scholarly journals Professional barriers and facilitators to using stratified care approaches for managing non-specific low back pain: a qualitative study with Canadian physiotherapists and chiropractors

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Fadi M. AL Zoubi ◽  
Simon D. French ◽  
Andrea M. Patey ◽  
Nancy E. Mayo ◽  
André E. Bussières
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Theoretical Domains Framework ◽  
Readiness For Change ◽  
Barriers And Facilitators ◽  
Low Back ◽  
Chronic Patients ◽  
Telephone Interviews ◽  
Stratified Care

Abstract Background Recent clinical practice guidelines for the management of non-specific low back pain (LBP) recommend using stratified care approaches. To date, no study has assessed barriers and facilitators for health professionals in using stratified care approaches for managing non-specific LBP in the Canadian primary care setting. This study aimed to identify and contrast barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors. Methods Individual telephone interviews, underpinned by the Theoretical Domains Framework (TDF), explored beliefs and attitudes about, and identified barriers and facilitators to the use of stratified care approaches for managing non-specific LBP in a purposive sample of 13 chiropractors and 14 physiotherapists between September 2015 and June 2016. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using directed content analysis. Results Three and seven TDF domains were identified as likely relevant for physiotherapists and chiropractors, respectively. Shared key beliefs (and relevant domains of the TDF) for both physiotherapists and chiropractors included: lack of time, cost, and expertise (Environmental Context and Resources); and consulting more experienced colleagues and chronic patients with important psychological overlay (Social Influences). Unique key domains were identified among physiotherapists: incompatibility with achieving other objectives (Goals), and chiropractors: confidence in using stratified care approaches (Beliefs about Capabilities); intention to use stratified care approaches (Intentions); awareness and agreement with stratified care approaches (Knowledge); assessment of readiness for change and intentional planning behaviour (Behavioural Regulation); and improving the management of non-specific LBP patients and the uptake of evidence-based practice (Beliefs about Consequences). Conclusions Several shared and unique barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors were identified. Findings may help inform the design of tailored theory-based knowledge translation interventions to increase the uptake of stratified care approaches in clinical practice.

Role of Vaitarana Basti in the management of Gridhrasi w.s.r. to Sciatica

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Suresh N. Hakkandi ◽  
Dr. Manjunath Akki ◽  
Dr. Bhavana KS
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Routine Activity ◽  
Daily Routine ◽  
Low Back ◽  
Common Condition ◽  
Locomotor System

Vata Vyadhi is one of the most prevailing health problems in our day today clinical practice, Gridhrasi is one among them. Gridhrasi is Shoola Pradhana Nanatmaja Vatavyadhi, affecting the locomotor system and disable from daily routine activity. Gridhrasi the name itself indicates the way of gait shown by the patient due to extreme pain i.e. like Gridhra or Vulture. Gridhrasi is a condition characterized by Ruk, Toda, Stambha, Spandana in Sphik Pradesha and radiates downwards to Kati, Prusta, Uru, Janu, Jangha and Pada. Gridhrasi can be compared with Sciatica. Pain is the chief cause of person to visit a doctor. Although low back pain is a common condition that affects as many as 80 to 90 percent of people during their lifetime. Gridhrasi can be cured by the help of Vaitarana Basti. Hence in the case study of male patient of age 30 yrs presenting with cardinal clinical sign and symptoms of Gridhrasi are Ruka, Toda and Muhu Spandana in the Sphika, Kati, Uru, Janu, Jangha and Pada in order and Sakthikshepanigraha that is restricted lifting of the leg.

Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline

2017 ◽  
Vol 166 (7) ◽  
pp. 493 ◽  
Author(s):  
Roger Chou ◽  
Richard Deyo ◽  
Janna Friedly ◽  
Andrea Skelly ◽  
Robin Hashimoto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Low Back

scholarly journals Stratified care to prevent chronic low back pain in high-risk patients: The TARGET trial. A multi-site pragmatic cluster randomized trial

2021 ◽  
Vol 34 ◽  
pp. 100795
Author(s):  
Anthony Delitto ◽  
Charity G. Patterson ◽  
Joel M. Stevans ◽  
Janet K. Freburger ◽  
Samannaaz S. Khoja ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
High Risk ◽  
Chronic Low Back Pain ◽  
Cluster Randomized Trial ◽  
Low Back ◽  
Target Trial ◽  
Stratified Care ◽  
Risk Patients ◽  
Cluster Randomized

Management Approach Combining Prognostic Screening and Targeted Treatment for Patients with Low Back Pain Compared with Standard Physiotherapy: A Systematic Review & Meta-analysis

