Research designs and instruments to detect physiotherapy overuse of low-value care services in low back pain management: A scoping review protocol

BackgroundThe provision of low value care services in low back pain management is a problem of global scope. Inappropriate imaging, overmedication and overused invasive therapies are prevalent in physician services. Yet, little is known about overused low-value physiotherapy services. Most studies addressing physiotherapy overuse in low back pain management arose from countries in which physiotherapy is established in primary care. However, measures and instruments addressing physiotherapy overuse limitedly fit legislative conditions of health systems in which physiotherapy is a service of secondary care. Thus, this scoping review’s purpose is to map existing research designs and instruments aiming to detect overused low-value physiotherapy services taking specific healthcare settings and aspects of the medical overuse into account.MethodsThe development of this scoping review is guided by the Arksey and O’Malley framework. A three-step, peer reviewed search strategy in accordance to the PRESS checklist will be conducted on Medline (PubMed), Web of Science and CINHAL. Additionally, grey literature will be searched on googlescholar. Preprints of empirical studies will be included. Initially, two reviewers will independently screen articles for eligibility by title and abstract. A third reviewer will mediate discrepancies. Uncertainties will be eliminated by full text analysis or by contacting the corresponding authors. A four-step analytical process will guide result reporting focusing on major research questions outlined in this protocol. Numerical and narrative tables, graphics and narrative summaries will be methods to summarize and collate results. In the final step, the German health system will serve as an exemplary setting and frame to practically apply results.DiscussionResults of this scoping review will help researchers to systematically select overuse measures referring to aspects of the overuse typology, specific healthcare settings and physiotherapy services. It will further provide information on limitations of present studies and will give advice how to address them. Moreover, this review will illustrate to what degree existing studies succeed to comprehensively cover the concept of the overuse typology.RegistrationThis protocol has been registered on open science framework. (https://osf.io/vzq7k DOI: 10.17605/OSF.IO/PMF2G)

Management of Low back pain in Saudi Arabia healthcare system. A Qualitative Study

Background Patients with chronic low back pain can contribute to a global socioeconomic burden. Current international recommendations emphasize that low back pain management should occur at the primary-care level. However, there is a lack of essential services for low back pain management at the primary-care level in Saudi Arabia. We explored the current state of low back pain management in Saudi Arabia from the perspective of spine surgeons and physiotherapists. Methods A qualitative study with semi-structured interviews was conducted on spine surgeons and physiotherapists. A total of 17 healthcare workers, 8 spine surgeons (age range 28–49 years) and 9 physiotherapists (age range 30–49 years) participated in the study. Data were recorded and analyzed thematically. Results Three main themes were identified from the interview data that outlined current low back pain management in Saudi Arabia: clinical guideline availability and pathways of care, utilization of primary care services, and overutilization of secondary care resources. Conclusions This study suggests underutilization of primary care services and overutilization of secondary care services in Saudi Arabia. Therefore, the implementation of local clinical guidelines could improve patient care as well as reduce the cost of low back pain management.