N. Hutting1, W. Oswald1,2, J.B. Staal3,4, Y.F. Heerkens1
1HAN University of Applied Sciences, Research Group Occupation & Health, Nijmegen, Netherlands, 2HAN University of Applied Sciences, Physical Therapy, Nijmegen, Netherlands, 3HAN University of Applied Sciences, Key Factors in Physiotherapy and Allied Health Research Group, Nijmegen, Netherlands, 4Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands

Background: Low back pain (LBP) is a major problem across the globe and is the leading cause worldwide of years lost to disability. Self-management is considered an important component the treatment of people with non-specific LBP. However, evidence suggests that the self-management support for people with non-specific LBP provided by physiotherapists can be improved. Moreover, the way exercise therapists (ET) address self-management in practice is unknown.

Purpose: The aim of this study was to investigate the ideas, opinions and methods used by physiotherapists and ET with regard to self-management and providing self-management support to patients with non-specific LBP.

Methods: This study was an inductive qualitative survey. An online questionnaire with open-ended questions was developed. The questionnaire was pre-tested by four therapists. The survey was conducted among physiotherapists and ET working in the Netherlands. Data was analysed using thematic analysis. Data analysis was carried out by the first author, trained and experienced in qualitative research methods. Verification of all the themes in the main categories and the final report was assured by having another author read all the surveys. Data saturation was considered to be reached in cases where no new codes were added during three consecutive surveys. This study fulfils the Consolidated Criteria for Reporting Qualitative Research.

Results: Data saturation occurred after coding 38 questionnaires, and these 38 questionnaires were therefore used in the analysis. The mean age of the respondents was 38.7 (range: 22 to 65 years). Most of the respondents were male (55.3%) and physiotherapists (81.6%). Respondents considered self-management support an important topic in physiotherapy and exercise therapy for people with non-specific LBP. In the self-management support provided by the respondents, providing information and advice were frequently mentioned. The topics included in the support given by the respondents covered a broad range of important factors. The topics frequently focused on biomechanical factors. Therapists mainly provide patient education rather than self-management support. Moreover, important self-management skills are generally not addressed sufficiently. The majority of respondents had a need with regard to self-management or providing self-management support. These needs include having more knowledge, skills and tools aimed at facilitating self-management.

Conclusion(s): Self-management and self-management support are considered important topics in providing therapy for people with non-specific LBP, but the way physiotherapists and ET address this in practice is not optimal and should be improved.

Implications: Incorporating a biopsychosocial orientation in self-management support and paying attention to important general self-management skills would be valuable for physiotherapists and ET. Since evidence demonstrates that musculoskeletal pain disorders are frequently comorbid and share common biopsychosocial risk profiles for pain and disability, self-management should focus on skills that can be generalised. A general training programme for physiotherapists and ET in providing self-management support could be offered for a broad range of musculoskeletal conditions and included in educational programmes. Future research should investigate the effects of individualised self-management support as part of the regular treatment programmes provided by physiotherapists, ET and other healthcare providers.

Funding, acknowledgements: This study was not funded

Keywords: Low Back Pain, Patient-Centred Care, Self-management

Topic: Musculoskeletal: spine

Did this work require ethics approval? No
Institution: n/a
Committee: n/a
Reason: This survey did not fall within the remit of the Medical Research Involving Human Subjects Act in the Netherlands.

All authors, affiliations and abstracts have been published as submitted.

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