Short summary

Management of persistent LBP disorders is a challenge for many physiotherapists and long term outcomes are sparse. In the study we educate 21 municipal physiotherapists in person-centred care within a bio-psycosocial framework. The training consists of online e-learning using the Evoolve-platform, workshops in dealing with emotional and cognitive factors, motivational interviewing, skills in behavioral experiments and clinical mentoring. Data from patients will be collected pre and post training

Rationale

Clinical guidelines recommend a multidimensional approach for the management of patients with low back pain, addressing structural, physical, cognitive, emotional, social factors, comorbidity, and how these collectively affect the patient's behavior and function. Research suggests that among clinicians who manage patients with low back pain, there is a significant "gap" between knowledge of multidimensional factors and the ability to integrate the management of these factors into clinical practice. Furthermore, qualitative studies show that clinicians do not feel competent in managing psychosocial factors, and that they want better training in how to address these factors. Around 20% of the patients at the Spine Center of Southern Denmark are referred to municipal rehabilitation. The referred patients typically have a complex profile with an interplay of both physical, psychological and social factors. A recent review of the efforts in the municipal rehabilitation units by the Spine Center of Southern Denmark shows a need for and desire for a competency boost in relation to the management of complex LBP patients. Many physiotherapists experience these patients as resource-intensive and difficult to help despite long-term rehabilitation in the municipality. The Spine Centre has previously conducted a clinical research project in which Cognitive Functional Therapy (CFT) was used for patients with persistent low back pain. CFT is an individually adapted physiotherapeutic intervention, designed to include a wide range of bio-psycho-social factors in relation to the patient's presentation. The results were promising and patient satisfaction was high, despite only 6 consultations. A recent large international study support the effect of CFT for patients with low back pain (The RESTORE-trail). The therapists who supervised the intervention had completed a relatively extensive course before the project. The course consisted of theoretical presentations, patient demonstrations, and five days of clinical supervision to ensure that the participants had acquired the relevant skills. Based on these experiences, the Spine Centre wants to meet the municipalities' need for a competency upgrade in handling the more complex citizens with low back pain in rehabilitation programs. Improved competency can create better health outcomes for the individual citizen, support return/retention to work and contribute to shorter programs. Objectives We will implement a structured continuing education course based on CFT for municipal physiotherapists, whose primary function is the rehabilitation of citizens with low back pain. The purpose of the project is to: • The municipal physiotherapists gain better clinical skills to handle complex citizens with low back pain, and are able to implement the newly acquired skills in clinical practice. • Citizens with low back pain achieve less pain, better function and increased work capacity after municipal rehabilitation.

Description of the cohort

Physiotherapists: 21 municipal therapists with at least 2 yaers experience og management og LBP. Patients: Diagnosis: non-specific LBP, refferd to municipal rehabilitation, Ørebro-score of > 40, age 18-75.

Data and biological material

The following patient-reported information (PRO) is collected at baseline and three months later to evaluate the citizen's benefit from the rehabilitation program: • Pain intensity 1-10 (NRS, 0-10) • Functioning level (Roland Morris Disability Questionnaire, 0-23) • Self-assessed work ability (Work ability index, sp. 1, 0-10) • Satisfaction with intervention (7-point Likert scale) Written demographic and health data are collected on all citizens immediately before the start of the rehabilitation program. PRO data are collected electronically at the start and end of the rehabilitation program. Before participating in the training program, the 20 participants must collect data on 4 citizens they see in a rehabilitation program. These patient cases will serve as control data. After participating in the training, the participants must collect data on 4 new citizens. Thus, data will be collected from a total of 80 citizens in the control and intervention groups from different municipalities in the region. The number of citizens to be included in the evaluation is calculated based on an expectation of at least a 30% difference in effect on functional level between the two groups (α = 0.05, β = 0.80), which we assess to be a clinically relevant difference.

Collaborating researchers and departments

Nordfyns Kommune

• Jannick Johansen

Smerte Center Syd

• Irene Stegemejer

Aalborg Universitets Hospital

• Thorvaldur Palsson

Curtin University

• Peter O'Sullivan
• Limerick University
• Kieran O'Sullivan