BackgroundLow back pain (LBP) is one of the major concerns in health care. In Switzerland, musculoskeletal problems represent the third largest illness group with 9.4 million consultations per year. The return to work rate is increased by an active treatment program and saves societal costs. However, results after rehabilitation are generally poorer in patients with a Southeast European cultural background than in other patients. This qualitative research about the rehabilitation of patients with LBP and a Southeast European cultural background, therefore, explores possible barriers to successful rehabilitation.MethodsWe used a triangulation of methods combining three qualitative methods of data collection: 13 semi-structured in-depth interviews with patients who have a Southeast European cultural background and live in Switzerland, five semi-structured in-depth interviews and two focus groups with health professionals, and a literature review. Between June and December 2008, we recruited participants at a Rehabilitation Centre in the German-speaking part of Switzerland.ResultsTo cope with pain, patients prefer passive strategies, which are not in line with recommended coping strategies. Moreover, the families of patients tend to support passive behaviour and reduce the autonomy of patients. Health professionals and researchers propagate active strategies including activity in the presence of pain, yet patients do not consider psychological factors contributing to LBP. The views of physicians and health professionals are in line with research evidence demonstrating the importance of psychosocial factors for LBP. Treatment goals focusing on increasing daily activities and return to work are not well understood by patients partly due to communication problems, which is something that patients and health professionals are aware of. Additional barriers to returning to work are caused by poor job satisfaction and other work-related factors.ConclusionsLBP rehabilitation can be improved by addressing the following points. Early management of LBP should be activity-centred instead of pain-centred. It is mandatory to implement return to work management early, including return to adapted work, to improve rehabilitation for patients. Rehabilitation has to start when patients have been off work for three months. Using interpreters more frequently would improve communication between health professionals and patients, and reduce misunderstandings about treatment procedures. Special emphasis must be put on the process of goal-formulation by spending more time with patients in order to identify barriers to goal attainment. Information on the return to work process should also include the financial aspects of unemployment and disability.

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Zusammenfassung Hintergrund: Der Direktzugang zur Physiotherapie birgt die Chance, antizipierte Engp?sse im Gesundheitswesen zu verhindern. Schweizer Physiotherapeuten bef?rworten mehrheitlich dessen Einf?hrung. Ziel: Die vorliegende Studie analysierte die Entscheidungen von Physiotherapeuten beim Erstkontakt mit Patienten. Methode: An die 7874 Mitglieder des Schweizer Physiotherapieverbands wurde ein zuvor validierter Fragebogen mit 12 klinischen Fallbeispielen geschickt. Die Teilnehmer entschieden f?r jedes Fallbeispiel, ob eine physiotherapeutische Behandlung indiziert und/oder eine ?berweisung in medizinische Behandlung notwendig war. Ergebnisse: An der Studie nahmen 2137 Mitglieder teil. Durchschnittlich 76?% der Physiotherapeuten w?hlten die richtige Vorgehensweise in F?llen, in denen eine physiotherapeutische Intervention indiziert und eine ?berweisung in ?rztliche Behandlung nicht notwendig war. In medizinischen, aber nicht kritischen F?llen ?berwiesen durchschnittlich 81?% der Befragten korrekt in medizinische Behandlung. In kritischen medizinischen F?llen ?berwiesen 67?% korrekt und ohne gleichzeitige Aufnahme einer Physiotherapie. Schlussfolgerungen: Die Mehrheit der befragten Schweizer Physiotherapeuten entschied in den meisten Fallbeispielen korrekt ?ber das weitere Vorgehen, obwohl die ?berweisungsfunktion in der heutigen Praxis nicht gefordert wird. In Bezug auf kritische medizinische Bedingungen sollen k?nftige Studien die Vertiefung der Kompetenzen in den Bereichen Pathologie und Differenzialdiagnostik pr?fen.

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