Abstract
Research Aim/Objective: To investigate (1) the use of clinical actions by general practitioners (GPs), physiotherapists (PTs) and chiropractors (DCs) when managing patients with low back pain (LBP), and (2) if distinct intra-professional clinician profiles with similar use of clinical actions could be identified using Latent Class Analysis.
Research Methods: All primary care GPs, PTs and DCs in the Region of Southern Denmark were invited to participate in a prospective survey of their management of LBP patients. During two to four weeks, clinicians registered consecutive consultations with patients presenting with LBP and filled in registration charts with patient characteristics and clinical actions (guideline-concordant and common clinical actions). The actions included information, advice, manual therapy, exercise, primary care referrals and profession-specific actions (e.g., GPs’ prescriptions of analgesics). Further, data on clinicians’ characteristics were collected. The clinical actions and clinician characteristics were analysed with descriptive statistics and presented as frequencies, medians, quartiles, and range. Latent Class Analysis of the most frequently observed actions was used to identify clinician management profiles within the professions.
Results: In all, 33 GPs, 67 PTs, 43 DCs collected data on 3,511 LBP consultations. The most frequent clinical actions included providing advice (GPs (56%), PTs (81%), DCs (66%)) and information (GPs (42%), PTs (56%), DCs (49%)). Further, GPs prescribed analgesics in 40% of consultations and referred to PTs in 36%; PTs provided
exercises in 81% and manual therapy in 65%; DCs almost always used manual therapy (96%), and exercises in 45%. Several actions (e.g., information) ranged in use from 0% to 100% of the consultations. Three clinician management profiles were identified for PTs and DCs. Both PTs’ and DCs’ profiles differed by low to high use of information and advice. PTs’ profiles had varying attention to exercises compared to manual
therapy, and DCs’ profiles had varying attention to exercises, where high use of exercises was observed with high use of information and advice. GP data did not allow these analyses.
Discussion:The variation seen across three professions shows that usual care for LBP varies widely. Several guideline recommended actions varied in use from none to all the consultations intra-professionally. The observed diversity of management approaches highlights the challenges of implementing guidelines to very different
clinicians. Identification of distinct clinician profiles may help directing guideline implementation initiatives towards clinicians with the maximum potential for improvement. Qualitative enquiries may elucidate how and why clinicians choose specific management approaches.
Research Methods: All primary care GPs, PTs and DCs in the Region of Southern Denmark were invited to participate in a prospective survey of their management of LBP patients. During two to four weeks, clinicians registered consecutive consultations with patients presenting with LBP and filled in registration charts with patient characteristics and clinical actions (guideline-concordant and common clinical actions). The actions included information, advice, manual therapy, exercise, primary care referrals and profession-specific actions (e.g., GPs’ prescriptions of analgesics). Further, data on clinicians’ characteristics were collected. The clinical actions and clinician characteristics were analysed with descriptive statistics and presented as frequencies, medians, quartiles, and range. Latent Class Analysis of the most frequently observed actions was used to identify clinician management profiles within the professions.
Results: In all, 33 GPs, 67 PTs, 43 DCs collected data on 3,511 LBP consultations. The most frequent clinical actions included providing advice (GPs (56%), PTs (81%), DCs (66%)) and information (GPs (42%), PTs (56%), DCs (49%)). Further, GPs prescribed analgesics in 40% of consultations and referred to PTs in 36%; PTs provided
exercises in 81% and manual therapy in 65%; DCs almost always used manual therapy (96%), and exercises in 45%. Several actions (e.g., information) ranged in use from 0% to 100% of the consultations. Three clinician management profiles were identified for PTs and DCs. Both PTs’ and DCs’ profiles differed by low to high use of information and advice. PTs’ profiles had varying attention to exercises compared to manual
therapy, and DCs’ profiles had varying attention to exercises, where high use of exercises was observed with high use of information and advice. GP data did not allow these analyses.
Discussion:The variation seen across three professions shows that usual care for LBP varies widely. Several guideline recommended actions varied in use from none to all the consultations intra-professionally. The observed diversity of management approaches highlights the challenges of implementing guidelines to very different
clinicians. Identification of distinct clinician profiles may help directing guideline implementation initiatives towards clinicians with the maximum potential for improvement. Qualitative enquiries may elucidate how and why clinicians choose specific management approaches.
| Original language | English |
|---|---|
| Publication date | Nov 2021 |
| Publication status | Published - Nov 2021 |
| Event | 2021 Back and Neck Pain Forum - Global virtual conference Duration: 11. Nov 2021 → 13. Nov 2021 https://backpainforum2021.neura.edu.au/ |
Conference
| Conference | 2021 Back and Neck Pain Forum |
|---|---|
| Location | Global virtual conference |
| Period | 11/11/2021 → 13/11/2021 |
| Internet address |