Varied use of physical therapists by people with back and neck pain suggests overuse by some patients and underuse by others

2006 ◽  
Keyword(s):  
Neck Pain ◽  
Physical Therapists

scholarly journals Manual Physical Therapists’ Use of Biopsychosocial History Taking in the Management of Patients with Back or Neck Pain in Clinical Practice

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Rob A. B. Oostendorp ◽  
Hans Elvers ◽  
Emilia Mikołajewska ◽  
Marjan Laekeman ◽  
Emiel van Trijffel ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neck Pain ◽  
Physical Therapists ◽  
Social Dimension ◽  
History Taking ◽  
Social Dimensions ◽  
Process Indicators ◽  
The Social ◽  
Audio Recordings ◽  
And Behavior

Objective.To develop and evaluate process indicators relevant to biopsychosocial history taking in patients with chronic back and neck pain.Methods.The SCEBS method, covering the Somatic, Psychological (Cognition, Emotion, and Behavior), and Social dimensions of chronic pain, was used to evaluate biopsychosocial history taking by manual physical therapists (MPTs). In Phase I, process indicators were developed while in Phase II indicators were tested in practice.Results.Literature-based recommendations were transformed into 51 process indicators. Twenty MTPs contributed 108 patient audio recordings. History taking was excellent (98.3%) for the Somatic dimension, very inadequate for Cognition (43.1%) and Behavior (38.3%), weak (27.8%) for Emotion, and low (18.2%) for the Social dimension. MTPs estimated their coverage of the Somatic dimension as excellent (100%), as adequate for Cognition, Emotion, and Behavior (60.1%), and as very inadequate for the Social dimension (39.8%).Conclusion.MTPs perform screening for musculoskeletal pain mainly through the use of somatic dimension of (chronic) pain. Psychological and social dimensions of chronic pain were inadequately covered by MPTs. Furthermore, a substantial discrepancy between actual and self-estimated use of biopsychosocial history taking was noted. We strongly recommend full implementation of the SCEBS method in educational programs in manual physical therapy.

scholarly journals Does Continuing Education Improve Physical Therapists’ Effectiveness in Treating Neck Pain? A Randomized Clinical Trial

2009 ◽  
Vol 89 (1) ◽  
pp. 38-47 ◽  
Author(s):  
Joshua A Cleland ◽  
Julie M Fritz ◽  
Gerard P Brennan ◽  
Jake Magel
Keyword(s):  
Physical Therapy ◽  
Neck Pain ◽  
Continuing Education ◽  
Rating Scale ◽  
Physical Therapists ◽  
Neck Disability Index ◽  
Mean Difference ◽  
Educational Outreach ◽  
Final Visit ◽  
Pain Rating

Background and PurposePhysical therapists often attend continuing education (CE) courses to improve their overall clinical performance and patient outcomes. However, evidence suggests that CE courses may not improve the outcomes for patients receiving physical therapy for the management of neck pain. The purpose of this study was to investigate the effectiveness of an ongoing educational intervention for improving the outcomes for patients with neck pain.ParticipantsThe study participants were 19 physical therapists who attended a 2-day CE course focusing on the management of neck pain. All patients treated by the therapists in this study completed the Neck Disability Index (NDI) and a pain rating scale at the initial examination and at their final visit.MethodsTherapists from 11 clinics were invited to attend a 2-day CE course on the management of neck pain. After the CE course, the therapists were randomly assigned to receive either ongoing education consisting of small group sessions and an educational outreach session or no further education. Clinical outcomes achieved by therapists who received ongoing education and therapists who did not were compared for both pretraining and posttraining periods. The effects of receiving ongoing education were examined by use of linear mixed-model analyses with time period and group as fixed factors; improvements in disability and pain as dependent variables; and age, sex, and the patient's initial NDI and pain rating scores as covariates.ResultsPatients treated by therapists who received ongoing education experienced significantly greater reductions in disability during the study period (pretraining to posttraining) than those treated by therapists who did not receive ongoing training (mean difference=4.2 points; 95% confidence interval [CI]=0.69, 7.7). Changes in pain did not differ for patients treated by the 2 groups of therapists during the study period (mean difference=0.47 point; 95% CI=−0.11, 1.0). Therapists in the ongoing education group also used fewer visits during the posttraining period (mean difference=1.5 visits; 95% CI=0.81, 2.3).Discussion and ConclusionThe results of this study demonstrated that ongoing education for the management of neck pain was beneficial in reducing disability for patients with neck pain while reducing the number of physical therapy visits. However, changes in pain did not differ for patients treated by the 2 groups of therapists. Although it appears that a typical CE course does not improve the overall outcomes for patients treated by therapists attending that course, more research is needed to evaluate other educational strategies to determine the most clinically effective and cost-effective interventions.

