Purpose and background. Nearly 70% of UK physiotherapists experience work-related musculoskeletal disorders (WRMSDs) during their career, with a significant proportion occurring in the back and being attributed to patient handling tasks. Evidence suggests that manual handling training alone is ineffective and interventions among nurses indicate that a tailored approach, including targeted exercise (TE), can reduce WRMSD rates. This study aimed to explore physiotherapists’ perspectives of WRMSDs, patient handling, and the role of TE in reducing WRMSDs among physiotherapists. Methods and Results. Key informant interviews were conducted with 4 physiotherapy operational leads and 1 manual handling trainer from NHS Grampian. Interviews were transcribed and Framework Analysis was utilised to identify key themes, including challenges, barriers, and facilitators. Following this, two online focus groups were conducted with 7 qualified NHS physiotherapists across the UK. Views of manual handling training varied across specialities, with some finding it comprehensive and adaptable, and others finding it less applicable to patients in their speciality or community setting. Physiotherapist views on fitness for work varied, with some highlighting the necessity of TE to ensure workforce health whilst others considered exercise to be a personal matter. Facilitators to implementation identified by participants were having support from management and a strong justification for the exercise content. Varied work schedules and facilities were identified as barriers to implementation of a work-based TE intervention. Conclusion. Varying perspectives on TE interventions and barriers to implementation were identified. This work will inform future research to develop TE interventions in consultation with key stakeholders. Conflicts of Interest. No conflicts of interest. Source of Funding. NHS Endowment Research Grant 22/001

Purpose and background. Although clinical guidelines recommend that low back pain (LBP) is best managed in primary or community care, in the UK and globally, LBP accounts for around 4% of emergency department (ED) attendances. Organising and delivering healthcare to be safe, effective, and acceptable requires hearing patients’ perspectives; this study therefore aimed to explore patients’ experiences of attending the ED for LBP. Methods and results. This was a multisite qualitative interview study with 47 adults (aged 23–79 years) who, in the past six weeks, had attended one of four UK NHS emergency departments for LBP (all types and durations). Purposive sampling was used to gain variation in the recruiting site, and LBP and demographic characteristics. Data were collected using individual, semi-structured, telephone interviews (median 45mins). Interviews were audio-recorded, transcribed verbatim, and analysed thematically. We identified significant variation in patients’ experiences of ED care for LBP, which we argue reflects contrasting cultures of ED care. We present three cultures, emergency screening only, ‘cynicism and neglect’, and ‘kindness’; these cultures differ in how they navigate the tension between the ED remit and patients’ perceived needs of care. We draw on Bourdieu's notions of field and habitus and professional identity theory to help explain these findings. Conclusion. Our findings suggest unwarranted variation in ED care for LBP. Implications include the need for urgent access to primary and community care and clarity about best practice managing LBP in the ED; best practice guidance and strategies to implement this should be informed by notions of culture and professional identity. No conflicts of interest.  . Sources of funding. Health Education England & National Institute of Health and Care Research (ICA-CDRF-2018-04-ST2-040)

Purpose of the study. The purpose of this project was to evaluate whether OHEIs could facilitate student physiotherapy placement training in their educational outpatient clinics. Background. The National Health Service (NHS) is actively promoting Allied Health Professionals (AHPs) to have a greater role in supporting healthcare delivery. There are challenges to increasing AHP numbers and one of these is providing enough student training placements to meet demand. Methods. This evaluation used quantitative and qualitative methods. The OHEI clinical tutors and students collected activity data Anonymised questionnaires for physiotherapy students examining expectation were completed online before placement and an experience questionnaire after placement. Interviews and focus groups were conducted to investigate the experiences of stakeholders involved in the project. This included physiotherapy and osteopathy students, clinic tutors, and placement coordinators in OHEIs and physiotherapy HEIs. Results. Four universities with physiotherapy courses participated, and 37 students in 2 cohorts completed either five- or six-week placements at three OHEI clinics between April and August 2021. Cohort 1 expressed uncertainties about roles and integration in clinic and with patients. Concerns were addressed for Cohort 2 and physiotherapy student learning experiences were much better with 83% of physiotherapy students satisfied or very satisfied with their placement. Conclusion. The placement of physiotherapists in OHEI clinics is feasible. Careful expectation management is essential. Future sustainability is dependent upon managing costs to the OHEIs as it is unlikely placements will generate income. The learning environment could be made more reciprocal with time and experience leading to better understanding of the different professions and enhanced multidisciplinary working. Conflicts of interest: Dawn Carnes and Carol Fawkes are both trained osteopaths. Sources of funding: Health Education England grant to the Institute of Osteopathy (the professional association for UK osteopaths)

