Abstract
Objectives: Patients with low back pain (LBP) seek care from different primary care clinicians, but little is known about the actual care delivered. Our objectives were to investigate (1) the frequency of clinical actions by chiropractors (DCs), physiotherapists (PTs), and general practitioners (GPs) when managing patients with LBP, and (2) if distinct intra-professional clinician profiles with similar frequencies of clinical actions could be identified using Latent Class Analysis (LCA).
Methods: All DCs, PTs and GPs in the Region of Southern Denmark were invited to participate in a prospective survey of LBP management. Over a two to four week period, clinicians registered all patient visits regarding LBP, registering patient and consultation characteristics, and clinicians’ own clinical actions in a validated survey containing guideline endorsed and/or commonly used clinical actions: i.e., information about LBP and its’ prognosis, advice to self-management, manual therapy, exercise instructions, referrals, and profession-specific actions (e.g., GPs’ prescriptions of pain medication). Further, clinicians completed a survey on their own demographics and work-related characteristics. To investigate recently initiated treatment courses, we limited the analysis to only include 1st to 6th time visits. The clinical actions were analysed using descriptive statistics presented as frequencies on profession level, and median, interquartile range and standard deviations on clinician level. To identify intra-professional clinician profiles in DCs and PTs, LCA was conducted for the most frequent actions using random predictions for start values (5 draws).
Results: In all, 43 DCs, 67 PTs, 33 GPs collected data on 3,511 LBP visits. The most frequent clinical actions included giving advice (DCs (66%), PTs (81%), GPs (56%)) and information (DCs (49%), PTs (56%), GPs (42%)). Further, DCs provided manual therapy in almost every visit (96%) and exercise instructions in 45%; PTs instructed in exercises in 81%, and provided manual therapy in 65%, while GPs prescribed pain medication in 40% of visits, and referred to PTs in 36%. For several actions (e.g., giving information), we observed large variation intra-professionally, ranging between use in (almost) none to all the registered visits. Within both DCs and PTs, three distinct clinician profiles with similar frequency of clinical actions were identified. All the profiles differed regarding the frequency of giving information and advice. Further, DCs’ profiles differed in the frequency of offering exercise instructions (frequency of exercise instructions increased when observed with higher frequency of providing information and advice), while PTs’ profiles were different in provision of exercises and manual therapy. GPs provided insufficient data to conduct the LCA.
Conclusion: Across the three professions, LBP management varies widely even intra-professionally. Guideline endorsed actions varied between clinicians of the same profession from being provided in none to all the visits. The observed diversity of management profiles highlights the challenges of implementing clinical practice guidelines to clinicians. Qualitative enquiries may elucidate how and why clinicians choose specific management approaches.
Methods: All DCs, PTs and GPs in the Region of Southern Denmark were invited to participate in a prospective survey of LBP management. Over a two to four week period, clinicians registered all patient visits regarding LBP, registering patient and consultation characteristics, and clinicians’ own clinical actions in a validated survey containing guideline endorsed and/or commonly used clinical actions: i.e., information about LBP and its’ prognosis, advice to self-management, manual therapy, exercise instructions, referrals, and profession-specific actions (e.g., GPs’ prescriptions of pain medication). Further, clinicians completed a survey on their own demographics and work-related characteristics. To investigate recently initiated treatment courses, we limited the analysis to only include 1st to 6th time visits. The clinical actions were analysed using descriptive statistics presented as frequencies on profession level, and median, interquartile range and standard deviations on clinician level. To identify intra-professional clinician profiles in DCs and PTs, LCA was conducted for the most frequent actions using random predictions for start values (5 draws).
Results: In all, 43 DCs, 67 PTs, 33 GPs collected data on 3,511 LBP visits. The most frequent clinical actions included giving advice (DCs (66%), PTs (81%), GPs (56%)) and information (DCs (49%), PTs (56%), GPs (42%)). Further, DCs provided manual therapy in almost every visit (96%) and exercise instructions in 45%; PTs instructed in exercises in 81%, and provided manual therapy in 65%, while GPs prescribed pain medication in 40% of visits, and referred to PTs in 36%. For several actions (e.g., giving information), we observed large variation intra-professionally, ranging between use in (almost) none to all the registered visits. Within both DCs and PTs, three distinct clinician profiles with similar frequency of clinical actions were identified. All the profiles differed regarding the frequency of giving information and advice. Further, DCs’ profiles differed in the frequency of offering exercise instructions (frequency of exercise instructions increased when observed with higher frequency of providing information and advice), while PTs’ profiles were different in provision of exercises and manual therapy. GPs provided insufficient data to conduct the LCA.
Conclusion: Across the three professions, LBP management varies widely even intra-professionally. Guideline endorsed actions varied between clinicians of the same profession from being provided in none to all the visits. The observed diversity of management profiles highlights the challenges of implementing clinical practice guidelines to clinicians. Qualitative enquiries may elucidate how and why clinicians choose specific management approaches.
Original language | English |
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Publication date | 2022 |
Publication status | Published - 2022 |
Event | ECU Convention 2022: Europran Chiropractors' Union - Utrecht, Netherlands Duration: 26. May 2022 → 29. May 2022 https://convention.chiropractic-ecu.org/programme/ |
Conference
Conference | ECU Convention 2022 |
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Country/Territory | Netherlands |
City | Utrecht |
Period | 26/05/2022 → 29/05/2022 |
Internet address |