Abstract
Background: Chronic low back pain is associated with disability and work absence. Stratified primary care management of acute low back pain using a prognostic screening tool (STarT Back) allows triage of those at risk of chronicity. Primary health practitioners can use this method of stratification to assess patients with low back pain then allocate them to matched treatment groups. STarT Back was designed for use in the health service in the United Kingdom (UK) where stratification using STarT Back has been shown to improve clinical outcomes, patient satisfaction, and reduce treatment costs and time off work. Implementation of STarT Back in health care systems outside of the UK is in an early stage and its success is dependent on the health practitioners using it and the healthcare system in which they work. Gaining health practitioners’ perspectives on STarT Back is an important step in effective implementation. This will help contextualise the tool to each healthcare environment, making it easier and more meaningful for intended users. Methods: A computerised search of qualitative literature was conducted across seven databases in August 2020 using keywords to identify studies that investigate the perspectives of physiotherapists and general practitionners on the use of STarT Back in primary health care. Study quality was assessed using the CASP tool. Data were analysed using reflexive thematic analysis. Results: Eight articles met the inclusion criteria where qualitative data was retrievable and included the views of general practitioners and physiotherapists from primary health care settings from four countries. Participants’ perspectives varied across the data, and three key themes were created from these findings: ‘making it work’, ‘will I do it?’, and ‘it’s all about the patient’. Conclusions: Physiotherapists and general practitioners found using STarT Back frequently enhanced their practice. General practitioners did express concerns about time constraints and the potential for STarT Back to undermine their clinical experience. Findings from this study will inform adaptations of STarT Back to ensure successful implementation into different health contexts.
Clinical assessment and patient-reported outcome measures in low-back pain – a survey among primary health care physiotherapists
