Background & Aims
Clinical practice guidelines (CPGs) have been developed to help clinicians choose the best course of treatment for low back pain (LBP). Adherence to treatment recommendations can improve the effectiveness of rehabilitation programmes and prevent the recurrence of chronic low back pain (CLBP) (1,2). Among other factors, clinicians’ adherence to CPGs is significantly impacted by patient preferences, expectations, and compliance (3). There is a paucity of research regarding the understanding of patient expectations regarding the management of LBP through physiotherapy in the context of India. We believe that understanding the viewpoints of stakeholders will assist in developing strategies that pose the greatest threats to the implementation of CPGs and shed light on factors to be considered while new CPGs are drafted.
Methods
A cross-sectional survey was conducted to collect data from patients with CLBP meeting the criteria. A questionnaire was drafted based on the Kiel et al. 2020 (4) study and CLBP (5) management recommendations by a multidisciplinary team. Those respondents who consented were offered a link to an online survey. Predictive indicators including demographic information, views, expectations, and opinions regarding the health status and treatment expectations of patients were derived from questionnaires. The dependent outcome variables were the absence of trust in treatment recommendations provided by physiotherapists, the anticipation of treatment recommendations based on patient expectations, and the resistance to modifying expectations despite efforts by physiotherapists to persuade otherwise.To allow study participants to answer fully, an open-ended response was requested (6). To analyse the association, we used multiple logistic regression analysis.
Results
The study found a substantial univariate correlation (p?0.10) between information seeking behaviour and treatment suggestions. A significant univariate relationship (p?0.10) exists between age, pain duration, negative expectations, health status, physiotherapy role, pain interference, positive beliefs, medical and passive physiotherapy prescriptions, information seeking behaviour, and lack of trust in physiotherapist recommendations.
Multivariate regression analyses show that age, expectations about diagnosis, preference for passive therapies and medical care, and information seeking behaviour emerged as independent predictors of a lack of trust in physiotherapists’ treatment recommendations. The information-seeking behaviour of the patients’ alone predicted the anticipation of treatment recommendations based on patient expectations and the reluctance to alter those expectations despite the physiotherapists’ persuasion.
Conclusions
Potentially, directing attention towards patients’ information needs and patient education could be useful in improving patient adherence to treatment recommendations. Given the presence of multiple conservative treatment choices for chronic low back pain (CLBP) that have limited effectiveness, the practical implications of the study propose that physiotherapists should ask patients about their treatment expectations and evaluate whether these align with the interventions offered to each individual patient. This could also enhance the implementation of collaborative decision-making between healthcare practitioners and patients, potentially resulting in enhanced patient compliance with treatment recommendations.
References
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2015;17(6):e143
3.Schers H, Braspenning J, Drijver R, Wensing M, Grol R. Low back pain in general practice: reported management and reasons for not adhering to the guidelines in the Netherlands. Br J Gen Pract. 2000;50(457):640–644
4.Kiel S, Raus C, Sierocinski E, Knauthe P, Chenot JF. Concordance of patient beliefs
and expectations regarding the management of low back pain with guideline
recommendations – a cross-sectional study in Germany. BMC Fam Pract. 2020;21(1):275. Published 2020 Dec 21. doi:10.1186/s12875-020-01352-1
5.George SZ, Fritz JM, Silfies SP, et al. Interventions for the Management of Acute and
Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021
Nov;51(11):CPG1-CPG60. doi: 10.2519/jospt.2021.0304. PMID: 34719942
6.Pham T, Roy C, Mariette X, et al. Effect of response format for clinical vignettes on
reporting quality of physician practice. BMC Health Serv Res. 2009;9:128. Published 2009 Jul 28. doi:10.1186/1472-6963-9-128
Presenting Author
G Shankar Ganesh
Poster Authors
Topics
- Racial/Ethnic/Economic Differences/Disparities