scholarly journals Predictors of Physical Therapy Clinic Performance in the Treatment of Patients With Low Back Pain Syndromes

2008 ◽  
Vol 88 (9) ◽  
pp. 989-1004 ◽  
Author(s):  
Linda Resnik ◽  
Dawei Liu ◽  
Vince Mor ◽  
Dennis L Hart
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Low Back ◽  
Therapist Experience ◽  
Performance Group ◽  
Pain Syndromes ◽  
Physical Therapist Assistants

Background and Purpose Little is known about organizational and service delivery factors related to quality of care in physical therapy. This study sought to identify characteristics related to differences in practice outcomes and service utilization. Subjects The sample comprised 114 outpatient clinics and 1,058 therapists who treated 16,281 patients with low back pain syndromes during the period 2000–2001. Clinics participated with the Focus on Therapeutic Outcomes, Inc (FOTO) database. Methods Hierarchical linear models were used to risk adjust treatment outcomes and number of visits per treatment episode. Aggregated residual scores from these models were used to classify each clinic into 1 of 3 categories in each of 3 types of performance groups: (1) effectiveness, (2) utilization, and (3) overall performance (ie, composite measure of effectiveness and utilization). Relationships between clinic classification and the following independent variables were examined by multinomial logistic regression: years of therapist experience, number of physical therapists, ratio of physical therapists to physical therapist assistants, proportion of patients with low back pain syndromes, number of new patients per physical therapist per month, utilization of physical therapist assistants, and setting. Results Clinics that were lower utilizers of physical therapist assistants were 6.6 times more likely to be classified into the high effectiveness group compared with the low effectiveness group, 6.7 times more likely to be classified in the low utilization group compared with the high utilization group, and 12.4 times more likely to be classified in the best performance group compared with the worst performance group. Serving a higher proportion of patients with low back pain syndromes was associated with an increased likelihood of being classified in the lowest or middle group. Years of physical therapist experience was inversely associated with being classified in the middle utilization group compared with the highest utilization group. Discussion and Conclusion These findings suggest that, in the treatment of patients with low back pain syndromes, clinics that are low utilizers of physical therapist assistants are more likely to provide superior care (ie, better patient outcomes and lower service use).

scholarly journals Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

2005 ◽  
Vol 85 (6) ◽  
pp. 544-555 ◽  
Author(s):  
Geertruida E Bekkering ◽  
Maurits W van Tulder ◽  
Erik JM Hendriks ◽  
Marc A Koopmanschap ◽  
Dirk L Knol ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Patient Outcomes ◽  
Physical Functioning ◽  
Clinical Guidelines ◽  
Physical Therapists ◽  
Low Back ◽  
Active Strategy ◽  
Active Implementation

Abstract Background and Purpose. An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. Subjects. One hundred thirteen primary care physical therapists treated a total of 500 patients. Methods. The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. Results. Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. Discussion and Conclusion. The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved.

scholarly journals Direct Access to Physical Therapy for Patients With Low Back Pain in the Netherlands: Prevalence and Predictors

2014 ◽  
Vol 94 (3) ◽  
pp. 363-370 ◽  
Author(s):  
Jantine Scheele ◽  
Frank Vijfvinkel ◽  
Marijn Rigter ◽  
Ilse C.S. Swinkels ◽  
Sita M.A. Bierman-Zeinstra ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
The Netherlands ◽  
Clinical Characteristics ◽  
Physical Therapists ◽  
Education Level ◽  
Direct Access ◽  
Low Back ◽  
Episodes Of Care

Background In the Netherlands, direct access to physical therapy was introduced in 2006. Although many patients with back pain visit physical therapists through direct access, the frequency and characteristics of episodes of care are unknown. Objective The purposes of this study were: (1) to investigate the prevalence of direct access to physical therapy for patients with low back pain in the Netherlands from 2006 to 2009, (2) to examine associations between mode of access (direct versus referral) and patient characteristics, and (3) to describe the severity of the back complaints at the beginning and end of treatment for direct access and referral-based physical therapy. Design A cross-sectional study was conducted using registration data of physical therapists obtained from a longitudinal study. Method Data were used from the National Information Service for Allied Health Care, a registration network of Dutch physical therapists. Mode of access (direct or referral) was registered for each episode of physical therapy care due to back pain from 2006 to 2009. Logistic regression analysis was used to explore associations between mode of access and patient/clinical characteristics. Results The percentage of episodes of care for which patients with back pain directly accessed a physical therapist increased from 28.9% in 2006 to 52.1% in 2009. Characteristics associated with direct access were: middle or higher education level (odds ratio [OR]=1.3 and 2.0, respectively), previous physical therapy care (OR=1.7), recurrent back pain (OR=1.7), duration of back pain <7 days (OR=4.2), and age >55 years (OR=0.6). Limitations The study could not compare outcomes of physical therapy care by mode of access because this information was not registered from the beginning of data collection and, therefore, was missing for too many cases. Conclusions Direct access was used for an increasing percentage of episodes of physical therapy care in the years 2006 to 2009. Patient/clinical characteristics associated with the mode of access were education level, recurrent back pain, previous physical therapy sessions, and age.

