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Best Practice Physiotherapy for Patients with Low Back Pain in Primary Care : = Clinical Outcomes and Explanatory Factors.

Record Type:	Language materials, manuscript : Monograph/item
Title/Author:	Best Practice Physiotherapy for Patients with Low Back Pain in Primary Care :/
Reminder of title:	Clinical Outcomes and Explanatory Factors.
Author:	Fors, Maria.
Description:	1 online resource (141 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 85-10, Section: B.
Contained By:	Dissertations Abstracts International85-10B.
Subject:	Exercise. -
Online resource:	click for full text (PQDT)
ISBN:	9798382218182

Best Practice Physiotherapy for Patients with Low Back Pain in Primary Care : = Clinical Outcomes and Explanatory Factors.
Fors, Maria.

Best Practice Physiotherapy for Patients with Low Back Pain in Primary Care :Clinical Outcomes and Explanatory Factors. - 1 online resource (141 pages)

Source: Dissertations Abstracts International, Volume: 85-10, Section: B.

Thesis (Ph.D.)--Linkopings Universitet (Sweden), 2023.

Includes bibliographical references

Background: Clinical practice guidelines provide general recommendations informing best practice physiotherapy for low back pain (LBP). Despite increased research on LBP, the recommendations have barely changed over the last few decades and the burden of LBP remains. New research strategies have been suggested to further understand the complexity of factors influencing recovery of LBP. Several mechanisms are expected to underpin the benefits of physiotherapy care. How different factors influence and explain treatment outcome in patients in different phases of primary care pathway needs to be better understood for the development of better targeted LBP interventions. The overall aim of this thesis was to investigate if and how best practice physiotherapy primary care for patients with LBP can improve clinical outcome. Methods: The four papers in the thesis are based on two randomised controlled trials (RCT) evaluating best practice physiotherapy for patients with LBP in different phases of the primary care pathway reflecting the variation of patients' needs. Two papers investigated pre-surgery physiotherapy compared to being on a waiting-list in patients with degenerative lumbar spine disorders who are surgical candidates (n = 197). Effects on walking ability and quadriceps femoris strength were evaluated. Associations between the pre-surgery physical factors with 1-year post-surgery physical activity (PA) level were analysed using multiple linear regression. The dose-response relationship was investigated comparing the effects of attending ≤11 treatment sessions with ≥12 treatment sessions. Multiple mediation analyses and conditional process analyses were used to explore physical and psychosocial factors as mediators and patients' treatment expectations as a moderator of the treatment's effects on disability, back pain intensity, health-related quality of life (HRQoL), and self-rated health. Two papers were based on a stepped cluster RCT, where a physiotherapy primary healthcare model for LBP (the BetterBack MoC) was regionally implemented. Patients seeking care for LBP were allocated to either the BetterBack MoC (after implementation) or to routine care (before implementation) (n = 467). In a prospective cohort study within the RCT, the associations between patients' initial illness perceptions and outcomes in disability, back pain intensity, HRQoL, and self-care enablement (i.e., perceived ability to understand and cope with LBP) after 3 and 12 months were explored using stepwise linear regression. Single mediation analyses were used to test whether a priori hypothesised patients' illness perceptions and self-care enablement at 3 months mediated effects in disability and pain at 6 months of care according to the BetterBack MoC compared to routine care. Exploratory mediation analyses were also used to compare guideline-adherent care with non-adherent care. Guideline-adherent care was defined as care that included education and exercise interventions and did not include non-evidence-based interventions, referral to specialist care, or imaging. Results: Small positive effects from pre-surgery physiotherapy were seen in walking ability and quadriceps femoris strength. No clear dose-response relationship could be demonstrated when comparing the effects of ≤11 treatment sessions with ≥12. Pre-surgery physical outcome measures together explained 27.5% of the variation in PA level 1-year post-surgery, mainly explained by the pre-surgery PA level. The effect of the pre-surgery physiotherapy on patients' PA level partly explained the treatment's effect on self-rated health. Furthermore, among biopsychosocial factors, self-efficacy related to activities of daily living (ADL) partly explained the effect on all outcomes. PA related fear avoidance beliefs partly explained the effects on pain and self-rated health. Patients' treatment expectations moderated the effect in all outcomes. High expectations had a positive moderating effect, while expectation of full recovery had a suppressive effect. In patients seeking physiotherapy for LBP, negative initial prognosis and treatment expectations were associated with worse scores in several outcomes at 3- and 12-month follow-ups. Patients' illness perceptions and self-care enablement did not explain the effects of care after implementing the BetterBack MoC. This was mainly due to the BetterBack MoC not having superior effects over routine care on the hypothesised mediators. Illness perceptions and self-care enablement at 3 months were associated with disability and pain at 6 months. Further, these factors partly explained the effects of guideline-adherent care in disability and pain. Conclusions: Patients' illness perceptions, self-care enablement, ADL self-efficacy, and PA related fear-avoidance beliefs were supported to be potential factors explaining the effect on clinical outcomes of best practice physiotherapy for LBP in primary care. Patients' initial expectations regarding the prognosis and treatment may influence prospective outcomes including patients' self-care enablement. More specifically, pain and disability outcomes of best practice physiotherapy for patients seeking care for LBP may improve by targeting patients' illness perceptions and self-care enablement. Patients who are surgical candidates can increase their physical capacity and walking related performance through best practice physiotherapy. In this pre-surgery phase, the treatment should include targeting patients' ADL self-efficacy, PA related fear-avoidance beliefs, and PA level for improved disability, pain, and HRQoL.

