Physiotherapists’ views of implementing a stratified treatment approach for patients with low back pain in Germany: a qualitative study

Abstract

BackgroundThe STarT-Back-Approach (STarT: Subgroups for Targeted Treatment) was developed in the UK and has demonstrated clinical and cost effectiveness. Based on the results of a brief questionnaire, patients with low back pain are stratified into three treatment groups. Since the organisation of physiotherapy differs between Germany and the UK, the aim of this study is to explore German physiotherapists’ views and perceptions about implementing the STarT-Back-Approach.MethodsThree two-hour think-tank workshops with physiotherapists were conducted. Focus groups, using a semi-structured interview guideline, followed a presentation of the STarT-Back-Approach, with discussions audio recorded, transcribed and qualitatively analysed using content analysis.ResultsNineteen physiotherapists participated (15 female, mean age 41.2 (SD 8.6) years). Three main themes emerged, each with multiple subthemes: 1) the intervention (15 subthemes), 2) the healthcare context (26 subthemes) and 3) individual characteristics (8 subthemes). Therapists’ perceptions of the extent to which the STarT-Back intervention would require changes to their normal clinical practice varied considerably. They felt that within their current healthcare context, there were significant financial disincentives that would discourage German physiotherapists from providing the STarT-Back treatment pathways, such as the early discharge of low-risk patients with supported self-management materials. They also discussed the need for appropriate standardised graduate and post-graduate skills training for German physiotherapists to treat high-risk patients with a combined physical and psychological approach (e.g., communication skills).ConclusionsWhilst many German physiotherapists are positive about the STarT-Back-Approach, there are a number of substantial barriers to implementing the matched treatment pathways in Germany. These include financial disincentives within the healthcare system to early discharge of low-risk patients. Therapists also highlighted the need for solutions in respect of scalable physiotherapy training to gain skills in combined physical and psychological approaches.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2991-3) contains supplementary material, which is available to authorized users.

Prognostic ability of the German version of the STarT Back tool: analysis of 12-month follow-up data from a randomized controlled trial

“…Primary users of the SBT are physiotherapists and primary care physicians [2, 3, 10]. In addition, utilisation of the tool by health insurance companies might have the potential for a more targeted disbursement of resources.…”

“…Back pain is one of the most prevalent symptoms encountered in primary care [1]. Its treatment is challenging for primary care practitioners, such as physiotherapists or general practitioners [2, 3]. It has been discussed that determining the prognosis of back pain is a priority for research and practice and may have the potential to supersede diagnosis in its relevance [4].…”

Exploring physiotherapists’ use of clinical practice guidelines, screening, and stratification tools for people with low back pain in New Zealand

“…A systematic review of qualitative studies by Synnott et al (2015) found that although physiotherapists recognised psychosocial factors in LBP patients, they preferred to treat the mechanical aspects of LBP and may stigmatise people based on psychosocial factors. Furthermore, physiotherapists often indicated they lacked the training and skillset to effectively address psychosocial factors in clinical practice (Karstens et al, 2018;Synnott et al, 2015).…”

“…This has the potential to also affect a patient's choices for treatment practitioner. Concern about lack of financial incentives to adopt stratified care for LBP was identified in a qualitative study of German physiotherapists (Karstens et al, 2018), which also reported participants felt they did not have the necessary skills to deliver psychosocially informed treatment. Given these challenges, it is likely that the adoption of a stratified model of care for LBP requires an approach tailored to each country to ensure it is fit for purpose and acceptable to multiple stakeholders (Sowden et al, 2018).…”

Interdisciplinary stratified care for low back pain: A qualitative study on the acceptability, potential facilitators and barriers to implementation

“…Since previous qualitative research has called attention for potential barriers that may prevent the successful implementation of the STarT Back in the UK as well as in other countries [24–27], the SPLIT research team has introduced several adjustments to the original model since its early conception. For example, rheumatologists and PTs from the research team delivered a training program, which was tailored to each professional group.…”