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The use of superficial heat in the management of low back pain by chiropractors and osteopaths in Australia

Journal: Unpublished MSc thesis Central Queensland University, Date: 2025/03, Pages: 153, type of study: mixed methods study

Free full text   (https://acquire.cqu.edu.au/articles/thesis/The_use_of_superficial_heat_in_the_management_of_low_back_pain_by_chiropractors_and_osteopaths_in_Australia/29832512/1?file=56930051)

Keywords:

Australia [172]
low back pain [508]
mixed method study [105]
osteopaths [250]
superficial heat [1]

Abstract:

Low back pain has a prevalence of approximately 619 million people worldwide, and it is the main contributor to the burden of disability globally. In recent years, multiple clinical practice guidelines have recommended superficial heat as a first-line, non-pharmacological intervention for the management of low back pain. As such, chiropractors and osteopaths may use it as an adjunct to spinal manipulation during the management of low back pain in clinical practice. Although recommended in clinical practice guidelines for low back pain, gaps in knowledge exist regarding the use of superficial heat by chiropractors and osteopaths in Australia. Specifically, when and how it is used, their perceptions of the role and effectiveness of superficial heat, and the extent of awareness and utilisation of clinical practice guidelines to guide the use of superficial heat for the management of low back pain. This thesis aimed to provide new evidence on the use of superficial heat by chiropractors and osteopaths in Australia for the management of low back pain. Firstly, a scoping review of the literature was conducted to systematically assess the scope of the available evidence and explore the mechanisms of how superficial heat may promote recovery for people experiencing low back pain. Thematic analysis was performed on data, extracted from 26 included studies, and four key themes were identified. Reducing pain and improving disability, physiological and biomechanical changes, psychological factors and patient education themes reflected the multifaceted factors involved in recovering from low back pain. Secondly, an observational, cross-sectional survey was developed and distributed to registered chiropractors and osteopaths in Australia to determine the use and perceptions of the role of superficial heat for the management of low back pain. This research revealed that half of all practitioners surveyed did not use superficial heat for the management of low back pain. There was a disparity between the professions, with double the percentage of chiropractors using superficial heat for chronic low back pain, which was converse for acute low back pain, whereas more osteopaths used superficial heat for acute low back pain. Nearly three-quarters of all practitioners agreed that superficial heat has a role in the management of low back pain. Two-thirds of practitioners reported that it was an adjunct to spinal manipulation for the management of low back pain. Importantly, two-thirds of practitioners perceived superficial heat as an effective non-pharmacological intervention in the management of low back pain. However, this perception contrasts with the reported use of superficial heat, which was notably low for both acute and chronic low back pain. The use of superficial heat by most chiropractors and osteopaths did not align with current recommendations according to clinical practice guidelines for low back pain. The study found that three in every five practitioners knew how and where to find clinical practice guidelines for low back pain, but while half of all practitioners agreed with the importance of clinical practice guidelines for low back pain, they advised the use of superficial heat for self-management of low back pain less than 25% of the time. Targeted educational initiatives to address this gap in knowledge and promote the implementation of clinical practice guideline recommendations are needed broadly across both professions. Results from the survey complemented findings from the scoping review that revealed the importance of prioritising holistic approaches that combine physiological, biomechanical, psychological, and educational elements for low back pain management. Limitations of the cross-sectional survey included the small sample size, particularly in the osteopath cohort, which could potentially affect the generalisability of findings to the broader professions. In hindsight, some survey questions may have been better designed to be more specific and remove ambiguity. This research offers new insight into how chiropractors and osteopaths in Australia use superficial heat in clinical practice, their preferences regarding its use, their awareness of clinical practice guidelines for low back pain and how these factors influence their clinical decision-making. Bridging this gap in knowledge between practitioner perceptions and clinical practice may contribute to improved management of low back pain by chiropractors and osteopaths and, ultimately, better patient outcomes via increased uptake of clinical practice guidelines for low back pain.


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