Abstract
ABSTRACT Objectives: Many barriers exist to delivering high-value care for people with low back pain (LBP). We have developed a multistrategy implementation system to overcome these barriers. Here we describe a qualitative evaluation of the experiences of private-sector physiotherapists implementing the system. Design: PRISM (Practice-based innovation and implementation system) is an iterative clinician-as-scientist implementation program, tailored here for acute and subacute LBP. PRISM integrates strategies from behavioral change, implementation, and educational science fields. Semistructured interviews, group discussion forums, and electronic questionnaires were used to collect data at multiple time points that were then analyzed using an interpretative descriptive approach. Participants: Six physiotherapists (purposive sample) practicing in private practice physiotherapy clinics in the Adelaide region, South Australia, were enrolled in the study. Interventions: Interventions included an educational pain science and care workshop incorporating self-regulated learning principles, a co-planned clinical pathway, an electronic decision support tool, development and support of a community of practice, case study simulations, audit and feedback, and collaborative problem solving and innovation for physiotherapists. Results: Participants’ experiences and perceptions centered around five themes: (1) knowledge and skills training; (2) networking and mentoring; (3) a clear clinical pathway; (4) practical tools; and (5) data feedback. Participants appraised the implementation process positively but identified patient receptiveness as a challenge at times. Suggestions for improvement included streamlining/automating data collection forms and processes and providing more simulation opportunities. Conclusions: PRISM appears to be a promising approach to overcoming several barriers that prevent people with back pain from receiving high-value care. It consolidates and increases pain science knowledge and increases physiotherapist confidence in delivering high-value care. It appears to legitimize some current practices, enhance clinical reasoning and communication skills, extend knowledge in line with contemporary pain science, and facilitate the application of a biopsychosocial management approach. The high-level acceptance by participants provides a foundation for further research to test outcomes and delivery in different settings. Contribution of the article A quality improvement intervention designed to improve delivery of high-value care was well received by private practice physiotherapists. Physiotherapists particularly valued using experiential learning to improve fluency in communicating with, and educating patients about, contemporary pain science. A structured clinical pathway and tools guided physiotherapists on the basic elements of necessary care and allowed them to concentrate on higher levels of decision making and communication with patients.
Highlights
Low back pain (LBP) is the leading cause of years lived with disability worldwide.[1]
The key participant in PRISM is a physiotherapist who takes the role of expert coach, providing the patient with high-quality information, reassurance, and pain education and facilitating informed self-management that is centered around graded physical activation according to a biopsychosocial model of pain
We aimed to characterize the experiences of physiotherapists involved in PRISM Back Pain to inform the feasibility of sustainably integrating PRISM within private physiotherapy practice
Summary
Low back pain (LBP) is the leading cause of years lived with disability worldwide.[1] In Australia, LBP is the leading cause of early departure from the workforce[2] and income poverty among older working-aged adults.[3] The National Health. Service in the United Kingdom recognizes LBP as a major contributor to sickness absence,[4] and current costs are unknown, they are almost certainly greater than the annual £10 billion estimated 20 years ago.[5]. LBP is a common yet complex disorder. Psychological, and social factors contribute to poor recovery and prolonged disability.[6,7] LBP has a fluctuating course with often incomplete resolution.[8] High-value care is defined as the best care for the patient, with the optimal result for the circumstances, delivered at the right price.[9]
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