Background. There is an increasing burden of LBP. Clinical guidelines promote physical activity (PA) and self-management strategies and aim to reform unhelpful clinical activity. This study explores osteopaths' beliefs about non-specific low back pain (NSLBP) and the role of activity in the treatment of NSLBP. Methods. Semi-structured interviews were conducted with a purposive sample of twelve qualified osteopaths in the UK. Interviews were transcribed verbatim and constructivist grounded theory was used to conceptualise, collect and analyse data. Results. Four categories; practitioners' beliefs and mode of practice, PA interventions used, challenges and obstacles to promoting activity and strategies used in practice; conceptualised three practitioner styles. Variation was reported in the management of NSLBP, perceptions of successful PA interventions and strategies used in practice. Perceived obstacles to PA were identified. A proposed model highlights how different practitioner styles adopted a biomedical or behavioural orientation towards NSLBP, leading to different approaches to behavioural change strategies and self-management in the treatment of NSLBP. Conclusion. There are opportunities for educational programs to enhance competencies in exercise prescription and activity promotion, and knowledge of behavioural change strategies to promote self-management in NSLBP. Further quantitative research is recommended to measure osteopaths' attitudes and behaviour related to activity promotion and to test clinical effectiveness of related interventions. No conflicts of interest. No funding obtained

Background. Sciatica is common and associated with significant impacts for the individual, health care and society. The SCOPiC randomised controlled trial (RCT) is investigating whether stratified primary care for sciatica is more effective and cost-effective than usual, non-stratified primary care. Stratified care involves subgrouping patients to one of three groups based on a combination of prognostic and clinical indicators. Patients in one of these groups are ‘fast-tracked’ with an MRI scan to spinal specialist opinion. Our aim was to understand the perspectives of clinicians on the acceptability of this ‘fast-track’ pathway. Methods. Qualitative, semi-structured interviews were conducted with general practitioners, spinal specialist physiotherapists and spinal surgeons (n=20 in total). Interviews were fully transcribed, and data were analysed using the constant comparison method. Results. Across all groups, clinicians identified potential added value in ‘fast-tracking’ some sciatica patients in terms of patient reassurance based on MRI scan findings. Whilst spinal physiotherapists felt that most ‘fast track’ patients were appropriate, some spinal physiotherapists and GPs had concerns that patients with symptom durations of less than 6 weeks might be inappropriately fast-tracked since their symptoms may still resolve without the need for invasive treatments. Spinal surgeons felt it was acceptable for patients with short symptom durations to be ‘fast-tracked’, but to provide early reassurance rather than direct treatment. Conclusion. Whilst clinicians saw added value in a group of sciatica patients being ‘fast-tracked’ to specialist opinion, there was some reservation about moving away from the usual stepped care, ‘wait and see’ approach for patients with short symptom duration. Conflicts of interest statement. No conflicts of interest. Sources of funding. This study is funded by the National Institute for Health Research Health Technology Assessment Programme (NIHR HTA project number 12/201/09) and will be published in full in Health Technology Assessment. Funding support is also received from an NIHR Research Professorship for Nadine Foster (NIHR-RP-011-015), who is an NIHR Senior Investigator, and a HEFCE Senior Clinical Lecturer award for Kika Konstantinou. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health and Social Care. The study was approved by the NRES Committee West Midlands – Solihull, 17/03/2015, ref: 15/WM/0078. Trial registration: ISRCTN75449581

Background. Almost 80% of people experience low back pain at least once in their life. A quarter suffers from Nonspecific Chronic Low Back Pain (NS-CLBP), where symptoms cannot be justified radiologically. There is evidence that imaging negatively impacts outcomes (increased painkillers and doctors' visits) in NS-CLBP patients. Despite clinical guidelines recommending against the use of imaging, healthcare practitioners and patients still request imaging to explain symptoms. Method. Qualitative, semi-structured interviews with NS-CLBP patients, physiotherapists, and doctors conducted using purposeful sampling of 6–11 people from each group. The interviews were recorded, transcribed and analysed using framework analysis. Validity was ensured by data triangulation with participants. Results. Interviews with 11 patients who had an MRI scan, 6 physiotherapists and 6 spine surgeons. Four main themes emerged from synthesis of findings across these three groups. Discussion. This study provides an insight of the lived experience of NS-CLBP among three different groups. It highlights the difference in expectation between healthcare provider and patients about how CLBP should be managed and the lack of coordination between primary and secondary healthcare services. Although patients seek imaging to explain NS-CLBP, they react to the results negatively. In accordance with fear avoidance model, participants reported fear avoidance behaviours and anxiety following MRI. That affect daily life activities and participation. Conclusion. This study highlights the need for early management of NS-CLBP patients in primary care. The psychosocial consequences of diagnosing by MRI are fear avoidance and anxiety. The current biomedical education to those patients may promotes these consequences. Conflict of interest. No conflicts of interest. Study fund. This research was supported through a PhD scholarship from Prince Sattam bin Abdul-Aziz University, Saudi Arabia, at the University of Nottingham, United Kingdom

