Exercise prescription for patients with non-specific chronic low back pain: A qualitative exploration of physiotherapy practice
Background: Providing an effective exercise prescription process for a patient with non-specific chronic low back pain (NSCLBP) within the limits of time that a busy clinician faces is a challenging task. Emerging research has indicated that partnership in care and shared decision making are important for people with NSCLBP, and calls for further investigation into the approaches used to prescribe exercise.
Objective: To explore the characteristics and processes of physiotherapy exercise prescription for patients with NSCLBP, and investigate how shared decision making and patient partnership are addressed by physiotherapists in this process.
Design: A qualitative study using a philosophical hermeneutic approach. In phase one of the study eight physiotherapists were each observed on three occasions undertaking their usual clinical activities. They participated in brief interviews after each observation and a later in depth semi-structured interview. In phase two semi-structured interviews with eight patients including use of some brief patient vignettes was undertaken to provide a rich descriptive text of their personal experiences of receiving exercise as part of the management of their NSCLBP, and their involvement in decisions regarding their treatment plans. In depth iterative hermeneutic strategies were used to interpret the texts and identify the characteristics and processes of exercise prescription for patients with NSCLBP.
Analysis: Thematic analysis (Braun and Clarke, 1996) was employed to search for themes and patterns from the observations and interviews with physiotherapists and patients.
Findings: The findings provide a complex understanding of how physiotherapists regard and utilise exercise based management strategies for patients with NSCLBP. Patient partnership and shared decision making were rarely evident and were linked to the physiotherapists’ clinical orientations, cognitive and decision making processes, and assumptions about patients.The overall feeling of the patients was that the role they played in the therapeutic interaction was a marginal one, such that the therapist was dominant in structuring the interactions, leaving the patients feeling disempowered to question and contribute.
Conclusions: This research, by focusing on a patient-centred approach, makes an important contribution to the body of evidence relating to the management of NSCLBP. It challenges physiotherapists to critically appraise their approaches to the prescription of exercise therapy in order to improve outcomes in these patients.
|APA6 Citation||Stenner, R. Exercise prescription for patients with non-specific chronic low back pain: A qualitative exploration of physiotherapy practice. (Thesis). University of the West of England|
|Keywords||back pain, exercise, prescription, patient-centred care|