, e.g. strength training (acute: 53%, n=726/chronic: 82%, n=1109). However, massage (acute: 46%, n=628/chronic: 45%, n=615) and Kinesio Taping (acute: 29%, n=393/chronic: 31%, n=417) were frequently used despite being not recommended.
The only predictor for guideline adherence, which could be identified, was the independent variable "educational level". Guideline adherence of physical therapists with an academic background was significantly higher as without (p 0.05).
Conclusion(s): The results of this study show deficits in guideline-adherent management of LBP by German physical therapists. To facilitate the transfer of scientific evidence into clinical practice and to optimize quality of health care, the improvement of implementation strategies and the removal of existing barriers in the application of evidence-based practice seem necessary.
Implications: Overuse, underuse and misuse in relation to physical therapy management of LBP in Germany need to be discussed. In addition, future research should identify factors influencing guideline adherence and promote improvements in guideline implementation.
Keywords: Low back pain, Guideline, Germany
Funding acknowledgements: None
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: Deutscher Verband fuer Physiotherapie
Ethics committee: Physio-Akademie gGmbH
Ethics number: 2017-08
All authors, affiliations and abstracts have been published as submitted.
