'Look up from the waiting list and see the bigger picture': a qualitative analysis of clinical specialist physiotherapist perspectives on low back pain care in Ireland

Cathriona Murphy; Helen French; Geraldine McCarthy; Caitriona Cunningham

doi:10.1016/j.physio.2024.02.002

'Look up from the waiting list and see the bigger picture': a qualitative analysis of clinical specialist physiotherapist perspectives on low back pain care in Ireland

Physiotherapy. 2024 Jun:123:133-141. doi: 10.1016/j.physio.2024.02.002. Epub 2024 Feb 12.

Authors

Cathriona Murphy¹, Helen French², Geraldine McCarthy³, Caitriona Cunningham⁴

Affiliations

¹ Physiotherapy Department, University Hospital Kerry, Tralee, Co. Kerry, Ireland. Electronic address: caitriona.murphy1@ucdconnect.ie.
² School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: hfrench@rcsi.ie.
³ School of Medicine, University College Dublin, Ireland; Department of Rheumatology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. Electronic address: g.mccarthy@ucd.ie.
⁴ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland. Electronic address: caitriona.g.cunningham@ucd.ie.

PMID: 38479069
DOI: 10.1016/j.physio.2024.02.002

Abstract

Introduction: Healthcare systems are struggling to deliver high-quality low back pain (LBP) care. In 2012 specialist physiotherapist-led musculoskeletal (MSK) triage services were introduced in Irish hospitals to expedite patient care and alleviate pressure on elective orthopaedic/ rheumatology consultant clinics. Specialist physiotherapists have expertise to inform health service improvement and reform, but their perspectives of LBP healthcare delivery have received scant attention.

Objectives: To explore specialist physiotherapists' perspectives on LBP care in Ireland, the barriers and facilitators to quality LBP care and the development of MSK interface services in primary care settings.

Design: Cross-sectional observational study using an anonymous electronic survey with thematic framework analysis of response data from open-ended questions.

Participants: Thirty-four clinical specialist physiotherapists in Irish MSK triage services.

Results: Thematic analysis resulted in six overarching themes, grouped into two categories. One category pertained to LBP healthcare in Ireland with the following three themes: 1) Inadequate health services for patients with LBP; 2) Need for defined LBP clinical pathways; 3) Need for a multisectoral approach to spine health. Themes in the second category, pertaining to the development of community-based MSK interface services, were: 4) Concern regarding isolation from secondary care services; 5) Unrealistic expectations of MSK triage; 6) Improved communication and collaboration with primary care services.

Conclusion: Specialist physiotherapists have concerns regarding LBP health services and persistence of a biomedical, secondary care-led approach. They advocate for investment in primary care multi-disciplinary teams, enhanced integration across primary and secondary care, development of a national clinical pathway and a multisectoral approach. CONTRIBUTION OF PAPER.

Keywords: Clinical engagement; Evidence-based healthcare; Low back pain; Physiotherapists; Qualitative research; Quality improvement.

Publication types

Observational Study

MeSH terms

Adult
Attitude of Health Personnel
Cross-Sectional Studies
Female
Humans
Ireland
Low Back Pain* / rehabilitation
Low Back Pain* / therapy
Male
Physical Therapists*
Primary Health Care
Qualitative Research*
Surveys and Questionnaires
Triage
Waiting Lists*