Short summary

Low back pain is common, costly and the leading cause of disability worldwide. Patients seek care from multiple health care practitioners with shared clinical practice guidelines, but how care is delivered is not well described. This project aims to

1) describe low back pain management in general, chiropractic and physiotherapy practice in primary care, and

2) by means of qualitative methods, explore how and why clinicians choose specific management approaches, including treatment, referrals, interprofessional collaboration and use of diagnostic imaging.

Finally, we will explore low back pain consultations from the patient and clinician perspective.

Methods

We conduct a mixed methods project: In study 1, we conduct a cross-sectional audit of LBP management among primary care clinicians (i.e., chiropractors, general practitioners and physiotherapists) with registration of patient and clinician characteristics, and LBP management approaches. Data is analyzed statistically.

In study 2, and by means of qualitative methods (focus group interviews, participant observation and individual interviews), we investigate how and why clinicians choose specific management approaches, including treatment, referrals, interprofessional collaboration, and use of DI.

Finally, we explore LBP patients' perceptions and expectations of LBP management and DI and explore the patient-clinician encounter.

Perspectives

This project provides in-depth knowledge of the current LBP management in three main primary healthcare professions, hereby contributing with evidence to inform clinicians, educators and decision-makers at regional and national levels about contemporary quality of care and target future improvement strategies.

Rationale

Low back pain is among the most common conditions in general, chiropractic and physiotherapy practice. Patients meet multiple health care practitioners which can result in conflicting advice and fragmentation of care.

Further, international studies have shown that low back pain management is not consistent with clinical practice guidelines with respect to inconsistent use of relevant information and advice, and overuse of diagnostic imaging and pain medication.

The results of this project may help inform health care practitioners, educators and decision-makers about contemporary quality of care and target future improvement strategies.

Description of the cohort

In study 1, all general practitioners, chiropractors and physiotherapists from the primary care of Southern Denmark were invited to participate in a prospective survey on consecutive patients to describe low back pain management and patient and clinician characteristics.

Participants from study 1 will be invited to participate in study 2 for focus group interviews and field studies.

Data and biological material

In study 1, data collected included patient characteristics (age, sex, duration of symptoms, characteristics of symptoms, other symptoms, examination findings), management characteristics (actions performed in the respective practices, e.g. manual treatment, prescribed medication, provide exercise instructions), purpose of actions and clinician background data (age, sex, type of practice, knowledge of Regional course of action protocols and STarT Back Screening Tool).

Qualitative data will be collected through a field study exploring the patient and clinician perspective of low back pain consultations, and focus group interviews conducted for each profession separately, and one focus group interview for all the professions, collectively.

Collaborating researchers and departments

Audit Projekt Odense, Department of Public Health, SDU.

• Jesper Lykkegaard, MD, PhD, Head of Research
• Merethe Kirstine Kousgaard Andersen, MD, PhD, Senior Researcher
• Anders Munk, MD PhD, Senior Consultant

Open Patient data Explorative Network, Department of Clinical Research, SDU

• Lars Morsø, MPH, PhD, Clinical Associate Professor

Chiropractic Knowledge Hub

• Mette Jensen Stochkendahl, PhD, Senior Researcher

Institute for Sports Science and Clinical Biomechanics, SDU

• Center for Muscle and Joint Health

Spine Center of Southern Denmark

• Anders Hansen, Post Doc

Research Unit of General Practice, SDU

• Elisabeth Assing Hvidt, mag.art, PhD, Associate Professor

Publications associated with the project

Madsen SD, Morsø L, Vach W, et alExploring usual care for patients with low back pain in primary care: a cross-sectional study of general practitioners, physiotherapists and chiropractorsBMJ Open 2023;13:e071602