Electronic reproduction.
Ann Arbor, Mich. :
ProQuest,
2024

Mode of access: World Wide Web

ISBN: 9798382218182Subjects--Topical Terms:

583899
Exercise.
Index Terms--Genre/Form:

554714
Electronic books.

Best Practice Physiotherapy for Patients with Low Back Pain in Primary Care : = Clinical Outcomes and Explanatory Factors.
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245 1 0 $a Best Practice Physiotherapy for Patients with Low Back Pain in Primary Care : $b Clinical Outcomes and Explanatory Factors.
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500 $a Source: Dissertations Abstracts International, Volume: 85-10, Section: B.
500 $a Advisor: Abbott, Allan;Enthoven, Paul.
502 $a Thesis (Ph.D.)--Linkopings Universitet (Sweden), 2023.
504 $a Includes bibliographical references
520 $a Background: Clinical practice guidelines provide general recommendations informing best practice physiotherapy for low back pain (LBP). Despite increased research on LBP, the recommendations have barely changed over the last few decades and the burden of LBP remains. New research strategies have been suggested to further understand the complexity of factors influencing recovery of LBP. Several mechanisms are expected to underpin the benefits of physiotherapy care. How different factors influence and explain treatment outcome in patients in different phases of primary care pathway needs to be better understood for the development of better targeted LBP interventions. The overall aim of this thesis was to investigate if and how best practice physiotherapy primary care for patients with LBP can improve clinical outcome. Methods: The four papers in the thesis are based on two randomised controlled trials (RCT) evaluating best practice physiotherapy for patients with LBP in different phases of the primary care pathway reflecting the variation of patients' needs. Two papers investigated pre-surgery physiotherapy compared to being on a waiting-list in patients with degenerative lumbar spine disorders who are surgical candidates (n = 197). Effects on walking ability and quadriceps femoris strength were evaluated. Associations between the pre-surgery physical factors with 1-year post-surgery physical activity (PA) level were analysed using multiple linear regression. The dose-response relationship was investigated comparing the effects of attending ≤11 treatment sessions with ≥12 treatment sessions. Multiple mediation analyses and conditional process analyses were used to explore physical and psychosocial factors as mediators and patients' treatment expectations as a moderator of the treatment's effects on disability, back pain intensity, health-related quality of life (HRQoL), and self-rated health. Two papers were based on a stepped cluster RCT, where a physiotherapy primary healthcare model for LBP (the BetterBack MoC) was regionally implemented. Patients seeking care for LBP were allocated to either the BetterBack MoC (after implementation) or to routine care (before implementation) (n = 467). In a prospective cohort study within the RCT, the associations between patients' initial illness perceptions and outcomes in disability, back pain intensity, HRQoL, and self-care enablement (i.e., perceived ability to understand and cope with LBP) after 3 and 12 months were explored using stepwise linear regression. Single mediation analyses were used to test whether a priori hypothesised patients' illness perceptions and self-care enablement at 3 months mediated effects in disability and pain at 6 months of care according to the BetterBack MoC compared to routine care. Exploratory mediation analyses were also used to compare guideline-adherent care with non-adherent care. Guideline-adherent care was defined as care that included education and exercise interventions and did not include non-evidence-based interventions, referral to specialist care, or imaging. Results: Small positive effects from pre-surgery physiotherapy were seen in walking ability and quadriceps femoris strength. No clear dose-response relationship could be demonstrated when comparing the effects of ≤11 treatment sessions with ≥12. Pre-surgery physical outcome measures together explained 27.5% of the variation in