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Exercise prescription for patients with non-specific chronic low back pain: a qualitative exploration of decision making in physiotherapy practice

Stenner, Rob; Swinkels, Annette; Mitchell, Theresa; Palmer, Shea

Authors

Rob Stenner

Annette Swinkels

Theresa Mitchell

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Shea Palmer Shea.Palmer@uwe.ac.uk
Occasional Associate Lecturer - HAS - HSW



Abstract

© 2015 Chartered Society of Physiotherapy Background Providing an effective exercise prescription process for patients with non-specific chronic low back pain (NSCLBP) 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 how shared decision making and patient partnership are addressed by physiotherapists in the process of exercise prescription for patients with NSCLBP. Design A qualitative study using a philosophical hermeneutic approach. Methods Eight physiotherapists were each observed on three occasions undertaking their usual clinical activities (total n=24 observations). They conducted brief interviews after each observation and a later in depth semi-structured interview. Iterative hermeneutic strategies were used to interpret the texts and identify the characteristics and processes of exercise prescription for patients with NSCLBP. Findings The findings revealed how physiotherapy practice often resulted in unequal possibilities for patient participation which were in turn linked to the physiotherapists’ assumptions about the patients, clinical orientation, cognitive and decision making processes. Three linked themes emerged: (1) I want them to exercise, (2) which exercise? – the tension between evidence and everyday practice and (3) compliance-orientated more than concordance based. 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 for these patients.

Citation

Stenner, R., Swinkels, A., Mitchell, T., & Palmer, S. (2016). Exercise prescription for patients with non-specific chronic low back pain: a qualitative exploration of decision making in physiotherapy practice. Physiotherapy, 102(4), 332-338. https://doi.org/10.1016/j.physio.2015.05.004

Journal Article Type Article
Online Publication Date Jun 6, 2015
Publication Date Dec 1, 2016
Journal Physiotherapy (United Kingdom)
Electronic ISSN 1873-1465
Publisher De Gruyter Open
Peer Reviewed Peer Reviewed
Volume 102
Issue 4
Pages 332-338
DOI https://doi.org/10.1016/j.physio.2015.05.004
Keywords exercise, back pain, decision making, patient-centred care
Public URL https://uwe-repository.worktribe.com/output/905632
Publisher URL http://dx.doi.org/10.1016/j.physio.2015.05.004
Additional Information Additional Information : © 2015, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

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