Background. Persistent low back and leg pain is a common and highly disabling musculoskeletal condition. Many patients seek the opinion of a neurosurgeon with a view to surgical intervention. Few data are available which document the experiences of patients at these consultations. Aims. To investigate the experiences of patients seeking a neurosurgical opinion for back and leg pain. Methods. 15 patients (Males 9 Females 6) were consented and recruited into this study and participated in an in-depth semi-structured interview about their experiences of the consultation. Interviews were recorded and transcribed. Transcribed data were read independently by two researchers and analysed using grounded theory. Results. Three subgroups of patients were identified from the interviews. Group 1: Patients that were offered surgery and described a positive experience. Group 2: Patients that were not offered surgery and described a positive experience. Group 3: Patients that were not offered surgery and described a negative experience. Analysis revealed a number of different themes pertaining to the experiences of each group. However, two overarching themes of i) meeting patients' expectations and ii) the factor of hope, emerged as significant contributors to their experience and were evident in all three subgroups. Conclusion. Findings identified the need to manage patient expectations in the consultation in order to provide a positive experience. Providing patients with hope who are not undergoing surgery, but who have an expectation for it, is likely to provide a more positive experience and therefore increased satisfaction with care. No conflicts of interest. Part funded by North East London Foundation Trust

Background to the study:. The use of Patient Reported Outcome Measures (PROMs) to measure effectiveness of care, and supporting patient management is being advocated increasingly. PROMs data are often collected using hard copy questionnaires. New technology enables electronic PROM data collection. Purpose of the study:. To identify patient and practitioner perceived opportunities and challenges to implementing electronic PROM data capture as part of the process for developing a PROM phone and online app. Methods:. Interviews were undertaken with patients (N=18), and clinicians (N=46). Patients and clinicians were recruited through practice advertisement, in printed healthcare media, social media, and professional networks. Semi-structured interviews were used. Data were analysed using the Framework approach. Themes, sub-themes, and models were developed from the analysed data. Results:. Patient themes included relevance of data collection, data protection, and confidentiality. Practitioner themes included issues around patient engagement, and relevance to clinical practice. Overall patients were more enthusiastic than clinicians about using PROMs in practice. They welcomed the opportunity to provide feedback, and were prepared to use technology to achieve this. In contrast, clinicians reported concerns that patients would not want to complete PROMs, or may be unable to use electronic devices to achieve this. Other clinicians noted that this was a professional demand and part of reflective practice. Conclusion:. The patients' enthusiasm to contribute data and the clinicians' paternalistic views were contrasting and suggests a greater need for patient centred communication

Objectives. To investigate the views and experiences of patients with sciatica who have undergone a bespoke physiotherapy programme whilst awaiting primary lumbar microdiscectomy. Methods. This is a qualitative study, nested within a preliminary RCT. All patients were listed for primary, single-level microdiscectomy surgery. In the experimental arm of the study 29 patients had up to 6 sessions of physiotherapy over an 8 week period while on the waiting list for lumbar microdiscectomy. After surgery, they were invited to participate in an in-depth semi-structured interview. At this time patients had either decided not to have the surgery, or had undergone surgery. Interviews were audio-recorded, transcribed, and thematically analysed. Two researchers were involved in the analysis of the data to ensure the interpretation of the findings was robust, credible and trustworhy. Results:. 21 patients were interviewed with 24 patients in the sample undergoing surgery following the physiotherapy. The physiotherapy was found to be of value with patients appreciating exercises to reduce pain and discomfort, techniques for improving properly, interventions to improve gait and posture, hands-on therapy and gym work through an individually tailored treatment approach. Another strong theme was that of perceived delays for scanning and entry into secondary care. Conclusion:. The nested qualitative study provides further evidence as to the experiences and difficulties faced by patients with sciatica. An emergent theme was the difficulty in accessing what patients perceived to be appropriate care. The bespoke, patient-orientated approach was well received by both clinicians and patients and provides opportunities for its wider introduction. This abstract presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant