Guidelines on low back pain disability: interprofessional comparison of use between general practitioners, occupational therapists, and physiotherapists

Stéphane Poitras, Marie-José Durand, Anne-Marie Côté, Michel Tousignant
Spine 2012 June 15, 37 (14): 1252-9

STUDY DESIGN: Individual semistructured qualitative interviews.

OBJECTIVE: To evaluate barriers to use of management recommendations, aimed at preventing low back pain (LBP) disability, with general practitioners (GPs), occupational therapists (OTs), and physiotherapists (PTs) working in Quebec (Canada), and identify areas of convergence and divergence between health professions.

SUMMARY OF BACKGROUND DATA: Studies have demonstrated inadequacies of practices of clinicians with regard to LBP management and prevention of persistent disability. Barriers to use of evidence by clinicians should be evaluated to understand these inadequacies and develop implementation strategies.

METHODS: Sixteen PTs, 8 OTs, and 8 GPs were recruited with different levels of experience and practice location (urban or rural). They were asked to follow management recommendations (Clinic on Low-back Pain in Interdisciplinary Practice [CLIP] guidelines), with a minimum of 2 patients. Individual semistructured interviews were used to identify barriers to use of management recommendations aimed at preventing LBP disability. Barriers between health professions were compared.

RESULTS: Barriers to use were lesser for OTs and greater for GPs, with divergences among PTs. OTs agreed with the guidelines, found them compatible with their current practice, and thought that using them would prevent persistent disability. GPs and PTs thought that the guidelines did not provide enough information on the pathophysiological management of LBP. GPs thought that it would be difficult to implement the guidelines in everyday practice. All 3 groups thought that management recommendations could conflict with patient expectations.

CONCLUSION: To address identified barriers, a process of care is proposed by fitting tasks to the most compatible providers. The task of GPs could focus on pain management through medication, red flag screening, encouragement to stay active, and reassurance. The tasks of PTs could center on pain management, general exercise, and encouragement to stay active. The tasks of OTs could focus on disability prognosis, yellow flags management, and return to activity parameters. The efficacy of this process of care to prevent persistent LBP disability should be assessed in a trial.

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