How do physiotherapists feel about treating more than just the back in people with chronic low back pain?

There is considerable evidence that when people have chronic low back pain (LBP), several factors can be involved in delaying their recovery and ability to enjoy a good quality of life. This is usually assumed to involve things seen on x-rays or MRI scans, and physical factors such as the way people with LBP move. However, it appears that non-physical things such as stress, fear, depression, poor job satisfaction and what people with LBP think is wrong with their back are at least as important in determining whether a person with LBP recovers. While the precise mix of factors involved in their LBP might vary for individual patients, most patients with chronic LBP will present with at least some need for these latter factors to be addressed.

Unfortunately, professionals who treat people with LBP (e.g. doctors, surgeons, physiotherapists and chiropractors) have been mostly trained to deal with physical and structural factors in LBP. Consequently, it is not clear whether non-physical factors are adequately recognised by healthcare professionals treating people with LBP, and how confident they are in addressing these as part of treating LBP.

This open-access systematic review looked at twelve studies in which physiotherapists were interviewed through focus groups or semi-structured interviews on their experiences of treating people with chronic LBP. The review found that physiotherapists only partially recognised cognitive, psychological and social factors in LBP, with most discussion of these involving factors such as family and work issues, as well as unhelpful patient expectations.

Patients with LBP were often stigmatised as demanding, attention-seeking and poorly motivated when they presented with behaviours suggestive of these factors. For example, if a person with LBP showed little interest in rehabilitation or little hope of recovery, they were criticised as being lazy and unmotivated rather than considering that this behaviour may be an indication of depression.

Physiotherapists perceived that neither their initial training, nor currently available professional development training, instilled them with the requisite skills and confidence to successfully address and treat these factors in people with LBP. Consequently, the physiotherapists questioned whether there was any point in even looking for these factors, as treatment of these factors was considered to be beyond their expertise.

The review did not consider how these findings reflect those other healthcare professionals, though it is likely to be very similar between professions. Considering the importance of these factors in helping people with LBP achieve lasting improvements in pain and quality of life, there is a need for physiotherapists – and other healthcare professionals – to increase competence in their identification and management.


Personal information:

Aoife Synnott is just about to complete the fourth (and final) year of the BSc in Physiotherapy programme at the University of Limerick, Ireland. Aoife has a keen interest in chronic LBP and qualitative research. To date, she has completed research combining her two interests as part of a Health Research Board of Ireland Summer Scholarship and her Final Year Research Project under the supervision of Dr. Kieran O’Sullivan. These projects have involved interviewing physiotherapists who have received additional training in the identification and management of “non-physical” factors in LBP, the results of which will be described in future posts on Pain-Ed.

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