scholarly journals Impact of Continuing Education Interventions on Clinical Outcomes of Patients With Neck Pain Who Received Physical Therapy

2006 ◽  
Vol 86 (9) ◽  
pp. 1251-1262 ◽  
Author(s):  
Gerard P Brennan ◽  
Julie M Fritz ◽  
Stephen J Hunter
Keyword(s):  
Physical Therapy ◽  
Neck Pain ◽  
Continuing Education ◽  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Physical Therapists ◽  
Improvement Project ◽  
Clinical Databases ◽  
Education Interventions ◽  
Ongoing Project

Abstract Background and Purpose. Physical therapists frequently attend continuing education courses with the goal of providing better care, yet the effectiveness of continuing education for improving outcomes has not been examined. Subjects. Data were obtained for all eligible patients (n=1,365; mean age=42.1 years, SD=14.0 years; 69.9% female) with a chief complaint of neck pain who were treated in 13 physical therapy clinics over a 24-month period. Disability data (Neck Disability Index scores) from the initial and final therapy sessions were recorded from clinical databases. Methods. Thirty-four of 57 physical therapists employed within the 13 clinics attended a 2-day continuing education course. Eleven of the 34 attendees also participated in an ongoing clinical improvement project for patients with neck pain. Clinical outcomes were compared in the pre- and post-course periods for therapists attending or not attending the course, and for therapists participating or not participating in the ongoing project. Results. There were no differences in clinical outcomes based on attendance at the continuing education course. There was an interaction between time and participation in the ongoing project, such that participants achieved greater change in disability after the course. The percentage of patients achieving at least the minimum detectable amount of change in disability with treatment increased significantly for participants after the course. Discussion and Conclusion. Attendance at a 2-day continuing education course was not associated with improvement in clinical outcomes, but participation in an ongoing improvement project did result in greater clinical improvement for patients with neck pain. Further investigation of educational methods to improve clinical outcomes is needed. These results suggest that traditional continuing education formats may not be effective for improving patient care. [Brennan GP, Fritz JM, Hunter SJ. Impact of continuing education interventions on clinical outcomes of patients with neck pain who received physical therapy. Phys Ther. 2006;86:1251–1262.]

scholarly journals A Qualitative Comparison of Reassurance Approaches Used by Physical Therapists to Address Fears and Concerns of Patients With Nonspecific Neck Pain and Whiplash-Associated Disorders: An Online Survey

2020 ◽  
Vol 100 (7) ◽  
pp. 1132-1141
Author(s):  
Alma Viviana Silva Guerrero ◽  
Jenny Setchell ◽  
Annicke Maujean ◽  
Michele Sterling
Keyword(s):  
Psychological Distress ◽  
Neck Pain ◽  
Online Survey ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Qualitative Comparison ◽  
Convenience Sampling ◽  
Whiplash Associated Disorders ◽  
Survey Responses ◽  
Constant Comparative Analysis

Abstract Objectives The study aimed to identify and compare (1) what physical therapists perceive to be the main concerns, fears, and worries that patients with whiplash-associated disorders (WAD) and nontraumatic neck pain (NTNP) have as a result of their condition, and (2) the strategies used by physical therapists to address these fears and concerns. Methods Using convenience sampling, 30 physical therapists completed 2 online open-ended surveys. The responses were analyzed using 2 descriptive analytic methods (thematic analysis and constant comparative analysis), and then themes were examined for areas of convergence and divergence. Results Four similar themes for both neck pain groups were produced from our analysis of the survey responses: (1) interference with daily life, (2) concerns related to pain, (3) psychological distress, and (4) ``When I will recover?'' Subthemes differed between the groups. For example, the theme “psychological distress” had subthemes of anger and thoughts about no resolution for the WAD group, whereas for the NTNP group, subthemes were anxiety and uncertainty. The only divergent theme was (5) fear avoidance, present in the NTNP group only. Analysis of physical therapist strategies identified 3 consistent themes and 5 divergent themes across the 2 groups. Conclusions Physical therapists described a wealth of reassurance strategies for individuals with NTNP and WAD. There were several shared themes but also some discordant ones. Reassurance is multifactorial and needs to be nuanced and not prescriptive. Impact These qualitative findings may be key to inform the differentiated content of training programs for physical therapists delivering reassurance for these 2 populations.

scholarly journals Management of Back and Neck Pain: Who Seeks Care From Physical Therapists?

