WORDS OF ADVICE: EXPLORING THE ADVICE GIVEN BY PHYSIOTHERAPISTS TO PATIENTS PRESENTING WITH BACK PAIN

H. Sydenham¹, L. Osborn-Jenkins^1,2, H. Sweeney¹, L. Roberts^1,2

Background: Since 84% of adults are estimated to experience low back pain at some point in their lives, it is imperative to reduce the burden on individuals and society that is associated with this condition.  In back pain guidelines, the recommended first-line of treatment for patients is to remain physically active and self-manage their symptoms.  In international back pain studies, advice was ranked as one of the most-frequently reported interventions used by physiotherapists, but despite its importance, there is little research published about the specific content of advice that clinicians offer during back pain consultations.

Purpose: To identify and categorise the content of advice provided by physiotherapists to patients during back pain consultations.

Methods: This research analysed data from a longitudinal study of 15 patients’ care episodes (involving 15 initial consultations and 38 follow-up appointments) that took place in a physiotherapy outpatient department in a city hospital in Southern England.  Patients were allocated an individual (45-minute) consultation with a physiotherapist, and 30-minute, follow-up treatment appointments as required.  All the clinical encounters were observed by the senior author, audio-recorded and transcribed verbatim.  Following the final appointment, a semi-structured interview took place in the patients’ home to explore their experiences of care, and if they did not complete the care episode, any factors that contributed to this.  The physiotherapists also participated in separate interviews.  Data were analysed thematically using a Framework approach, comprising transcription, familiarisation, coding, developing and applying an analytical framework, charting and interpreting the data.

Results: The content of the advice provided by the physiotherapists was categorised into 5 themes: 1) activity (including exercises to improve flexibility, balance, strength, breathing, posture and antalgic positions); 2) pain relief (non-pharmacological such as heat, and pharmacological); 3) the consultation process; 4) treatment options; and 5) signposting the next steps (beyond physiotherapy), such as providing information about community groups or onward referral.
Eight of the 15 patients did not complete their care episode. The reasons given were: symptom resolution (n=2); other health issues (n=1); their own behaviours and ‘poor organisation’ due to moving house, being busy etc. (n=2); the physical healthcare environment (n=1) – ‘I can’t stand going up there, especially with cubicles and stuff’; guilt following a comment made by another patient (n=1); and unknown (n=1).

Conclusion(s): This study highlighted the complexity of offering advice and empowering patients to self-manage as part of their physiotherapy treatment.  The interviews in patients’ homes revealed rich data underlying their decisions not to complete their care, with some mismatches evident between patients and clinicians.

Implications: Learning to offer advice is a core skill within physiotherapy practice and is essential to master when promoting self-management.   Clinicians need to be aware of the content of advice that they offer (including advice that relates to the patient’s symptoms as well as advice that helps the patient navigate through the care pathway), and invest time in honing their skills in delivering tailored advice, to optimise the patient’s outcome and experience.

Funding, acknowledgements: Versus Arthritis (formerly Arthritis Research UK) funded the fellowship of the senior researcher that enabled data collection (grant number 17830)

Keywords: Back pain, Advice, Self-management

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: University of Southampton

Committee: Faculty of Environmental and Life Sciences Ethics Committee

Ethics number: 56336 and 56341