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Do physical therapists recognise established risk factors?: Swedish physical therapists' evaluation in comparison to guidelines
Örebro University, School of Health and Medical Sciences.
Örebro University, Department of Behavioural, Social and Legal Sciences.ORCID iD: 0000-0001-5359-0452
2004 (English)In: Physiotherapy, ISSN 0031-9406, Vol. 90, no 1, 35-41 p.Article in journal (Refereed) Published
Abstract [en]

Background and purpose The Swedish Council on Technology Assessment in Health Care has widely distributed the most recent Swedish evidence-based review on neck and back pain. In this review psychosocial factors were acknowledged as important risk factors for developing chronic pain. We surveyed physical therapists’ evaluation of risk factors for the development of chronic pain. The results were compared to the review of the Swedish Council on Technology Assessment in Health Care.

Methods A postal questionnaire was sent to all 117 physical therapists working in primary care in Örebro County, Sweden.

Results The survey was responded to by 102 physical therapists (87%). Over 50% of them indicated as important more than twice as many risk factors than are supported by the evidence-based review.

More than 50% of the physical therapists pointed out all eight evidence-based factors described in the evidence-based review but they also indicated a median of 10 additional factors with little or no support in the literature. More than 80% of the physical therapists responded according to the recommendations of the evidence-based review concerning sick leave and instructions to patients regarding activities and pain relief. Forty-four physical therapists (43%) indicated that they could predict which patients would develop chronic pain in the future.

Conclusions Physical therapists represented by this sample were well aware of the importance of psychosocial risk factors, but because of the large number of additional factors indicated it seems physical therapists lack specificity about which factors are important.

Place, publisher, year, edition, pages
Amsterdam: Elsevier , 2004. Vol. 90, no 1, 35-41 p.
Keyword [en]
Psychosocial factors, physical therapy, evidence-based medicine, risk factors
National Category
Family Medicine
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:oru:diva-10395DOI: 10.1016/S0031-9406(03)00002-6OAI: oai:DiVA.org:oru-10395DiVA: diva2:311061
Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2015-03-10Bibliographically approved
In thesis
1. Implementing psychosocial factors in physical therapy treatment for patients with musculoskeletal pain in primary care
Open this publication in new window or tab >>Implementing psychosocial factors in physical therapy treatment for patients with musculoskeletal pain in primary care
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This dissertation focuses on 2 parts: 1) Whether evidence-based guidelines are recognized and integrated into clinical practice in primary care and 2) Whether a university course aimed at teaching physical therapists to identify and address evidence-based psychosocial factors in primary care might change practice behaviour and patient outcome. To this end practising clinicians were surveyed and a course for physical therapists was developed.Concerning the first part, we showed that a relatively large proportion of clinicians in primary care were unfamiliar with the content of evidence-based guidelines and/or with the concept of “Red flags”. Yet, concerning the self-reported practice behaviour, the majority indicated they followed the key points in the guidelines. To enhance the impact of guidelines, interventions or tactics for teaching and implementing guidelines should include interactive education,discussion, feedback, and reminders which in research have shown to enhance knowledge,skills and change behaviour. Furthermore, the clinical applicability of the guidelines needs to be further developed. We could also show that psychosocial factors were integrated up to a certain point and that physical therapists in primary care were well aware of the importance of psychosocial risk factors, but it seemed physical therapists lack specificity about which factors are important. Physical therapists may have heard about risk factors but probably did not have a clear model or structure about how these factors work.Concerning the second part, the results showed that we, by means of a university course, managed to change attitudes and beliefs, increase knowledge, skills and competencies towards a more biopsychosocial standpoint. But despite these changes, the results did not show a behavioural change on behalf of the physical therapists or a better outcome for patients at risk of longterm pain and disability. Several possible explanations for this are discussed. First, the content of the course should be changed so it focuses more on behavioural change on behalf of the physical therapists. This would facilitate implementation of new behaviour in clinical practice and increase the likelihood that the new behaviour is maintained and thereby the possibility of improved patient outcome. Second, treating patients at risk for long-term pain and disability may also be too difficult for a single physical therapist in a clinical setting. This would imply large changes in the way patients are directed through the health care system compared to now. The main tasks of the physical therapists in primary care would then be to select patients at risk for long-term pain and disability. They would then treat the patients not at risk and refer the patients at risk for long-term pain and disability to more suitable treatment, for example CBT treatment delivered by a psychologist or multimodal treatment delivered by a team of experts.Since risk patients experience most suffering and are the most costly for the health care system, it is important they get the appropriate treatment at the earliest possible opportunity.In summary, this dissertation shows that integrating psychosocial factors in physical therapy is not an easy task.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2010. 69 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 44
Keyword
Physical therapy, musculoskeletal pain, psychosocial factors, dissimilation, evidence based, education, primary health care
National Category
Family Medicine
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:oru:diva-10426 (URN)978-91-7668-727-7 (ISBN)
Public defence
2010-05-28, Bomanssonsalen, Universitetssjukhuset Örebro, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2010-04-21 Created: 2010-04-21 Last updated: 2011-04-26Bibliographically approved

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