Background and purpose

Sleep disturbance is a prevalent symptom in people with chronic low back pain (CLBP >12 weeks), but there is currently no knowledge of the effectiveness of physiotherapy for this problem. This study evaluated the feasibility of a randomised controlled trial (RCT) exploring the effects of physiotherapy on sleep disturbance in CLBP [Current controlled trial ISRCTN 54009836].

Background & Purpose: Clinical guidelines support physical activity for people with chronic low back pain (CLBP); walking is an ideal form of physical activity as it is easy to do, requires no special skills and is achievable by virtually all ages with little risk of injury but there are no current evidence-based structured walking programmes (WP) for this population. The purpose of this study was to develop a WP for CLBP patients in preparation for a proposed randomized controlled trial.

Methods: An 8-week structured WP was developed using Intervention Mapping (IM) principles:

literature review,

Results: Both the CLBP patients and physiotherapists interviewed endorsed walking as a suitable form of physical activity, and identified possible barriers as fear avoidance, exacerbation of pain, behavioural change, motivation, time, personal safety and adverse weather. The pilot study found 90% compliance with the WP. Descriptive analysis of change scores showed improvements at 8-weeks in all self reported outcomes and objectively measured physical activity and functional capacity.

Conclusion: Intervention Mapping was successfully used to develop a WP intervention for chronic LBP, the efficacy of which is being evaluated in a randomized controlled trial.

Background & Purpose: This pragmatic randomised clinical trial (RCT) investigated differences in the clinical outcomes of physiotherapy for low back pain (LBP) delivered in

public hospital-based secondary care versus

Methods: Between March 2005 and May 2006, 160 consenting subjects [110F, 50M; mean age (SD) yrs: 41.28 (12.83)] were recruited, stratified (acute: < 3/12; chronic: > 3/12), and randomly allocated to public hospital (H) or private community (P) physiotherapy. Subjects completed clinical outcomes (Roland Morris Disability Questionnaire (RMDQ). SF-36, Fear Avoidance Beliefs & Back Beliefs Questionnaires) at baseline, 3, 6 and 12 months post randomisation and the Patient Satisfaction with Outpatient Physical Therapy (PTOPS) survey at the end of treatment. Intention-to-treat analysis was conducted using the Statistical Package for the Social Sciences (SPSS, Version 12).

Results: There were no significant differences between groups at baseline (p> 0.05). Patient response rates were 85% (n=137), 80% (n=128) and 74% (n=118) at 3, 6, and 12 months. Despite significantly longer waiting times for public hospital physiotherapy, repeated measures ANOVA found no significant differences over time between groups for any of the outcome measures (p> 0.05), except ‘patient satisfaction with outcome,’ which was significantly higher in the P group (median difference: 0.00; p=0.020, Mann Whitney U=1324.50).

Conclusions & Implications: The trial cannot recommend one physiotherapy setting over the other for LBP management. However, the limited adherence to LBP clinical guidelines in both settings and the lack of improvement in psychosocial outcomes in subjects managed in both settings warrant further investigation.

Acknowledgements: Physiotherapists, General practitioners and patients in both settings.

Background: General practitioners (GPs), orthopaedic surgeons, neurosurgeons, rheumatologists and pain consultants manage the majority of patients with chronic low back pain (CLBP) in the Republic of Ireland. However, little is known about their attitudes and beliefs and the factors that influenced them. This study aimed to investigate factors that influenced doctors’ attitudes and beliefs to CLBP.

Method: A cross-sectional questionnaire was mailed to a random sample of GPs (n=750; 35%), and all orthopaedic surgeons (n=81), neurosurgeons (n=9), rheumatologists (n=26), and pain consultants (n=24) in the republic of Ireland. The questionnaire pack contained a demographic data form, two clinical vignettes, and an attitudes measure, the Pain Attitudes and Beliefs Scale (PABS.PT). Approval was obtained from the UCD Human Research Ethics Committee.

Results: The response rate was 58% (n=523). Doctors were qualified 23.4±9.4 years. Analysis of the vignettes showed there was no significant difference (p> 0.05) between those who had undertaken postgraduate education (PGE) regarding referral rates to physiotherapy, investigations, or secondary care. Prescription rates were significantly lower for those who had undertaken PGE (88% v 94%, χ² =4.95, p< 0.05), as was their biomedical score on the PABS.PT (41.3 v 43.1, df=507, p=0.03). The number of years since qualification was dichotomised (1–23 yrs, > 23 yrs), and there was no significant difference in the management of the vignettes, except referral rates for investigations which was greater for doctors qualified > 23 years (3% v 52%, χ² =10.71, p=0.001).