2005 ◽  
Vol 85 (9) ◽  
pp. 872-886 ◽  
Author(s):  
Janet K Freburger ◽  
Timothy S Carey ◽  
George M Holmes
Keyword(s):  
Physical Therapy ◽  
Neck Pain ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Illness Severity ◽  
Initial Evaluation ◽  
Factors Associated ◽  
Health And Illness ◽  
Spine Care ◽  
Therapy Services

Abstract Background and Purpose Little information is available on factors associated with physical therapist use by people with back or neck pain. Identifying the characteristics of people who seek care from physical therapists is a useful first step in determining whether there is appropriate use of physical therapy services. The purpose of this study was to identify factors associated with physical therapist use by people with back or neck pain. Subjects The subjects were 29,049 people who had back pain or neck pain, or both, and who were seen for an initial evaluation at 1 of 21 US spine care centers. Each subject and evaluating physician completed a written survey at the time of the initial evaluation. Methods Multiple logistic regression analyses were conducted to identify factors associated with physical therapist use. Results Several measures of health and illness severity were associated with physical therapist use. Age and being male were negatively associated with physical therapist use. Education level, having workers' compensation coverage, and being in litigation were positively associated with physical therapist use. Physical therapist use also varied by previous physician use and census region. Discussion and Conclusion The results suggest that variations in physical therapist use are associated with factors other than health and illness severity. The results also suggest that people who would benefit from physical therapy may not be receiving it or that people who would not benefit from physical therapy are receiving it, or both.

scholarly journals Postural Correction in Persons with Neck Pain. I. A Survey of Neck Positions Recommended by Physical Therapists

1986 ◽  
Vol 8 (5) ◽  
pp. 235-239 ◽  
Author(s):  
Chukuka S. Enwemeka ◽  
Ivette M. Bonet ◽  
Jayanti A. Ingle ◽  
Somsri Prudhithumrong ◽  
Frank E. Ogbahon ◽  
...  
Keyword(s):  
Neck Pain ◽  
Physical Therapists ◽  
Postural Correction

scholarly journals An Overview of 5 Years of Patient Self-Referral for Physical Therapy in the Netherlands

2014 ◽  
Vol 94 (12) ◽  
pp. 1785-1795 ◽  
Author(s):  
Ilse C.S. Swinkels ◽  
Margit K. Kooijman ◽  
Peter M. Spreeuwenberg ◽  
Daniël Bossen ◽  
Chantal J. Leemrijse ◽  
...  
Keyword(s):  
General Practice ◽  
Physical Therapy ◽  
The Netherlands ◽  
Neck Pain ◽  
Physical Therapists ◽  
Incidence Rates ◽  
Data Sources ◽  
Low Back ◽  
Gp Care ◽  
Existing Data

BackgroundSelf-referral for physical therapy was introduced in 2006 in the Netherlands. Internationally, debate on self-referral is still ongoing.ObjectiveThe aim of this study was to evaluate the effects of self-referral for physical therapy in the Netherlands, focusing on volume of general practice and physical therapy care (incidence rates and utilization of services).DesignThe study was based on monitoring data from existing data sources.MethodsLongitudinal electronic medical record data from general practitioners (GPs) and physical therapists participating in the NIVEL Primary Care Database were used, as well as public data from Statistics Netherlands. Descriptive statistics and Poisson multilevel regression analyses were used for analyzing the data.ResultsIncidence rates of back (including low back), shoulder, and neck pain in general practice declined slightly from 2004 to 2009. No linear trends were found for number of contacts in GP care for back (including low back) and neck pain. The number of patients visiting physical therapists and the proportion of self-referrers are growing. Self-referrers receive treatment less often after initial intake than referred patients, and the mean number of visits is lower.LimitationsThis study was based on data of various patient populations from existing data sources.ConclusionsThe current study indicates that self-referral in the Netherlands has fulfilled most expectations held prior to its introduction, although no changes to the workload of GP care have been found. Use of physical therapy grew, but due to population aging and increasing prevalence of chronic diseases, it remains unclear whether self-referral affects health care utilization. Therefore, cost-benefit analyses are recommended.

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