Independent prescribing by advanced Physiotherapists for patients with low back pain in primary care: feasibility trial with an embedded qualitative-component

IntroductionLow back pain (LBP) is the most prevalent musculoskeletal condition in the UK. Guidelines advocate a multimodal approach, including prescription of medications. Advanced physiotherapy practitioners (APPs) are well placed to provide this care in primary care. Physiotherapist independent prescribing remains novel, with the first prescribers qualifying in 2014. This feasibility trial aims to evaluate the feasibility, suitability and acceptability of assessing the effectiveness of independent prescribing by APPs for patients with LBP in primary care, to inform the design of a future definitive stepped-wedged cluster trial.Method and analysis(1) Trial component. An APP (registered prescriber) will complete the initial participant consultation. If prescription drugs are required within the multimodal physiotherapeutic context, these will be prescribed. Patient-reported outcome measures will be completed prior to initial assessment and at 6 and 12 weeks to assess feasibility of follow-up and data collection procedures. Accelerometers will be fitted for 7 days to assess physical activity, sedentary behaviour and feasibility of use. (2) Embedded qualitative component. A focus group and semistructured interviews will be used to evaluate the views and experiences of the participants and APPs respectively, about the feasibility, suitability and acceptability of the proposed full trial. A Consolidated Standards of Reporting Trials diagram will be used to analyse feasible eligibility, recruitment and follow-up rates. Descriptive analysis of the data will be completed to evaluate procedures. Thematic analysis will be used to analyse and synthesise the qualitative data.Ethics and disseminationThis feasibility trial is approved by the Health Research Authority (HRA). Ethical approval was sought and granted via the Integrated Research Application System (IRAS) ID 250734.Data will be disseminated via publication in peer reviewed journal and conference presentation. It is anticipated that the results of this study will be used in conjunction with ethical evaluation, economic and risk analyses, as well as consultation with key stakeholders including the British health consumer when contemplating change, enhancement or redesign of the essential full randomised controlled trial.Trial registration numberISRCTN15516596, Pre-results.

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Independent prescribing by advanced physiotherapists for patients with low back pain in primary care: a feasibility trial with an embedded qualitative component

http://isrctn.com/ ◽

10.1186/isrctn15516596 ◽

2018 ◽

Author(s):

Timothy Noblet

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Feasibility Trial ◽

Low Back ◽

Independent Prescribing ◽

Qualitative Component

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Using an internet intervention to support self-management of low back pain in primary care: protocol for a randomised controlled feasibility trial (SupportBack)

BMJ Open ◽

10.1136/bmjopen-2015-009524 ◽

2015 ◽

Vol 5 (9) ◽

pp. e009524 ◽

Cited By ~ 8

Author(s):

Adam W A Geraghty ◽

Rosie Stanford ◽

Paul Little ◽

Lisa Roberts ◽

Nadine E Foster ◽

...

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Internet Intervention ◽

Feasibility Trial ◽

Self Management ◽

Low Back ◽

Care Protocol ◽

Randomised Controlled

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Exploring Patients’ Experiences of Internet-Based Self-Management Support for Low Back Pain in Primary Care

Pain Medicine ◽

10.1093/pm/pnz312 ◽

2019 ◽

Vol 21 (9) ◽

pp. 1806-1817 ◽

Cited By ~ 1

Author(s):

Adam W A Geraghty ◽

Lisa C Roberts ◽

Rosie Stanford ◽

Jonathan C Hill ◽

Dinesh Yoganantham ◽

...

