Abstract
BackgroundThis study aims to explore (i) physiotherapists’ current use in daily practice of patient-reported measurement instruments (screening tools and questionnaires) for patients with acute low back pain (LBP), (ii) the underlying reasons for using these instruments, (iii) their perceived influence on clinical decision-making, and (iv) the association with physiotherapist characteristics (gender, physiotherapy experience, LBP experience, overall e-health affinity).MethodsSurvey study among Dutch physiotherapists in a primary care setting. A sample of 650 physiotherapists recruited from LBP-related and regional primary care networks received the survey between November 2018 and January 2019, of which 85 (13%) completed it.ResultsNearly all responding physiotherapists (98%) reported using screening tools or other measurement instruments in cases of acute LBP; the Quebec Back Pain Disability Scale (64%) and the STarT Back Screening Tool (61%) are used most frequently. These instruments are primarily used to evaluate treatment effect (53%) or assess symptoms (51%); only 35% of the respondents mentioned a prognostic purpose. Almost three-quarters (72%) reported that the instrument only minimally impacted their clinical decision-making in cases of acute LBP.ConclusionsOur survey indicates that physiotherapists frequently use patient-reported measurement instruments in cases of acute LBP, but mostly for non-prognostic reasons. Moreover, physiotherapists seem to feel that current instruments have limited added value for clinical decision-making. Possibly, a new measurement instrument (e.g., screening tool) needs to be developed that does fit the physiotherapist’s needs and preferences. Our findings also suggest that physiotherapist may need to be more critical about which measurement instrument they use and for which purpose.
Highlights
This study aims to explore (i) physiotherapists’ current use in daily practice of patient-reported measurement instruments for patients with acute low back pain (LBP), (ii) the underlying reasons for using these instruments, (iii) their perceived influence on clinical decision-making, and (iv) the association with physiotherapist characteristics
A sample of around 650 physiotherapists from LBPrelated and regional networks in primary care and located throughout the Netherlands received the survey between November 2018 and January 2019
Male gender was the only physiotherapist characteristic for which we found an association with using a larger number of instruments for acute LBP, but this findings needs to be interpreted with caution due to the explorative character of this analysis
Summary
This study aims to explore (i) physiotherapists’ current use in daily practice of patient-reported measurement instruments (screening tools and questionnaires) for patients with acute low back pain (LBP), (ii) the underlying reasons for using these instruments, (iii) their perceived influence on clinical decision-making, and (iv) the association with physiotherapist characteristics (gender, physiotherapy experience, LBP experience, overall ehealth affinity). Patients with an expected favourable course of LBP should be reassured and given only minimal care at most [13, 14], thereby avoiding unnecessary care and its associated costs [15]. For patients with an expected unfavourable course of LBP, physiotherapists are recommended to provide treatment (primarily patient education and exercise therapy) or to refer patients to specialised professionals and/ or multidisciplinary care [13]. Targeted treatment of at-risk patients might prevent chronification of the complaints while reducing costs of care and lifelong suffering. Such a stratification of care has been found to improve the overall effectiveness of LBP treatment in a cost-effective manner [16]
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