Background & Aims
Persistent low back pain (LBP) among older people can impact their physical and social activities. The aim of this study was to assess physiotherapists’ and occupational therapists’ recommendations of physical activity for managing persistent low back pain in older adults vs. younger adults. All the study participants were involved in a specialized pain physio-/occupational-therapy training program in Germany. The purpose was to investigate whether the participants’ recommendations on activity, exercise, work or bed rest differ for older vs. younger people with LBP, and if their responses are appropriate to guideline recommendations. In addition, it was to be analyzed whether there was a relation between kinesiophobic beliefs among the participants and their recommendations.
Methods
Therapists´ recommendations were gathered via a cross-sectional survey. Those enrolled in the training courses from 2017 till 2023 were invited to participate. The survey was done after 30-45 hours of the educational training, just before the topic “pain management for older adults” was started. All responses were anonymous, and participants were provided with an information sheet and signed an informed consent prior to participation. They randomly received a vignette describing either a 70-yr-old or a 40-yr-old patient with chronic LBP. Apart from the age, both vignettes were identical. Participants gave their recommendations about (voluntary) work, exercise, daily activity and bed rest; and whether they would recommend further medical tests. Answers were dichotomized into according or not-according to the guideline. Kinesiophobic beliefs among the participants were assessed on the first training day with the Tampa Scale for Kinesiophobia (TSK-PT).
Results
Among the 227 responders (response rate: 89 %), 125 received a 70-yr-old and 102 a 40-yr-old patient vignette. Sociodemographic characteristics in both groups were comparable.
There was no significant difference in the proportion of appropriate recommendations for both vignettes, neither for overall composite score (79% vs. 77%, p>0.05) as for separate questions about exercise, work, activities and bed rest (p>0.05). Therapists experienced in chronic pain show a tendency to give less appropriate advice for return to work for the 70-yr-old patient vignette compared to therapists experienced with acute pain.
Analyses of all responses together (n=227) show, that responders who recommend more tests (e.g. Xray, MRT) give inappropriate recommendations for work, bed rest and in the overall composite score to a greater degree. Furthermore, therapists who gave inappropriate recommendations scored higher on the TSK compared to those giving appropriate recommendations (p=0.002 d=0.58).
Conclusions
Results of this study suggest that the recommendations given by physio- and occupational therapists are largely in accordance with the guideline, and that age discrimination is not present. A subgroup of therapists who advises further medical tests also gives inappropriate recommendations for work, bed rest and overall composite score. Also, therapists with higher kinesiophobic beliefs are more likely to give inappropriate recommendations. Compared with the results of the survey 2017 [3], done on physiotherapy students’, the current results demonstrate more appropriate recommendations (overall composite score of the current survey=79 % vs. survey 2017=47 %), specifically for the elderly patients.
References
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