German physiotherapists' views on a single appointment for low-risk patients within the start-back approach.

Abstract

Background: The STarT-Back-Tool (Subgroups for Targeted Treatment) classifies patients with low back pain depending on their risk of a poor prognosis into low-, medium- and high-risk subgroups in order to deliver matched targeted treatment pathways. Implementing stratified care in Germany may require modifying aspects of the treatment pathways. In the original UK trial testing this approach, the low risk matched treatment pathway consisted of patients receiving a minimal intervention involving a single physiotherapy session with standardised examination, reassurance, advice on activity promotion, and no further treatment.

Purpose: The objective of this project was to identify potential obstacles and opportunities of implementing the STarT-Back stratification approach in Germany. This abstract focuses on German physiotherapists’ perceptions of delivering the low-risk treatment pathway.

Methods: Three two-hour workshops were conducted with physiotherapists, starting with an introduction about the STarT-Back low-risk treatment pathway, followed by focus group discussions guided by a semi-standardised interview guideline. The discussions were digitally recorded, transcribed verbatim and coded using a content analysis approach.

Results: In total 19 physiotherapists (4 male, 15 female, mean age=41 years, SD=8.6) from different clinical settings participated. The results identified four themes; patient information, clinical framework/settings, physiotherapists’ qualifications, and the application of media to support patient education.

Participants highlighted the following obstacles to the low risk pathway; the fact it was very different to their usual approach, that a single session might adversely affect the therapeutic relationship as patients might have opposing views about minimal treatment, that it might decrease diagnosis-based decision making, that one session could be insufficient for some patients, and the need for additional support to enable them to sign-post patients to local exercise services. Finally, heterogeneous current physiotherapy clinical standards and qualifications were stated as possible obstacles to being able to implement the low-risk pathway.

Participants voiced opportunities from the low-risk pathway including; potential to gain new clients, that German physiotherapists were appropriately qualified to deliver the pathway, that the use of media to support patient education was positive, that allowing the provision of a follow-up appointment or optional telephone consultation might help maintain some patients’ trust, and that the pathway might facilitate inter-professional networking with healthcare partners.

Conclusion: The findings demonstrate German physiotherapists are interested in the STarT-Back low-risk treatment pathway. However, its implementation would lead to a significant change in current practice and professional identity, particularly promoting self-management treatment option. Inter-professional networks would have to be established and further expanded and patients’ compliance and perceptions carefully evaluated.

Implications: Overall, physiotherapists and GPs, as previously reported, agree that STarT-Back implementation has potential to improve patient care and optimise cost-effectiveness. However, modifying the low-risk pathway to better align with current physiotherapy practice in Germany, e.g. follow-up contact, might foster implementation.

Citation

Kuithan, P., Krug, K., Hill, J., Szecsenyi, J., Steinhaeuser, J., Joos, S., & Karstens, S. (2016). German physiotherapists' views on a single appointment for low-risk patients within the start-back approach. Manual Therapy, 25, e150. https://doi.org/10.1016/j.math.2016.05.290

• Journal Article Type: Article
• Online Publication Date: Jul 13, 2016
• Publication Date: 2016-09
• Deposit Date: Jun 20, 2023
• Journal: Manual Therapy
• Print ISSN: 1356-689X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Pages: e150
• DOI: https://doi.org/10.1016/j.math.2016.05.290
• Keywords: Physical Therapy, Sports Therapy and Rehabilitation; General Medicine