Department of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
Department of Research & Development, Fysius Back Experts, Nijverdal, The Netherlands.
J Eval Clin Pract. 2022 Dec;28(6):1147-1156. doi: 10.1111/jep.13703. Epub 2022 May 26.
Adherence rates to guidelines show room for improvement, and increase in adherence to guidelines may potentially lead to better outcomes and reduced costs of treatment. To improve adherence, it is essential to understand the considerations of physiotherapists regarding the assessment and management of low back pain (LBP). The purpose of this study is to gain insight in the considerations of Dutch physiotherapists on adherence to the national physiotherapy guideline in the treatment of patients with LBP.
This is a qualitative study, using an interpretive approach of semi-structured interviews with 14 physiotherapists who regularly treat patients with LBP. Thematic analysis was conducted with open coding using an existing framework. This framework distinguishes five components to adherence based on patient factors, provider factors, guideline characteristics, institutional factors and the implementation process.
Participating physiotherapists mentioned that the guideline should provide more information about psychosocial prognostic factors and psychosocial treatment options. The participants experienced difficulties in addressing patient expectations that conflict with guideline recommendations. The implementation process of the guideline was considered insufficient. Physiotherapists might rely too much on their experience, and knowledge of evidence-based treatment might be improved. In general, the interviewed physiotherapists thought they were mainly non-adherent to the guidelines. However, when comparing their considerations with the actual guideline recommendations they were mainly adherent.
To improve adherence, the guideline should provide more information about addressing psychosocial prognostic factors, and Dutch physiotherapists might be trained in communication skills to better address patient expectations. A more extensive implementation process is warranted for the next guideline to increase the physiotherapists' knowledge of evidence-based treatment.
对指南的依从率显示出仍有改进的空间，而增加对指南的依从可能会带来更好的结果，并降低治疗成本。为了提高依从性，了解物理治疗师在评估和管理下腰痛（LBP）时的考虑因素至关重要。本研究的目的是深入了解荷兰物理治疗师在治疗 LBP 患者时对国家物理治疗指南依从性的考虑。
这是一项定性研究，采用半结构式访谈的解释性方法，对 14 名经常治疗 LBP 患者的物理治疗师进行访谈。使用现有的框架进行主题分析，并进行开放式编码。该框架基于患者因素、提供者因素、指南特征、机构因素和实施过程，将依从性分为五个组成部分。
参与的物理治疗师提到，指南应提供更多关于心理社会预后因素和心理社会治疗选择的信息。参与者在解决与指南建议相冲突的患者期望方面遇到困难。指南的实施过程被认为是不充分的。物理治疗师可能过于依赖自己的经验，并且对循证治疗的知识可能需要提高。总体而言，接受访谈的物理治疗师认为他们主要不遵守指南。然而，当将他们的考虑与实际的指南建议进行比较时，他们主要是遵守的。
为了提高依从性，指南应提供更多关于处理心理社会预后因素的信息，荷兰物理治疗师可能需要接受沟通技巧的培训，以更好地满足患者的期望。下一个指南需要更广泛的实施过程，以提高物理治疗师对循证治疗的了解。
