Clinical challenges of classification based targeted therapies for non-specific low back pain

Classification of non-specific low back pain (NSLBP) was suggested to better target care and so maximise treatment potential. This study examined physiotherapy practitioners’ (PPs) and managers’ (PMs) views, experiences and perceptions of barriers and enablers for using classification systems (CSs) to better target treatment for NSLBP in the NHS primary care setting. Five themes emerged (i) CS knowledge: PPs and PMs were aware of CSs and agreed with its usefulness. PPs were mostly aware of CSs informing specific treatments whilst PMs were aware of prognosis based CSs. (ii) Using CSs: PPs classify by experience and clinical reasoning skills, shifting between multiple CSs. PMs were confident that evidence-based practice takes place but believed CSs may not be always used. (iii) Advantages/disadvantages of CSs: Effective targeting of treatments to patients was perceived as advantageous; but the amount of training required was seen as disadvantageous. (iv) Barriers: Patients’ expectations, clinicians’ perceptions, insufficiently complex CSs, lack of training resources. (v) Enablers: Development of adequately complex CSs, placed within the clinical reasoning pro cess, mentoring, positive engagement with stakeholders and patients.

PPs and PMs were aware of CSs and agreed with its usefulness. The current classification process was seen to be largely influenced by individual practitioner knowledge and clinical reasoning skills instead of their being based on one CS alone. Barriers and enablers were identified for future research.

Neck Pain

Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability and 21st in terms of overall burden.

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