Design and Development of a Decision Support Package for Low Back Pain

Abstract

ObjectiveTo develop a decision support package for people with low back pain (LBP) referred for physiotherapy.MethodsWe used a program of exploratory work, including literature reviews, a Delphi study, a nominal group with physiotherapists, focus groups with patients, and secondary analysis of existing interview data.ResultsWe developed an information booklet describing the evidence-based treatment modalities available in a physiotherapy department. This includes data on likely benefits and risks and how the intervention is delivered. The booklet specifically addresses questions identified as important in our exploratory work. Space is provided for patients to note down the pros and cons of each treatment and what matters to them when choosing treatments. The patient is subsequently directed to a section that explores any gaps in knowledge, values, support, and choice before finally clarifying if a treatment decision is possible. At this stage they are encouraged to note down any questions or concerns they have to be discussed at the first physiotherapy consultation. This overall package includes patient material in the form of a booklet posted prior to their consultation, plus the enhanced consultation with the specially trained physiotherapist. Patients then receive their chosen treatment. In addition we developed a training package for physiotherapists that explains the content of the booklet and supports them in using informed, shared decision making in their consultation.ConclusionThis package has the potential to improve effectiveness of treatments and patient satisfaction for LBP by facilitating patient choice and therefore matching patients more effectively to different treatments.

Nursing intervention protocol for adult patients experiencing chronic low back pain

“…More important is the knowledge acquired during the intervention, which turned out to be the most significant independent predictor of improvements in pain and disability scores. The merits of similar protocols and guidelines have been shown in previous studies (Patel et al, 2014;University Health Services, 2014). In addition, Marlowe (2012) highlights the beneficial effects of such interventions on patient's coping and behaviour and consequently on their pain and disability.…”

Primum non nocere: shared informed decision making in low back pain – a pilot cluster randomised trial

“…The study protocol and the intervention are described in detail elsewhere [ 31 , 32 ]. They are briefly summarised here.…”

“…Our intervention package was developed after exploratory work including literature reviews, a Delphi study, a nominal group with physiotherapists, focus groups with patients’ and secondary analysis of existing interview data. We have described this process in detail elsewhere [ 32 ]. We developed a patient decision support package in the form of a booklet and associated training for the physiotherapists [ 32 ] (Additional file 1 ).…”

“…We have described this process in detail elsewhere [ 32 ]. We developed a patient decision support package in the form of a booklet and associated training for the physiotherapists [ 32 ] (Additional file 1 ). The physiotherapist training was a two-hour session to enable the therapists to develop an understanding of how to incorporate the decision support package within their patient-centred consultations, facilitate patient involvement as well as providing appropriate information by recognising and responding to patient concerns.…”

“…Once the baseline questionnaire was received those participants allocated to a therapist in the intervention arm of the study were sent a copy of the decision support booklet by post from the physiotherapy department; typically around two weeks prior to their first consultation [ 32 ]. Participants were then expected to attend their appointment as usual.…”