Development Of A Knowledge Translation Intervention To Improve Physiotherapists Clinical Decisions In The Management Of Non Specific Low Back Pain

Abstract

Background: Despite the availability of evidence-based interventions for managing nonspecific low back pain (NSLBP), physiotherapists often fail to adhere to them, resulting to inadequate clinical practices and increased disability. Physiotherapists can change their behaviors by using knowledge translation interventions for NSLBP. Although some knowledge translation (KT) interventions exist, there is a need to develop a theory-guided, multifaceted, and context-specific KT intervention applicable to the Indian context. newlineAim: To develop a multifaceted knowledge translation intervention to improve physiotherapists clinical decisions in management of acute and subacute non-specific low back pain. newlineMethods: We have used a mixed-method design. A qualitative and a quantitative study was conducted to understand perceived barriers to implement evidence recommended interventions; and influence of practitioner-specific and setting-related factors on physiotherapists clinical decisions in the management of nonspecific low back pain in clinical settings. Based on the findings of qualitative and quantitative studies, we have developed a knowledge translation intervention. The primary aim of the intervention was to improve physiotherapists adherence to evidence recommended interventions in the management of nonspecific low back pain within Indian clinical settings.Results: We identified three general themes and seven sub themes from the data relating to barriers and facilitators of adherence to high value care in managing nonspecific low back pain: (1) misconceptions about low back pain and its management; (2) perceived lack of professional autonomy; (3) conflicts with patient priorities, preferences and expectations. The majority of participants were classified as non-adherent to the evidence-recommended interventions and indicated that they would recommend bed rest instead of exercising as the primary intervention. Clinical decisions to deliver exercise as a primary intervention were associated with previous training in LBP