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Ease Of Use ◽

Internet Intervention ◽

Feasibility Trial ◽

Self Management ◽

Low Back ◽

Management Support ◽

Convenience Sample

Abstract Objective We explored patients’ experiences of using Internet-based self-management support for low back pain (LBP) in primary care, with and without physiotherapist telephone guidance. Design Exploratory descriptive qualitative study using thematic analysis, nested within a randomized feasibility trial. Methods Patients with LBP who participated in a feasibility trial of the SupportBack Internet intervention (ISRCTN: 31034004) were invited to take part in semistructured telephone interviews after the three-month intervention period (a convenience sample from within the trial population). Fifteen participants took part (age range = 36–87 years, 66.7% female, characteristics representative of the trial population). Data were analyzed thematically. Results Analysis resulted in the development of six themes (subthemes in parentheses): Perceptions of SupportBack’s design (Clarity and ease of use, Variety and range of information provided, Need for specificity and flexibility), Engaging with the SupportBack intervention, Promoting positive thought processes (Reassurance, Awareness of self-management), Managing behavior with SupportBack (Motivation and goal setting, Using activity as a pain management strategy, Preferences for walking or gentle back exercises), Feeling supported by telephone physiotherapists (Provision of reassurances and clarity, Physiotherapists are motivating), Severity and comorbidity as barriers (Preexisting condition or severity acting as a barrier, Less useful for mild low back pain). Conclusions The Internet intervention SupportBack appeared to feasibly support self-management of LBP. Reassurance and ongoing support to implement behavioral changes were central to reported benefits. The addition of physiotherapist telephone support further enhanced the patient experience and the potential utility of the intervention.

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Theory-driven group-based complex intervention to support self-management of osteoarthritis and low back pain in primary care physiotherapy: protocol for a cluster randomised controlled feasibility trial (SOLAS)

BMJ Open ◽

10.1136/bmjopen-2015-010728 ◽

2016 ◽

Vol 6 (1) ◽

pp. e010728 ◽

Cited By ~ 15

Author(s):

Deirdre A Hurley ◽

Amanda M Hall ◽

Laura Currie-Murphy ◽

Tamar Pincus ◽

Steve Kamper ◽

...

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Complex Intervention ◽

Feasibility Trial ◽

Self Management ◽

Low Back ◽

Cluster Randomised ◽

Randomised Controlled

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Comparing an e-Health Program Vs Home Rehabilitation Program in Patients With Non-Specific Low Back Pain: Study Protocol Randomized Feasibility Trial.

10.21203/rs.3.rs-33103/v1 ◽

2020 ◽

Author(s):

Adelaida María Castro-Sánchez ◽

Eduardo Antequera Soler ◽

Guillermo A. Matarán-Peñarrocha ◽

Deirdre Hurley-Osing ◽

Manuel Fernández-Sánchez ◽

...

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Health Intervention ◽

The Self ◽

Feasibility Trial ◽

Self Management ◽

Control Group ◽

Low Back

Abstract Background: Most patients who experience chronic low back pain are managed in primary care services, the international clinical guidelines endorse like first line of treatment the self-management and recommendations for the management of their ailment. The treatment of low back pain an individual self-maintenance program through a web application could mean maintaining of the symptoms, reducing costs in terms of medical care and time work absence. There is little evidence on the reliability of the via Internet-based rehabilitation systems to treat low back pain, the implementation of a clinical and efficient self-maintenance web program is a key priority for the health service in Andalusia.Methods: This protocol describes a double-blind, randomized controlled feasibility trial of a telemedicine program (e-Health intervention) developed to support the self-management of people with chronic low back pain in primary care physiotherapy. Three Hospital with primary care for outpatients will be the units of randomisation, in each Hospital the participants will be randomized to one of two groups, a pragmatic control group receiving either the usual home program based on electrostimulation and McKenzie Therapy and e-Health intervention. Patients are followed up at 2 and 6 months. The primary outcomes are (1) acceptability and demand of the intervention by general practitioners, physiotherapists and patients and (2) feasibility and optimal study design/ methods for a definitive trial. Secondary outcomes will include exploratory analysis and variation in clinical outcomes of pain, disability, fear of movement, quality of life, isometric resistance of the trunk flexors, lumbar mobility in flexion and lumbar segmental range of motion; and the effect of the intervention.Discussion: Through the specific e-Health programs at home, could increase adherence to treatment, patients could learn to control and self-manage the evolution of their low back pain, preventing its evolution to stages of greater pain and disability. If the painful symptomatology improves could be cost-effective healthcare tool that can reach a large number of people living in rural or remote areas.Trial Registration: PC-0185-2017/ NCT04283370. Registered 20 February 2020, https://clinicaltrials.gov/ct2/show/NCT04283370. Recruiting.

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