Exploring usual care for patients with low back pain in primary care: a cross-sectional study of general practitioners, physiotherapists and chiropractors

Madsen, Simon Dyrløv; Morsø, Lars; Vach, Werner; Andersen, Merethe Kirstine; Lykkegaard, Jesper; Schiøttz-Christensen, Berit; Stochkendahl, Mette Jensen

doi:10.1136/bmjopen-2023-071602

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…While previous studies in primary care have focused on the prevalence of different treatments, including the use of medications and the extent of referral for imaging or specialist care (Kamper et al., 2020; Madsen et al., 2023), there remains a gap in our understanding of the full spectrum of LBP management in general practice. This is particularly true for patient‐directed self‐management strategies, which include lifestyle modification, physical activity, and various home remedies.…”

Section: Introductionmentioning

confidence: 99%

Usual care for low back pain and barriers to best practice: A cross‐sectional study in Danish general practice

Arnbak,

Jensen,

Lund

et al. 2024

Musculoskeletal Care

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ObjectivesTo describe the current content of low back pain (LBP) care in Danish general practice, the patients' self‐management activities, and the clinicians' experienced barriers to providing best practice care.MethodsThis cross‐sectional observational study included adults with LBP seeking care in Danish general practice from August 2022 to June 2023. Patient‐reported information included demographics, pain intensity, medical history, treatments, and self‐management strategies. Clinicians provided data specific to each consultation, detailing the content of these consultations, and barriers to best practice in the specific cases.ResultsThe study involved 71 clinicians from 42 general practice clinics, with patient‐reported data from 294 patients, and clinician‐reported data from 283 (95%) consultations. The mean age for the included patients was 53 years, 56% were female, and 31% had been on sick leave for LBP during the previous 3 months. Moreover, 44% had seen two or more healthcare professionals in the previous month, 55% had previously undergone diagnostic imaging for LBP, 81% reported using any type of analgesics, and 14% reported using opioids. The majority (91%) reported engaging in self‐management activities to alleviate pain. Consultations typically included a physical examination (84%), information about the cause of the pain (74%), and management advice (68%), as reported by clinicians or patients. In general, clinicians reported consultation elements more frequently than patients. Clinicians reported providing best practice care in 84% of cases, with time constraints (23%) and patient expectations (10%) being the most common barriers.ConclusionsThis study provides detailed insights into the management of LBP in Danish general practice. It reveals a complex landscape of patient engagement, varying management strategies, and differing perceptions of care content between patients and clinicians. Patients were often engaged in self‐management activities and clinicians reported few barriers to providing best practice care.

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Section: Introductionmentioning

confidence: 99%

Usual care for low back pain and barriers to best practice: A cross‐sectional study in Danish general practice

Arnbak,

Jensen,

Lund

et al. 2024

Musculoskeletal Care

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Effect of exercise and manual therapy or kinesiotaping on sEMG and pain perception in chronic low back pain: a randomized trial

Blanco-Giménez,

Vicente-Mampel,

Gargallo

et al. 2024

BMC Musculoskelet Disord

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The importance of incorporating lumbo-pelvic stability core and controlling motor exercises in patients with chronic low back pain (CLBP) reinforces the use of strategies to improve biopsychosocial beliefs by reducing biomedical postulations. However, clinical practice guidelines recommend multimodal approaches incorporating exercise and manual therapy (MT), and instead reject the application of kinesiotape (KT) in isolation. Therefore, the objectives of this study were to analyze the effects of 12 weeks of exercises combined with MT or KT on perceived low back pain using the visual analog scale (VAS) and muscle electric activity measured with electromyography (EMG) of the rectus abdominis and multifidus in CLBP (mild disability) and to explore the relationship between the rectus abdominis and multifidus ratios and pain perception after intervention. A blinded, 12-week randomized controlled trial (RCT) was carried out, involving three parallel groups of patients with CLBP. The study was registered at Clinicaltrial.gov and assigned the identification number NCT05544890 (19/09/22). The trial underwent an intention-to-treat analysis. The primary outcome revealed a multimodal treatment program supplemented by additional therapies such as MT and KT, resulting in significant reductions in perceived low back pain. The subjective assessment of individuals with CLBP indicated no discernible distinction between exclusive core stability exercises and control-motor training when combined with MT or KT. Notably, our findings demonstrated positive alterations in both the mean and peak EMG values of the right rectus abdominis in the exercise group, suggesting a beneficial impact on muscle activation. This study focused on assessing the activation levels of the trunk musculature, specifically the rectus abdominis (RA) and multifidus (MF), in individuals with CLBP exhibiting mild disability according to the Oswestry Disability Index. Importantly, improvements in the VAS values were observed independently of changes in muscle electrical activity.

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Patient perspectives on low back pain treatment in primary care: a qualitative study of hopes, expectations, and experiences

Madsen,

Stochkendahl,

Morsø

et al. 2024

BMC Musculoskelet Disord

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Background Patients’ hopes and expectations for low back pain treatment influence their consultation experiences and treatment outcomes. These hopes and expectations may evolve over time, potentially leading to a shift in what patients consider important before and after a consultation. Understanding the distinction between hopes and expectations, and how they evolve is important for improving patient care. This study explored patients’ hopes and expectations prior to LBP consultations and examined how these were reflected in their post-consultation experiences. Methods We employed a qualitative design consisting of individual semi-structured pre- and post-consultation interviews with patients seeking care for low back pain from general practitioners, physiotherapists, and chiropractors in Denmark. A convenience sample of 18 patients (10 females and 8 males) aged between 28 and 79 years were interviewed about their hopes and expectations before a consultation and their experiences immediately following the consultation. Data were analysed employing Braun and Clarke’s thematic analysis. Results Two themes with five subthemes were developed: (1) “Something needs to be done,” which included subthemes related to life disruption, expectations of clinical assessment, and the clinicians as experts; and (2) “Experiences and emotional responses to the interaction with the clinician”, highlighting the importance of trust and the personal attributes of clinicians. Patients initially sought urgent help and clarity regarding their condition but shifted their focus post-consultation to the relational dynamics and emotional engagement experienced during interactions with clinicians. Conclusions This study contributes to the understanding of how patients’ hopes and expectations regarding low back pain consultations evolve, shifting from a focus on clinical actions and outcomes to valuing interpersonal relationships and emotional support from clinicians. Recognising these shifts can enhance clinician-patient interactions and improve overall patient satisfaction and treatment outcomes. Clinical trial number Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-024-08116-3.

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Exploring usual care for patients with low back pain in primary care: a cross-sectional study of general practitioners, physiotherapists and chiropractors

Cited by 3 publications

References 28 publications

Usual care for low back pain and barriers to best practice: A cross‐sectional study in Danish general practice

Usual care for low back pain and barriers to best practice: A cross‐sectional study in Danish general practice

Effect of exercise and manual therapy or kinesiotaping on sEMG and pain perception in chronic low back pain: a randomized trial

Patient perspectives on low back pain treatment in primary care: a qualitative study of hopes, expectations, and experiences

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