Hanney W J, Munyon M D, Mangum L C, Rovito M J, Kolber M J, Wilson A T
Musculoskeletal Laboratory, Institute of Exercise Physiology and Rehabilitation Sciences, School of Kinesiology and Physical Therapy, University of Central Florida, Orlando, FL, United States.
Orblytics, LLC, Orlando, FL, United States.
Front Health Serv. 2022 Dec 8;2:1032474. doi: 10.3389/frhs.2022.1032474. eCollection 2022.
Low back pain (LBP) affects up to 84% of adults and physical therapy (PT) has been reported to be an effective approach to conservative care. For those individuals with LBP referred to PT, the decision to initiate and follow through with care is influenced by numerous factors. Currently, a paucity of evidence exists to identify barriers for patients with LBP to access PT care. Thus, the purpose of this study was to investigate perceived barriers influencing the decision to pursue PT care in the state of Florida.
A purposive survey was administered Qualtrics ESOMAR. Screener questions ensured candidates had LBP, resided in Florida, and were referred to PT. Participants that met the screener questions were offered an opportunity to participate in the full survey. Once a participant completed the full survey, variables assessing LBP, access to PT services, and potential barriers were analyzed. A partial least squares structural equation model (PLS-SEM) WarpPLS 7.0 was used to explore which of the perceived barriers had the greatest influence on whether an individual with LBP was able to pursue PT care.
The conceptual framework that demonstrated the best fit of direct effects of potential barriers to accessing care included six independent exogenous latent variables: (a) unaware of a PT clinic near their home or work, (b) had children but no childcare for them, (c) had long PT sessions (e.g., 60 min), (d) had more than one PT session per week, (e) had fewer days active per week, and (f) exercised fewer times per day. Together the six variables explained 19% of the variance related to following through with care ( = 0.19).
The ability of an individual with LBP to access PT care in the state of Florida is multifactorial. There appears to be three broad factors that are the primary barriers, which include (a) the logistic ability (location and access to childcare) to attend PT treatment, (b) how much time is dedicated to the PT treatment, and (c) activity frequency of the individual seeking care. These findings support previous conceptual frameworks for predicting PT treatment. Practitioners and policy makers should consider these barriers when developing plans for conservative management of LBP in Florida.
腰痛（LBP）影响着多达84%的成年人，据报道物理治疗（PT）是保守治疗的有效方法。对于那些被转诊至物理治疗的腰痛患者，开始并坚持治疗的决定受到众多因素的影响。目前，缺乏证据来确定腰痛患者获得物理治疗的障碍。因此，本研究的目的是调查影响佛罗里达州患者寻求物理治疗决定的感知障碍。
通过Qualtrics ESOMAR进行了一项有目的的调查。筛选问题确保候选人患有腰痛、居住在佛罗里达州且被转诊至物理治疗。符合筛选问题的参与者有机会参与完整调查。一旦参与者完成完整调查，就会分析评估腰痛、获得物理治疗服务的情况以及潜在障碍的变量。使用偏最小二乘结构方程模型（PLS - SEM）WarpPLS 7.0来探究哪些感知障碍对腰痛患者能否寻求物理治疗的影响最大。
展示了获得治疗的潜在障碍直接效应最佳拟合的概念框架包括六个独立的外生潜在变量：（a）不知道家或工作地点附近有物理治疗诊所，（b）有孩子但无人照顾，（c）物理治疗疗程长（例如60分钟），（d）每周物理治疗疗程超过一次，（e）每周活动天数少，（f）每天锻炼次数少。这六个变量共同解释了与坚持治疗相关的19%的方差（r² = 0.19）。
佛罗里达州腰痛患者获得物理治疗的能力是多因素的。似乎有三个主要的广泛因素是主要障碍，包括（a）参加物理治疗的后勤能力（地点和儿童保育情况），（b）用于物理治疗的时间，以及（c）寻求治疗者的活动频率。这些发现支持了先前预测物理治疗的概念框架。从业者和政策制定者在制定佛罗里达州腰痛保守管理计划时应考虑这些障碍。
