Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2016; 7(9): 561-569
Published online Sep 18, 2016. doi: 10.5312/wjo.v7.i9.561
Attitudes and diagnostic practice in low back pain: A qualitative study amongst Greek and British physiotherapists
Evdokia Billis, Christopher J McCarthy, John Gliatis, Charalampos Matzaroglou, Jacqueline A Oldham
Evdokia Billis, Charalampos Matzaroglou, Department of Physical Therapy, Technological Educational Institute of Western Greece, 25100 Aigion, Greece
Christopher J McCarthy, Imperial College Healthcare NHS Trust, St Mary’s Hospital, Paddington, London W2 1NY, United Kingdom
John Gliatis, Department of Orthopaedic, University Hospital of Patras, 25100 Patras, Greece
Jacqueline A Oldham, University of Manchester, Manchester: Integrating Medicine and Innovative Technology, Manchester M13 9NQ, United Kingdom
Author contributions: Billis E designed the research, conducted the data collection and analysis and wrote the manuscript; McCarthy CJ contributed to the conception of the design and facilitated data collection amongst British physiotherapists; Gliatis J contributed to the data interpretation and analysis of this design; Matzaroglou C assisted in data collection and proof reading of this article; Oldham JA was responsible for making critical revisions to the conceptual content of the manuscript and conducted the final approval of the manuscript.
Supported by The MACP’s Elsevier Science and Doctoral Awards for Research in Manipulative Physiotherapy.
Institutional review board statement: The study was reviewed and approved by the Ethical Committees of Technological Educational Institute (TEI) of Lamia, Greece and University of Manchester, United Kingdom.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Evdokia Billis, Assistant Professor in Physiotherapy, Department of Physical Therapy, Technological Educational Institute of Western Greece, Psaron 6, 25100 Aigion, Greece. ebillis@teiwest.gr
Telephone: +30-26-91061150 Fax: +30-26-91061250
Received: February 22, 2016
Peer-review started: February 23, 2016
First decision: March 25, 2016
Revised: April 21, 2016
Accepted: June 27, 2016
Article in press: June 29, 2016
Published online: September 18, 2016
Processing time: 203 Days and 16.7 Hours
Abstract
AIM

To explore current diagnostic practice and attitudes of Greek and United Kingdom physiotherapists (PTs) on assessing low back pain (LBP) patients.

METHODS

Three focus groups were undertaken, followed by a structured questionnaire-type survey comprising 23 health professionals and a random stratified sample of 150 PTs, respectively. Twenty-nine themes relating to LBP diagnostic practice emerged. These were then given to 30 British PTs assessing their level of agreement with their Greek counterparts. Analysis was performed by percentage agreements and χ2 tests.

RESULTS

The survey was divided into three subsections; PTs’ attitudes on LBP assessment, patients’ attitudes and diagnostic/healthcare issues, each constituting 14, 7 and 8 statements, respectively. Over half of the statements fell within the 30%-80% agreement between Greece and United Kingdom whereas, 5 statements reported low (< 10%) and 8 statements demonstrated high (> 90%) PT percentage agreement. Similarities across British and Greek PTs were detected in history taking methods and in the way PTs feel patients perceive physiotherapy practice whereas, re-assessment was undertaken less frequently in Greece. Diagnosis according to 91% of the Greek PTs is considered a “privilege” which is exclusive for doctors in Greece (only 17% British PTs agreed) and is accompanied with a great overuse of medical investigations. Forty percent of Greek PTs (compared to 0% of British) consider themselves as “executers”, being unable to interfere with treatment plan, possibly implying lack of autonomy.

CONCLUSION

Although similarities on history taking methods and on patients’ attitudes were detected across both groups, gross differences were found in re-assessment procedures and diagnostic issues between Greek and British physiotherapists, highlighting differences in service delivery and professional autonomy.

Keywords: Diagnostic practice; Low back pain; United Kingdom; Greek; Physiotherapists

Core tip: This small-scale observational study explored commonalities and differences in low back pain (LBP) perspectives and diagnostic practice between Greek and British physiotherapists (PTs). There was agreement on clinical examination features for targeting treatment; indicating that LBP is a clinical entity whose clinical “expressions” amongst PTs and patients are common across different cultural groups. The differences detected particularly referred to diagnostic issues (i.e., overuse of medical investigations/radiography, etc.), reflecting differences in medical and physiotherapy services delivery. Such comparisons contribute to the understanding of the course and/or management of LBP across the two countries.