Abstract
Abstract
Introduction
Low back pain (LBP) is the leading musculoskeletal cause of disability internationally and in New Zealand, placing a global burden on financial and health systems. Current treatments of LBP have not been found to be effective at abolishing an episode, or preventing recurrence, of LBP. Due to the high recurrence rate of LBP it could be considered as a life-long condition. Self-management in life-long conditions such as diabetes, has been found to be an effective treatment approach. It is therefore appropriate to encourage self-management for people with LBP. Self-management is an approach that develops self-efficacy, and can be interwoven within all aspects of treatment. Effective self-management is the ability of a person and their whānau (family) to make decisions and implement behaviours to treat LBP, seeking health care only when required. Physiotherapists should be ideally placed to support self-management in people with LBP. In order to encourage and confidently support self-management, it is important that we understand what the current attitudes and beliefs are of physiotherapists towards self-management for people with LBP.
Methods
This qualitative study used the Interpretive Description methodology, which recognises that reality is subjective and the researcher’s values and experiences cannot be separated from the research process. Semi-structured individual interviews with physiotherapists throughout New Zealand were conducted via video conferencing. The data was analysed and themes were defined. Implications were determined to help influence clinical practice.
Results
Seventeen physiotherapists participated, aged from 24 to 65 years, with professional experience ranging from one to more than 40 years. Four main themes were defined. 1) Participants had good understanding about the complexity and impact of LBP. However, they lacked knowledge of current evidence of the natural history of LBP. 2) Responsibility for persistence or recurrence of symptoms was apportioned to the person with LBP. 3) Self-management was considered to have an important role to play in the treatment of LBP. 4) Participants lacked a clear understanding of what self-management entailed and how to support self-management for a person with LBP.
Conclusion and Implications
Overall, our study showed that physiotherapists had good understanding of LBP, yet appeared not to have current knowledge of the natural history. They tended to apportion responsibility for persistent or recurrent LBP to the person with LBP. While they placed high value on the role self-management in the treatment of LBP, they appeared to lack enough understanding of the skills and components required for effective self-management. Therefore, physiotherapists may not be able to fully support self-management for people with LBP.
Physiotherapists should be encouraged to assimilate more recent evidence into their expectations for the timeframe for recovery from an episode and the recurrence rate of future episodes of LBP. Physiotherapists should be offered further training in what self-management entails and should be supported to upskill in enabling self-management strategies. The funding model of treatment of LBP in New Zealand may need to be modified to enable enough time and resources to effectively support self-management.
Key words:
Low back pain, self-management, attitudes and beliefs, physiotherapy, physiotherapists