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Changing the practice of osteopaths, chiropractors and musculoskeletal physiotherapists in relation to the management of low back pain

Journal: Unpublished PhD thesis Keele University, Date: 2007/01, , type of study: mixed methods study

Full text    (https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.484899)

Keywords:

attitudes [46]
low back pain [413]
mixed method study [52]
osteopaths [138]
practice [207]

Abstract:

Low back pain (LBP) is a common and costly problem. In western society, huge resources have been directed at providing solutions to this problem, yet this investment has shown relatively little return. One possible avenue for reducing the societal impact of LBP is through improving the quality of healthcare. In the UK, the three professional groups of chiropractic, osteopathy and musculoskeletal physiotherapy are involved in the management of 15-20% of all people with LBP, yet previous research suggests that many do not follow 'best practice' recommendations for LBP. Methods. The first study of this thesis was an exploratory study, based on a Grounded Theory approach, in which data were collected using focus groups. The primary aim of this study was to develop a theoretical model of factors that influence the behaviour of individual chiropractors, osteopaths and musculoskeletal physiotherapists when caring for patients with LBP. The second study of the thesis was a pragmatic randomised controlled trial that was designed to test whether the reported behaviour and beliefs of these practitioners would change if exposed to a passively disseminated, printed educational package, relating to the management of LBP. The data from this trial were also used to evaluate whether the previously developed theoretical model predicted reported behaviour in representative groups of these practitioners. Results. The theoretical model formed from the exploratory study consisted primarily of three meta-themes: professional identity, occupational beliefs and clinical behaviour. In the trial, a small but significant overall change in the intended direction in both reported behaviour and beliefs was measured in the intervention group, in response to the educational package. A cross-sectional analysis of the baseline trial data showed professional identity, as marked by professional grouping, to be associated with distinct profiles of attitudes, beliefs and reported behaviour. Furthermore, beliefs were strongly associated with reported behaviour at baseline. Hence, a portion of the theoretical model was supported by these data. By contrast, further exploration of the trial data showed that professional identity did not predict baseline-to-follow-up changes in the key reported behaviours measured, and beliefs and reported behaviour did not always change in unison. Conclusion. Attitudes, beliefs and the professional identities of the healthcare practitioners studied in this thesis are related to their reported behaviour. Behaviour may be changed through exposure to written educational material but, when used in isolation, this change is likely to be small.


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