Physical therapy for patients with low back pain in Germany: a survey of current practice

Abstract

Background Low back pain (LBP) is one of the most common musculoskeletal disorders worldwide. The National Disease Management Guideline (NVL) “Non-specific LBP” is a practical decision-making aid for both physicians and non-medical professionals in Germany to improve quality of health care. Although LBP is the most frequent diagnosis resulting in physical therapy treatment, information on the current management of patients with LBP and guideline adherence is limited. The objective of this study was to evaluate the current physical therapy management of patients with LBP in Germany, and to explore guideline adherence to the NVL “Non-specific LBP” recommendations. Methods An online survey among physical therapists working in Germany was conducted based on the recommendations given in the NVL “Non-specific LBP”. Participants were recruited using a snowball sampling approach and invited to complete the questionnaire. Guideline adherence was evaluated by comparing the survey findings with the recommendations of the NVL. Results In total, 1361 physical therapists (41 years of age (SD 11); 839 female, 514 male; 16 years of clinical experience (SD 10)) completed the survey. Fifty percent (n = 675) of our respondents adhered to the recommendations of the NVL on the therapeutic diagnostic process, and 72% (n = 973) to the recommendations concerning treatment. The guideline adherence across the entire management process (i.e., both diagnosis and treatment) of LBP was 38% (n = 513). German physical therapists predominantly provide active interventions, e.g., exercise therapy, but also use interventions with low or conflicting evidence, respectively. Massage and Kinesio Taping were frequently used despite being not recommended. Less than one third of study participants (n = 400, 29%) answered to know the NVL or had dealt with its recommendations. Conclusions In the management of LBP, overall guideline adherence among German physical therapists was 38% with higher adherence in the treatment section than in the physical therapeutic diagnostic process. Widespread employment of implementation strategies and removal of existing barriers against the application of evidence-based guidelines could facilitate the transfer of scientific evidence into clinical practice and contribute to optimize the quality of health care. Trial registration German Clinical Trials Register (DRKS00012607). Registered 04 October 2017.

Current physical therapy practice and implementation factors regarding the evidence-based ‘Rehabilitation of Mobility after Stroke (ReMoS)’ guideline in Germany: a cross-sectional online survey

“…In the light of the self-selected participation and the self-reported information, frequencies of adherence for some recommendations can be considered as good to excellent [ 25 , 47 ]. Because our sample conveniently over-represented professionals with an academic degree, our results are also likely to overestimate the true level of guideline adherence amongst all physical therapists [ 44 ].…”

“…Although we attempted to distribute the survey to a large number of physical therapists using an open sampling approach, the number of study participants ( n = 170) was small compared to the total number of approximately 200,000 physical therapists working in Germany [ 17 , 74 ]. However, surveys conducted in Germany also recruited comparatively small samples related to the total number of physical therapists in Germany [ 44 , 75 ]. As there is no register for physiotherapists in Germany, it is unclear how large the proportion of those working with neurological patients is.…”

“…The survey questions were structured into three sections. As with earlier studies, participants were asked to rate the implementation of the ReMoS guideline recommendations regarding physical therapy in the subacute phase after stroke on an ordinal scale (always, often, sometimes and never) in the first section [ 44 , 45 ]. In the second section, the validated BFAI by Peters et al [ 41 ] was translated pragmatically to explore the determining factors of ReMoS guideline usage.…”

Tailored GuideLine Implementation in STrokE Rehabilitation (GLISTER) in Germany. Protocol of a Mixed Methods Study Using the Behavior Change Wheel and the Theoretical Domains Framework

“…Each survey item will be analyzed using descriptive statistics as appropriate. Guideline adherence will be defined as 80% of the participants complying with the ReMoS guideline recommendations either “always” or “often” ( 55 ).…”

Community

“…Das Angebot kommt von der Hochschule Bremen und einem dort angesiedelten studentischen Projekt des Studienganges Angewandte Therapiewissenschaften Logopädie/Physiotherapie BSc (ATW). Ziel des Ganzen: Da der Transfer von evidenzbasiertem Wissen in die physiotherapeutische Praxis bislang noch unzureichend erfolgt 1 – 4 , sollte der PSP einen niederschwelligen Zugang außerhalb von akademischen Räumen ermöglichen. Ziel ist es auch, wissenschaftliche Erkenntnisse in entspannter und geselliger Pub-Atmosphäre zu vermitteln.…”