New thesis on low back pain and treatments in primary care

Hello Borgitta Widerström, PhD student at the Division of Physiotherapy. You are about to defend your thesis on 15 December, what is the main focus of your research?

"The main purpose of the thesis was to explore physiotherapists’ clinical decision-making in physiotherapy for low back pain (LBP) in primary healthcare. This was made through the development and evaluation of a new decision-making treatment-strategy-based classification system (TREST) and through interviews with clinical physiotherapists."

Which are the most important results?

"The TREST with its four subgroups, pain modulation, stabilization exercise, mobilization and training and the criteria in each of the four subgroups are described. These subgroups were reliably applied when experienced physiotherapists categorized patients with LBP into TREST subgroups. The inter-examiner agreement was moderate to almost perfect for three of the five suggested subgroup criteria in TREST (neurological symptoms and signs, uni-bilateral spinal signs and symptom irritability) and feasibility of the suggested criteria was supported for the presence/absence of; neurological symptoms and signs, uni-bilateral spinal signs and specific segmental signs, as well as for the level of disability and symptom irritability.

The advocated working approach at the workplace and health care priorities influences the decision-making in treatments offered to patients with LBP in primary healthcare. The categorization of the LBP disorder itself as well as bodily examination findings designate to treatments. Patients’ capabilities and participation constitute the prerequisites for treatment. Physiotherapists’ personal convictions and terms, as well as their confidence in treatments and in themselves decide treatment selection, while their perceived insufficiency limits the decision-making in treatment, that primarily focuses on patient education, physical exercise and combined treatments."

How can this new knowledge contribute to the improvement of people’s health?

"LBP is a global health problem, complex and heterogeneous in nature and commonly encountered at physiotherapy clinics, with most cases associated with an unknown cause. Identifying LBP subgroups for targeted treatment has been highlighted as a priority research task. It is unclear how physiotherapists make decisions on treatment and how the various treatments they use in LBP are matched to patients. The TREST classification system can facilitate and guide physiotherapy decision-making which can, by extension, lead to the identification of subgroups in the population of LBP patients and their targeted optimal treatment."

What´s in the future for you? Will you keep on conducting research?

"The analysis of the forth study is not fully completed and additional data in the interviews needs to be analyzed. I will keep on working as a clinical physiotherapist but hope to be able to continue the development of TREST and investigate its clinical applicability and acceptance among physiotherapists and patients in clinical practice."

Thesis

Clinical decision-making in physiotherapy for low back pain in primary health care

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