Evidence-based practice for non-specific low back pain: Canadian physiotherapists’ adherence, beliefs, and perspectives
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Date
2019-08-24
Authors
do Prado, Tamires Cristina
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Abstract
Incidence and prevalence of low back pain (LBP) continue to grow in Canada and world- wide; associated psychosocial demands often lead to long-term disability increasing individual and socioeconomic burden. In spite of efforts to develop and update evidence-based clinical practice guidelines (EBCPGs), a gap remains between research findings and physiotherapists’ practice. Registered Canadian physiotherapists (n=525) completed a cross-sectional online survey including demographic and practice characteristics, a clinical scenario, a questionnaire to assess back pain beliefs (PABS-PT), and a scale to measure self-efficacy in implementing evidence-based practice (EPIC). Treatment choices related to the clinical scenario were scored on a 4-point scale according to recent EBCPGs, and 77.3% of respondents were deemed to have higher adherence (score of 3 or 4) to EBCPGs; however, only 29.5% of respondents chose interventions to directly address psychosocial demands. Physiotherapists with higher adherence to EBCPGs had significantly lower biomedical (mean difference: -3.6, p < 0.001, 95% CI(-5.1, - 2.1)) and significantly higher behavioural (mean difference: 2.6, p < 0.001, 95% CI(1.6, 3.6)) scores on the PABS-PT questionnaire compared to the other group; scores on the EPIC scale were no different between the groups (mean difference: 1.7, p = 0.299, 95% CI(-1.5, 4.8)). A binary logistic regression analysis was conducted to identify predictors of group membership. Physiotherapists’ intention to use EBCPGs, subjective norms regarding use of EBCPGs, biomedical beliefs, and having post-graduate training were significant predictors; the latter being the strongest predictor of higher-adherence. Seven Manitoban physiotherapists were interviewed and reported being highly satisfied with the care they have been providing to patients with LBP even when psychosocial issues are present. Interviewees did not perceive a need for immediate change in their practice but described that it is their responsibility to remain up to date with evidence and identify areas that need improvement. Although overall adherence was high, Canadian physiotherapists do not address psychosocial demands of LBP patients as frequently and do not perceive it as an issue that requires practice changes. Further education and training in EBCPGs and how to address psychosocial demands for physiotherapists in Canada is warranted.
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Keywords
Evidence-based practice, Physiotherapy, Guidelines, Low back pain, Non-specific low back pain, NSLBP, EBP, Clinical behaviour