Therapist knowledge, adherence and use of low back pain guidelines to inform clinical decisions--a national survey of manipulative and sports physiotherapists in New Zealand

Abstract

Identifying factors which influence guideline-informed clinical decisions by therapists will help tailor implementation strategies to improve guideline use. The aims of this study were to investigate; the extent to which current physiotherapy practice in New Zealand adheres to low back pain (LBP) guidelines and the factors which influence the use of guidelines to inform clinical decisions for patients with non-specific low back pain (NSLBP). A cross-sectional on-line survey of NZ physiotherapists (n = 1039) was conducted which included the guideline adherence measures, therapists' treatment orientation about NSLBP and a question on the perceived helpfulness of guidelines in decisions for patients with NSLBP. Data from 170 physiotherapists were analysed descriptively and univariate and multivariate associations were conducted for therapist factors (predictor variables) which predicted guidelines being helpful in decisions for management of patients with NSLBP (Y|N). The majority of respondents provided advice which was broadly inline with guideline recommendations [work (60%), activity (87.6%), and bed rest (63%)]. A lower biomedical belief orientation for LBP, higher reported LBP caseload and postgraduate qualifications demonstrated significant univariate associations (P ≤ 0.20) for guidelines being helpful to inform decisions for a patient with NSLBP. The only significant (P = 0.043) predictor variable in the multivariate model was the therapists' biomedical treatment orientation (Exp (B): odd ratio: 1.56). Differences between behaviours and beliefs in guideline use were found. A lower focus on a biomedical model for LBP influenced usage of LBP guidelines to inform clinical decisions for patients with LBP. Implications for improving guideline usage are discussed.