PA level 1-year post-surgery, mainly explained by the pre-surgery PA level. The effect of the pre-surgery physiotherapy on patients' PA level partly explained the treatment's effect on self-rated health. Furthermore, among biopsychosocial factors, self-efficacy related to activities of daily living (ADL) partly explained the effect on all outcomes. PA related fear avoidance beliefs partly explained the effects on pain and self-rated health. Patients' treatment expectations moderated the effect in all outcomes. High expectations had a positive moderating effect, while expectation of full recovery had a suppressive effect. In patients seeking physiotherapy for LBP, negative initial prognosis and treatment expectations were associated with worse scores in several outcomes at 3- and 12-month follow-ups. Patients' illness perceptions and self-care enablement did not explain the effects of care after implementing the BetterBack MoC. This was mainly due to the BetterBack MoC not having superior effects over routine care on the hypothesised mediators. Illness perceptions and self-care enablement at 3 months were associated with disability and pain at 6 months. Further, these factors partly explained the effects of guideline-adherent care in disability and pain. Conclusions: Patients' illness perceptions, self-care enablement, ADL self-efficacy, and PA related fear-avoidance beliefs were supported to be potential factors explaining the effect on clinical outcomes of best practice physiotherapy for LBP in primary care. Patients' initial expectations regarding the prognosis and treatment may influence prospective outcomes including patients' self-care enablement. More specifically, pain and disability outcomes of best practice physiotherapy for patients seeking care for LBP may improve by targeting patients' illness perceptions and self-care enablement. Patients who are surgical candidates can increase their physical capacity and walking related performance through best practice physiotherapy. In this pre-surgery phase, the treatment should include targeting patients' ADL self-efficacy, PA related fear-avoidance beliefs, and PA level for improved disability, pain, and HRQoL.
520 $a Bakgrund: Evidensbaserade kliniska riktlinjer ger generella rekommendationer for fysioterapi enligt basta praxis vid landryggsbesvar (LB). Trots okad forskning pa LB har rekommendationerna i stort varit oforandrade de senaste artiondena och bordan av LB kvarstar. Nya forskningsstrategier har foreslagits for att forsta komplexiteten av faktorer som paverkar aterhamtning av LB. Flera faktorer forvantas kunna forklara effekterna av fysioterapi. Mer kunskap behovs om vilka faktorer som paverkar och forklarar effekter av fysioterapi hos patienter med LB i olika faser av primarvardsforloppet for att kunna utveckla battre riktade behandlingar. Det overgripande syftet med denna avhandling var att undersoka om och hur fysioterapi enligt basta praxis for patienter med LB i primarvard kan forbattra kliniska utfall. Metoder: Avhandlingen ar baserad pa tva randomiserade kontrollerade studier som utvarderar fysioterapi enligt basta praxis for patienter med LB i olika faser av primarvardsforloppet och med olika vardbehov. I tva delarbeten undersoktes preoperativ fysioterapi jamfort med att vara pa vantelista infor ryggkirurgi hos patienter med degenerativ landryggsakomma (n = 197). Effekter pa gangformaga och styrka i quadriceps femoris utvarderades. Associationer mellan de preoperativa fysiska faktorerna och fysisk aktivitetsniva ett ar efter operation analyserades med multipel linjar regression. Dos-responsforhallande undersoktes genom att jamfora effekter av ≤11 med ≥12 behandlingstillfallen. Explorativa mediatoranalyser och modererade mediatoranalyser anvandes for att undersoka fysiska och psykosociala faktorer som medierande faktorer, och patienternas forvantan pa behandlingen som modererande faktor, av behandlingens effekt pa funktion, smartintensitet, halsorelaterad livskvalitet och sjalvskattad halsa. Tva delarbeten baserades pa en stegvis klusterrandomiserad kontrollerad studie dar ett fysioterapeutiskt vardprogram for LB (BattreRygg) implementerades regionalt. Patienter som sokte vard for LB allokerades