scholarly journals FREQUENCY OF WORK RELATED LOW BACK PAIN AMONG PHYSICAL THERAPISTS

2013 ◽  
Vol 2 (2) ◽  
pp. 38-44
Author(s):  
Saima Javed ◽  
Anum Jawaid Sultan ◽  
M. Usman Khan ◽  
Maria Rahim
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Tertiary Care ◽  
Activity Level ◽  
Care Hospital ◽  
Low Back ◽  
Specialty Area ◽  
Work Related

To find out the frequency of work, related to Low Back Pain (LBP) among physical therapist of tertiary care hospital of Karachi. To analyze the effects of physical activity level, sub-specialty areas and Body Mass Index (BMI) on Work Related Low Back Pain (WRLBP) as well. A cross-sectional survey was conducted with non-probability convenience sampling technique was used. The study included 265 Physical Therapist working in Tertiary Care Hospitals of Karachi. Data was collected throughpre-tested, structured and self-administered questionnaire and then,wasanalyzed on SPSS version 17. This study reported that prevalence of WRLBP was 66.4%. The rate was higher in femalephysiotherapist, that is, 42.6%. Data revealed that, 69% of respondents experienced WRLBP within 2 years of their practices. Moreover, the manual therapy was found to be the most common cause for WRLBP. No significant association was found between BMIand physical activitylevel of physical therapist, but interestingly, it was found that sub-specialty area of work was correlated with WRLBP. The rate of WRLBP has been found to be high in physical therapists due to their profession. It is therefore, required to build up an effective ergonomic strategy, strengthen training for prevention at undergraduate level in order to reduce and prevent WRLBP.

scholarly journals Physical Therapists' Evaluation of the Trunk Flexors in Patients With Low Back Pain.

2004 ◽  
Author(s):  
Shari Rone-Adams ◽  
Eric Shamus ◽  
Melissa Hileman
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Study Design ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Chief Complaint ◽  
Abdominal Muscles ◽  
Low Back ◽  
Single Blind ◽  
Flexor Strength

Study Design: This study utilized a single blind design in the observation of 20 initial low back evaluations performed by physical therapists. The physical therapists were blinded to what the researchers were observing. Objective: The objective of this study was to determine whether or not physical therapists were quantifying the strength of trunk flexors when the patient’s chief complaint was low back pain. Background: The literature has shown that there is a relationship between back pain and decreased strength in the abdominal muscles. Therefore, it appears important for physical therapists to evaluate the abdominal muscles in patients with low back pain. Methods and Measures: Twenty physical therapists participated in the study. The researchers observed if trunk flexor strength was quantified during the initial evaluation of 20 patients with low back pain. Following the observation, each physical therapist was given a questionnaire and asked to comment on their evaluation of the trunk flexors. Results: Of the evaluations that were observed, 15% of the physical therapists evaluated the trunk flexors and 85% did not. Conclusion: This study demonstrated that therapists did not consistently quantify abdominal strength when treating patients with low back pain.

scholarly journals PREVALENCE OF LOW BACK PAIN IN HOME-BASED PHYSICAL THERAPISTS

2013 ◽  
Vol 2 (1) ◽  
pp. 15-20
Author(s):  
Ghazala Noor Nizami ◽  
Muhammad Sarfaraz ◽  
Dr. Shazia Noor Nizami
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Physical Therapists ◽  
Sampling Technique ◽  
Survey Study ◽  
Low Back ◽  
Work Related ◽  
Home Based ◽  
Significant Difference

BACKGROUND To find out the prevalence and to highlight the risk factors of low back pain in home-based physical therapist. STUDY DESIGN AND SAMPLING TECHNIQUE A cross-sectional survey study with non-probability convenience sampling technique STUDY SETTING AND PARTICIPANTS 200 physical therapists that were doing home patients in Karachi, either without or with their jobs were the part of this study. They were either self-employed or affiliated to different hospitals. DATA COLLECTING TOOL AND DATA ANALYSIS A questionnaire was used to collect data, which was adopted from Nordic questionnaire and other researches. The collected data was analyzed on SPSS 20. RESULTS 93 % home-based physical therapists had experienced the work-related pain or discomfort in the last 12 months. Among them the low back is the highly affected site with prevalence of 81.5%. Their working status of job in physical therapy department or academics with home-based physical therapy had a significant difference in presence or absence of work related pain or discomfort. CONCLUSION This study shows that home-based physical therapists are more prone to develop work-related problems and had higher prevalence of work-related LBP. This may be due to more work load, lower bed height of home patients, poor ergonomics at homes of patients and poor posture of physical therapists.

scholarly journals Work-Related Low Back Pain Among Physical Therapists in Riyadh, Saudi Arabia

2017 ◽  
Vol 65 (8) ◽  
pp. 337-345 ◽  
Author(s):  
Ahmad Alghadir ◽  
Hamayun Zafar ◽  
Zaheen A. Iqbal ◽  
Einas Al-Eisa
Keyword(s):  
Saudi Arabia ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Demographic Data ◽  
Daily Activities ◽  
Low Back ◽  
Online Questionnaire ◽  
Work Related