2021 ◽  
pp. 7
Author(s):  
Collins Ogbeivor
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Usual Care ◽  
English Language ◽  
Weighted Mean Difference ◽  
Economic Benefits ◽  
Management Approach ◽  
Controlled Trials ◽  
Low Back ◽  
Stratified Care

Introduction: Research evidence suggests that a stratified care management approach is better at improving clinical and economic outcomes for low back pain (LBP) patients compared with usual care in the short term. However, it is unclear if these health and economic benefits are sustainable in the longer term. The aim of this study was, therefore, to determine the effectiveness of stratified care compared with standard physiotherapy for LBP treatment. Methodology: A comprehensive search was undertaken of seven electronic databases (CINAHL, MEDLINE, Pedro, EMBASE, PsycINFO, Cochrane Register for Controlled Trials, and Web of Science with full text). Although no time limits were applied, studies were limited to English language publications and those involving human participants only. Study selection, data extraction, and appraisal of study were independently undertaken by both reviewers (CO and LE). Result: In total, 6842 patients (aged 18 years and above) were included in the eight trials reviewed;  four were randomized controlled trials (RCTs) and four were non-RCTs. The pooled analysis of three studies (n = 2460) demonstrated a strong evidence in favor of stratified care over standard care at improving overall pain (Weighted Mean Difference (WMD) [random] 0.46 [95% CI 0.21, 0.71]; P < 0.0003), with overall effect (Z = 3.6) and (Roland-Morris disability questionnaire (RMDQ) scores (WMD [random] 0.71 [95% CI 0.05, 1.37]; P < 0.03), with overall effect (Z = 2.11) at three-, four-, and six-months’ follow-up periods. Conclusion: This current review demonstrated that a stratified care approach provides substantial clinical, economic, and health-related cost benefits in the medium- and high-risk subgroups compared with usual care. Further research is needed for longer-term benefits.

Treatment of low back pain in 2020: Monitoring clinical practice through audit

Physiotherapy ◽  
2021 ◽  
Vol 113 ◽  
pp. e193
Author(s):  
W.J. Gregory ◽  
K. Jeavons ◽  
G. Ford
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Low Back

scholarly journals Feasibility of delivering and evaluating stratified care integrated with telehealth (‘Rapid Stratified Telehealth’) for patients with low back pain: protocol for a feasibility and pilot randomised controlled trial

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e056339
Author(s):  
Joshua R Zadro ◽  
Christopher Needs ◽  
Nadine E Foster ◽  
David Martens ◽  
Danielle M Coombs ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Waiting Times ◽  
Education Programme ◽  
Low Back ◽  
Pain Education ◽  
Stratified Care ◽  
Randomised Controlled

IntroductionLong waiting time is an important barrier to accessing recommended care for low back pain (LBP) in Australia’s public health system. This study describes the protocol for a randomised controlled trial (RCT) that aims to establish the feasibility of delivering and evaluating stratified care integrated with telehealth (‘Rapid Stratified Telehealth’), which aims to reduce waiting times for LBP.Methods and analysisWe will conduct a single-centre feasibility and pilot RCT with nested qualitative interviews. Sixty participants with LBP newly referred to a hospital outpatient clinic will be randomised to receive Rapid Stratified Telehealth or usual care. Rapid Stratified Telehealth involves matching the mode and type of care to participants’ risk of persistent disabling pain (using the Keele STarT MSK Tool) and presence of potential radiculopathy. ‘Low risk’ patients are matched to one session of advice over the telephone, ‘medium risk’ to telehealth physiotherapy plus App-based exercises, ‘high risk’ to telehealth physiotherapy, App-based exercises, and an online pain education programme, and ‘potential radiculopathy’ fast tracked to usual in-person care. Primary outcomes include the feasibility of delivering Rapid Stratified Telehealth (ie, acceptability assessed through interviews with clinicians and patients, intervention fidelity, appointment duration, App useability and online pain education programme usage) and evaluating Rapid Stratified Telehealth in a future trial (ie, recruitment rates, consent rates, lost to follow-up and missing data). Secondary outcomes include waiting times, number of appointments, intervention and healthcare costs, clinical outcomes (pain, function, quality of life, satisfaction), healthcare use and adverse events (AEs). Quantitative analyses will be descriptive and inform a future adequately-powered RCT. Interview data will be analysed using thematic analysis.Ethics and disseminationThis study has received approval from the Ethics Review Committee (RPAH Zone: X21-0221). Results will be published in peer-reviewed journals and presented at conferences.Trial registration numberACTRN12621001104842.

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