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

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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Faculty Opinions recommendation of Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717969063.793468611 ◽

2013 ◽

Author(s):

Steven George ◽

Jason Beneciuk

Keyword(s):

Primary Care ◽

Health Care ◽

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Health Care Utilization ◽

Care Utilization ◽

Low Back ◽

Future Health ◽

Future Health Care

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The Influence of Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review

PM&R ◽

10.1016/j.pmrj.2018.09.029 ◽

2019 ◽

Vol 11 (2) ◽

pp. 167-176 ◽

Cited By ~ 12

Author(s):

Abdolhamid Hajihasani ◽

Mitra Rouhani ◽

Mahyar Salavati ◽

Rosita Hedayati ◽

Amir H. Kahlaee

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Cognitive Behavioral Therapy ◽

Chronic Low Back Pain ◽

Behavioral Therapy ◽

Low Back

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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

Physical Therapy ◽

10.1093/ptj/85.6.544 ◽

2005 ◽

Vol 85 (6) ◽

pp. 544-555 ◽

Cited By ~ 88

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.

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GENDER DIFFERENCE IN OCCUPATIONAL PERFORMANCE, QUALITY OF LIFE AND TRUNK MUSCLE ENDURANCE IN PHYSICAL THERAPISTS WITH LOW BACK PAIN

International Journal of Advanced Research ◽

10.21474/ijar01/9950 ◽

2019 ◽

Vol 7 (10) ◽

pp. 1250-1256

Author(s):

Salma E Ahmad ◽

◽

Ebtessam F Gomaa ◽

Nadia A Fayaz ◽

Ahmad H Azzam ◽

...

Keyword(s):

Quality Of Life ◽

Low Back Pain ◽

Back Pain ◽

Gender Difference ◽

Physical Therapists ◽

Muscle Endurance ◽

Low Back ◽

Occupational Performance ◽

Performance Quality

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Adherence to Clinical Practice Guidelines for Low Back Pain in Physical Therapy: Do Patients Benefit?

Physical Therapy ◽

10.2522/ptj.20090173 ◽

2010 ◽

Vol 90 (8) ◽

pp. 1111-1122 ◽

Cited By ~ 83

Author(s):

Geert M. Rutten ◽

Saskia Degen ◽

Erik J. Hendriks ◽

Jozé C. Braspenning ◽

Janneke Harting ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapy ◽

Physical Functioning ◽

Guideline Adherence ◽

Internal Validity ◽

Small Sample ◽

Low Back ◽

Process Of Care ◽

Dutch Version

BackgroundVarious guidelines for the management of low back pain have been developed to enhance the effectiveness and efficiency of care. Evidence that guideline-adherent care results in better health outcomes, however, is not conclusive.ObjectiveThe main objective of this study was to assess whether a higher percentage of adherence to the Dutch physical and manual therapy guidelines for low back pain is related to improved outcomes. The study further explored whether this relationship differs for the individual steps of the process of care and for distinct subgroups of patients.DesignThis was an observational prospective cohort study (2005–2006) in the Netherlands that included a sample of 61 private practice therapists and 145 patients.MethodsTherapists recorded the process of care and the number of treatment sessions in Web-based patient files. Guideline adherence was assessed using quality indicators. Physical functioning was measured by the Dutch version of the Quebec Back Pain and Disability Scale, and average pain was measured with a visual analog scale. Relationships between the percentage of guideline adherence and outcomes of care were evaluated with regression analyses.ResultsHigher percentages of adherence were associated with fewer functional limitations (β=−0.21, P=.023) and fewer treatment sessions (β=−0.27, P=.005).LimitationsThe relatively small self-selected sample might limit external validity, but it is not expected that the small sample greatly influenced the internal validity of the study. Larger samples are required to enable adequate subgroup analyses.ConclusionsThe results indicate that higher percentages of guideline adherence are related to better improvement of physical functioning and to a lower utilization of care. A proper assessment of the relationship between the process of physical therapy care and outcomes may require a comprehensive set of process indicators to measure guideline adherence.

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