Abstract
Abstract
Background
Globally, low back pain is the leading cause of disability in adults. The majority of low back pain resolves within 2-6 weeks, with some people experiencing persistent symptoms. The STarTBack Approach has been developed to identify individuals who are at risk of persistent low back pain and deliver matched treatments to their risk level. New Zealand has a unique healthcare system and examination of the how the STarTBack Approach could fit into the system is warranted.
Objectives
The objectives of this study were a) train New Zealand based physiotherapists on the STarTBack Approach and introduce the STarTBack screening tool into routine clinical practice; b) investigate potential barriers and facilitators to implementing the STarTBack Approach into routine clinical care within the New Zealand healthcare system.
Methods
The study utilised a mixed methods design, with the qualitative component as the main focus to identify potential barriers and facilitators to implementing the STarTBack Approach. Qualitative data was obtained via two focus groups to describe individuals’ experiences of the approach. Quantitative surveys were used to provide context to the qualitative data. Physiotherapists from a private practice were recruited. They were provided training on the STarTBack Approach and used the STarTBack screening tool over a four week period in their normal clinical practice. Participants views on the STarTBack Approach were gathered via focus groups. Audio data was transcribed and analysed using the methodological framework of Interpretive Description to produce clinically relevant and applicable findings. Data were coded into individual themes, with similar themes that emerged grouped together under higher level descriptive labels from the Consolidated Framework for Implementation Research.
Results
Sixteen physiotherapists participated in the focus groups. Participants were equally split between male and female and had 6 years of postgraduate experience, with 38% having a postgraduate qualification. They were more likely to be have a biopsychological orientation in their treatment approach. Three main themes emerged: STarTBack Intervention Characteristics (7 subthemes), Healthcare Setting (9 subthemes), and Characteristics of Individuals Working under the STarTBack (2 subthemes).
Conclusion
This study implemented the STarTBack screening tool into routine clinical practice and gathered physiotherapists views on the STarTBack Approach. Overall, several salient barriers and facilitators to implementation of the STarTBack Approach in New Zealand were identified. Physiotherapists agreed with the evidence behind the STarTBack Approach, did not foresee significant impacts to their normal clinical practice, and felt confident to deliver the matched treatment protocols. Concerns were noted with meeting patient expectations, managing changes to remuneration, and potential lack of funding agencies endorsement of the STarTBack Approach. Any future implementation studies need to address these barriers to facilitate successful uptake of the STarTBack Approach.