Conclusion: Demographic factors (PGE and the number of years since qualification) did not significantly influence doctors’ practice behaviour.

Background: General practitioners (GPs), orthopaedic surgeons, rheumatologists and pain consultants manage the majority of patients with chronic low back pain (CLBP) in primary and secondary care settings in the Republic of Ireland. Little is known about their attitudes and beliefs to CLBP, although the existing literature highlights a range of factors influencing such beliefs including: past experience, education, time and resources¹. This study aimed to investigate factors influencing attitudes and beliefs of Irish doctors to the management of CLBP patients.

Method: A multiple case studies design of semi-structured audiotaped interviews (30 minutes) was conducted on a purposeful sample of GPs (n=7) and Consultants (n=7: orthopaedic surgeons, n=2; Pain consultants, n=2; Rheumatologists n=2 Neurosurgeon, n=1) in July 2006. Questions were devised based on the results of a systematic review of the literature of the topic. All interviews were subsequently transcribed, coded and a cross case analysis was constructed. Approval was obtained from the UCD Human Research Ethics Committee.

Results: The main emerging themes included Doctors current holistic management (referral for physical and mental health treatment), the negative impact of lack of resources on treatment options (lack of multidisciplinary services and prolonged waiting times for Consultant appointments), the influence of the medicolegal system on patients (increased stress) and Doctors (increased referral rates for investigations and procedures).

Conclusion: Doctors’ attitudes and beliefs regarding CLBP management may have important influences on both patient outcomes and resource utilization within the health service. These findings will inform a national postal survey of Doctors attitudes to CLBP.

Background: This pragmatic randomised controlled trial aimed to investigate any differences in the clinical outcomes of patients with low back pain (LBP) receiving physiotherapy in (i) the current public hospital-based secondary healthcare model (H) versus (ii) a private community-based primary healthcare model (P)

Participants & Methods: Between March 2005 and May 2006, 160 consenting subjects [110F, 50M; mean age (SD) yrs: 41.28 (12.83}], referred by GPs for physiotherapy for non-specific LBP were recruited across three clinical centres within Ireland Subjects completed a baseline interview and outcome measures (Roland Morris Disability Questionnaire (RMDQ), SF-36 V2 Pain Subscale, Fear Avoidance Beliefs Questionnaire, Back Beliefs Questionnaire), were stratified (acute: < 3/12; chronic: > 3/12), and randomised to one of the two groups (i.e. H: n=80; P: n=80), with follow ups at 3, 6 and 12 months post randomisation.

Analysis: Data were coded and questionnaires scored, then analysed using the Statistical Package for the Social Sciences (SPSS, Version 11). An intention-to-treat analysis was conducted. Patient follow-ups are ongoing: 3-month [completed by 31stth August 2006; current response rate: 82% (n =117/143)].

Results: Both groups were comparable for all baseline demographic variables and questionnaire scores. Current descriptive analysis of mean change scores (SD), from baseline to 3-months, show clinically meaningful improvements in both groups RMDQ: [H=3.95(−1.172); P=4.94(−0.816)] and SF-36 Bodily pain: [H=−7.51(=3.6); P= −10.54(−2.6)]. The complete 3-month data set will be presented at the meeting.

Conclusion & Implications: The findings may influence future health policy regarding the funding of physiotherapy services in Ireland.

Background: In the Republic of Ireland, physiotherapy for low back pain (LBP) is delivered in both public and private sectors via hospital-based departments (H) and community-based private practices (P) respectively. However, there is inequity in access and minimal evidence of the physiotherapy management of LBP in these two settings.

Purpose: To investigate any differences in patient profile and physiotherapy management of LBP in H and P settings.

Methods: A random sample of one Dublin city hospital and neighbouring private practices (n=3) were recruited. A retrospective chart survey of all LBP patients who commenced physiotherapy during 2003 was conducted. Data were analysed using Statistical Package for Social Sciences (SPSS, v.11). Ethical approval was granted by the participating hospital.

Results: In total, 249 charts were identified: H=93 [male n=32, female n=61, mean age (SD) = 46 years (20)]; P =156 [male n=78, female n=78, mean age (SD) = 36 years (10)]. Statistically significant differences between settings were found for:

percentage of patients with ‘acute’ (< 12 weeks) and ‘chronic’ (≥12 weeks) LBP [H: acute LBP = 4.7%, chronic LBP = 95.3%; P: acute LBP= 84.7%, chronic LBP= 15.3%; χ² = 120.34, df=1, p< 0.001];

Conclusion: Findings suggest a two-tier system of health care for LBP patients in Ireland. A randomised controlled trial evaluating patient outcomes in both settings is currently underway by the Research Team.