What Do Patients with Chronic Spinal Pain Expect from Their Physiotherapist?

Abstract

Evidence has suggested that patients' expectations influence the clinical course when they present with low back pain (LBP). However, little empirical evidence has outlined the nature of these expectations. The aim of this study was to describe LBP patients' expectations of physiotherapy. Seventy-nine adult patients who had LBP for more than 16 weeks and were referred for physiotherapy at two hospital physiotherapy departments in St. John's, Newfoundland and Labrador, were included. They filled out a questionnaire detailing their expectations of treatment. Before treatment, more than 90% of patients expected a physical examination, tests or investigations, a diagnosis, reassurance and advice, and clear explanations of causation, symptom management, and benefits and risks of treatment. Approximately half hoped for a prescription or referral to a specialist, and about 60% hoped to discuss problems in their life. The findings of this study indicate that patients attend physiotherapy with clear expectations about what information should be provided. Most expected tests or investigations leading to diagnosis and an explanation of causation; this presents a challenge for clinicians, given the current understanding of LBP reflected in international practice guidelines. The fact that more than half of the patients wanted to discuss problems in their life points to the need for physiotherapists to consider LBP from a bio-psychosocial perspective.

Physical Therapy Informed by Acceptance and Commitment Therapy (PACT) Versus Usual Care Physical Therapy for Adults With Chronic Low Back Pain: A Randomized Controlled Trial

“…The PACT treatment approach can address physical therapists' barriers to using psychological techniques, 25 as well as patients' concerns about finding a credible treatment offering aspects of care they value. 17 As physical therapy is a common treatment for CLBP and millions of patients are referred to physical therapists every year, even small additional benefits could have a considerable impact for patients, healthcare providers, and society. Next steps might include refining the training and support for physical therapists, as well as investigating whether to select patients and/ or provide additional treatment sessions.…”

“…15 Recent reviews have concluded that this could be rectified with additional training and support. 16 Other findings have suggested patients with CLBP want to discuss personal issues with their physical therapist, 17 although many physical therapists perceive they lack the skills or confidence to address these concerns. 14 This highlights the need to develop psychologically informed interventions that are suitable for physical therapists and the training to help them provide it.…”

What do the General Public Believe About the Causes, Prognosis and Best Management Strategies for Low Back Pain? A Cross Sectional Study

“…The ndings of this survey point to challenges for clinicians in the management of their patients with back pain, and align with ndings from a clinical sample in the same jurisdiction. [21] These challenges lie with commonly held beliefs that run contrary to evidence-based management of LBP. Most notably, substantial proportions of people believe that they should stop working and rest, that their backs will forever be weak, that there is no real treatment and that imaging is necessary.…”

Healthy Lifestyle Program (HeLP) for low back pain: protocol for a randomised controlled trial

“…Physical assessment, education and advice are built on guideline recommendations and in line with expectations from physiotherapists of patients with back pain 23–25 35–37. Education and advice are designed to improve participants’ understanding of the biopsychosocial nature of low back pain by presenting information on the nature of pain biology,38 address erroneous beliefs about back pain (eg, that low back pain is always associated with pathology) and outline links between low back pain and health behaviour risks (weight, smoking, and so on).…”