Low back pain (LBP) is a common health problem. Professions like physical therapy (PT), involving frequent lifting, bending, or standing, are at risk for developing LBP. The objective of this study was to determine the prevalence of work-related LBP and factors associated with and consequences of work-related LBP among physical therapists in Riyadh, Saudi Arabia. A self-administered online questionnaire (i.e., demographic data, history of LBP before and after working as a physical therapist, work setting, and effect on daily activities) was sent to 600 members of the Saudi PT association. Data were analyzed using the Pearson chi-square test and Mann-Whitney U test. Eighty-eight percent of potential respondents completed the questionnaire. Of these, 89.65% of the therapists reported LBP after beginning their PT practice, and 35.6% reported LBP at the time of this survey. Gender, PT specialty, and duration of contact with patients were all found to be related to LBP. The prevalence of work-related LBP among physical therapist in Riyadh was high, affecting patient care and daily activities of the therapists. Both primary and secondary prevention strategies (e.g., introduce ergonomics into PT curricula, reduce therapist stress, and promote teamwork) are needed to decrease LBP among therapists, so they can effectively care for patients.

scholarly journals Physical Therapist Management of a Patient With Acute Low Back Pain and Elevated Fear-Avoidance Beliefs

2004 ◽  
Vol 84 (6) ◽  
pp. 538-549 ◽  
Author(s):  
Steven Z George ◽  
Joel E Bialosky ◽  
Julie M Fritz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Physical Therapist ◽  
Previous History ◽  
Sales Manager ◽  
Low Back ◽  
Fear Avoidance ◽  
Fear Avoidance Beliefs ◽  
Acute Low Back Pain

Abstract Background and Purpose. Elevated fear-avoidance beliefs are believed to be a precursor of chronic disability, yet effective intervention options have not been described in the literature. The purpose of this case report is to describe physical therapist management of a patient with acute low back pain and elevated fear-avoidance beliefs. Case Description. The patient was a 42-year-old sales manager with acute low back pain. The patient had no previous history of activity-limiting low back pain and initially had limitations in straight leg raising, limitations in lumbar movement, and elevated fear-avoidance beliefs. Intervention. Treatment-based classification and graded exercise were used. Outcome. Disability, fear-avoidance beliefs, and pain decreased 4 weeks after starting physical therapy. Six months later, disability and fear-avoidance beliefs had increased, but were still improved when compared with the initial measurements. Discussion. Disability and fear-avoidance beliefs improved following a fear-avoidance-based physical therapy intervention. Research is warranted to investigate the effectiveness of this approach.

scholarly journals A Qualitative Investigation of Physical Therapists' Experiences and Feelings of Managing Patients With Nonspecific Low Back Pain

2012 ◽  
Vol 92 (2) ◽  
pp. 266-278 ◽  
Author(s):  
Janet E. Jeffrey ◽  
Nadine E. Foster
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Working Relationships ◽  
Low Back ◽  
Pain Beliefs ◽  
Semistructured Interviews ◽  
Therapist Communication ◽  
Beliefs And Attitudes

Background Physical therapists' management of patients with nonspecific low back pain (NSLBP) has been found to be associated with their beliefs and attitudes toward NSLBP, as well as with guideline recommendations. Greater knowledge of physical therapists' experiences and feelings of treating patients with NSLBP may help to explain these associations and increase our understanding of some of the challenges physical therapists face when treating patients with NSLBP in clinical practice. Objectives The objective of this study was to understand more about how the personal experiences and feelings of physical therapists might influence their decision making when treating patients with NSLBP. Design This was a qualitative study using a phenomenological hermeneutical approach and practitioner-as-researcher model. Methods Eleven semistructured interviews with physical therapists were conducted and analyzed using the hermeneutical circle to identify key themes relating to their experiences and feelings in treating patients with NSLBP. Results Three linked themes emerged: (1) physical therapists believe that NSLBP has an underlying mechanical and recurring nature, (2) physical therapists' attitude toward managing NSLBP is to empower patients to exercise and self-manage their pain and functional problems, and (3) physical therapists experience feelings of tension between the advice and treatment they feel is best for their patient and the patient's own beliefs and attitudes. Conclusions The experiences and feelings of physical therapists treating patients with NSLBP include conflict among their pain beliefs, attitudes, and working partnerships with patients. Treatment decisions may be influenced when physical therapists modify their beliefs and attitudes to reduce this sense of conflict. Improving physical therapist communication skills may help decrease feelings of conflict, enhance working relationships, and encourage a more consistent approach toward patients with NSLBP.

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

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Carolin Bahns ◽  
Lisa Happe ◽  
Christian Thiel ◽  
Christian Kopkow
Keyword(s):  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Physical Therapy ◽  
Guideline Adherence ◽  
Physical Therapists ◽  
Diagnostic Process ◽  
Low Back ◽  
German Physical

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.

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