Abstract
Background: Psychosocial factors have been shown to be important in the progression from acute low back pain (LBP) to chronic disability. Early identification of individuals at risk of developing chronic disability is important. The aim of this study was to determine if physiotherapists recognise when patients with LBP are at risk of chronicity due to psychosocial factors. A secondary aim was to explore the advice they give to patients about work and activities.
Methods: A cross-sectional, descriptive survey of practising, musculoskeletal physiotherapists was designed and completed. Vignettes were written based on three acute LBP patients at low, moderate or high risk of chronicity due to psychosocial factors as measured by the Acute Low Back Pain Screening Questionnaire. The vignettes were tested by an expert panel (n=6) and incorporated into a postal questionnaire, which was piloted (n=50) and then sent to a simple random sample of experienced musculoskeletal physiotherapists in the UK (n=900). After one reminder, 20% of non-responders were sent a further questionnaire (n=80) to explore the non-response bias. Data were analysed using the Statistical Package for the Social Sciences (SPSS version 11).
Results: The response rate was 57.7% (n=518). The sample consisted of experienced physiotherapists (mean of 18 years postgraduate experience) working across all practice settings. Most correctly rated the chronicity risk of the low and high risk patient cases (56.6% and 89.1 %), but the moderate risk case appeared to cause some difficulty. Chronicity rating appeared to be more highly associated with biomedical factors such as the perceived pathology. Most therapists (95%, 88.6% and 85.8%) reported they would recommend some limitation of activity for each case.
Conclusions: Most physiotherapists recognise when patients are at high and low risk of developing chronicity, but this seems to be influenced more by biomedical than psychosocial factors. Even when therapists recognise that a patient is at high risk of chronicity, many recommend the patient limit their activity levels and not work. Many physiotherapists may be providing advice, which aids the progression to chronicity. Research is needed to explore how to facilitate a change in therapists’ beliefs and practices.
The abstracts were prepared by Editorial Secretary, Dr Charles Pither. Correspondence should be addressed to SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