till sedvanlig fysioterapeutisk vard (fore implementeringen) eller till BattreRygg (efter implementeringen) (n = 467). I en prospektiv kohortstudie, inom den randomiserade kontrollerade studien, undersoktes associationer mellan patienternas initiala sjukdomsuppfattningar och funktion, smartintensitet, halsorelaterad livskvalitet och egenvardsformaga efter 3 och 12 manader med stegvis multipel regression. Mediatoranalyser anvandes for att bekrafta om patienternas sjukdomsuppfattningar och egenvardsformaga vid 3 manader medierade effekten i funktion och smarta vid 6 manader av vard enligt BattreRygg jamfort med sedvanlig vard. Explorativa mediatoranalyser jamforde dessutom riktlinjebaserad vard med vard som inte foljde riktlinjer. Riktlinjebaserad vard definierades som vard som inneholl utbildnings- och traningsinterventioner och inte innefattade icke-evidensbaserade interventioner, remittering till specialistvard eller rontgen. Resultat: Preoperativ fysioterapi visade sma positiva effekter pa gangformaga och quadriceps femorisstyrka. Inget tydligt dos-responsforhallande kunde pavisas vid jamforelse mellan ≤11 och ≥12 behandlingstillfallen. Preoperativa fysiska faktorer forklarade tillsammans 27.5% av variationen i fysisk aktivitetsniva ett ar efter operation, dar preoperativ fysisk aktivitetsniva var den framsta forklarande faktorn. Den preoperativa fysioterapins effekt pa patienternas fysiska aktivitetsniva forklarade delvis behandlingens effekt pa sjalvskattad halsa. Bland fysiska och psykosociala faktorer, sags aven patientens tilltro till sin formaga att utfora dagliga aktiviteter (ADL self-efficacy) delvis forklara effekten i samtliga utfallsmatt. Radsla-undvikande-installning till fysisk aktivitet sags delvis forklara effekten i smarta och sjalvskattad halsa. Patienternas forvantan pa behandlingen modererade behandlingens effekt pa samtliga utfallsmatt. Hog forvantan pa behandlingen hade en positiv okande effekt, medan forvantan om att bli helt aterstalld hade en supprimerande effekt. Hos patienter som sokte fysioterapeut for LB, var negativ forvantan pa prognos och behandling associerat med samre skattningar i flera utfallsmatt vid 3- och 12-manaders uppfoljning. Patienternas sjukdomsuppfattningar och egenvardsformaga forklarade inte effekter av behandling efter implementeringen av BattreRygg. Detta berodde framst pa att BattreRygg inte hade storre effekt pa de hypotiserade mediatorerna jamfort med sedvanlig vard. Patienternas sjukdomsuppfattningar och egenvardsformaga vid 3 manader var associerade med funktion och smarta vid 6 manader. Vidare forklarade faktorerna delvis effekter av riktlinjebaserad vard pa funktion och smarta. Konklusioner: Patienters sjukdomsuppfattningar, egenvardsformaga, ADL self-efficacy samt radsla-undvikande-installning till fysisk aktivitet var potentiella faktorer som forklarade effekter i kliniska utfall av fysioterapi enligt basta praxis for LB i primarvard. Patienternas initiala forvantningar pa prognos och behandling kan paverka prospektiva utfall, inklusive patienternas egenvardsformaga. Mer specifikt, att rikta fysioterapi enligt basta praxis mot patienternas sjukdomsuppfattningar och egenvardsformaga kan forbattra smarta och funktion hos patienter som soker primarvard for LB. Patienter som ar aktuella for ryggkirurgi kan oka sin fysiska kapacitet och gangrelaterad funktion av fysioterapi enligt basta praxis. Behandling i den preoperativa fasen bor inkludera inriktning mot patientens ADL self-efficacy, radsla-undvikande-installning till fysisk aktivitet, och fysisk aktivitetsniva i syfte att forbattra funktion, smarta, och halsorelaterad livskvalitet.
533 $a Electronic reproduction. $b Ann Arbor, Mich. : $c ProQuest, $d 2024
538 $a Mode of access: World Wide Web
650 4 $a Exercise. $3 583899
650 4 $a Activities of daily living. $3 1372485
650 4 $a Physical therapy. $3 678370
650 4 $a Back pain. $3 1473856
655 7 $a Electronic books. $2 local $3 554714
690 $a 0382
710 2 $a ProQuest Information and Learning Co. $3 1178819
710 2 $a Linkopings Universitet (Sweden). $3 1473719
773 0 $t Dissertations Abstracts International $g 85-10B.
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=31247265 $z click for full text (PQDT)