Education of Municipality-based Physiotherapists in Managing Disabling Low Back Pain - an Observational Study

NCT05794373 | Enrolling By Invitation

• 1 other identifier: Back pain in Municipalities
• Study Type: observational
• Target: 200
• Locations: 1 country
• Sites: 1

Brief Summary

A consistent theme in the modern-day healthcare system is the difficulty of transferring research knowledge into clinical practice. Recently, it has been pointed out that this is a barrier for providing care that is evidence-based which may partly explain the growing burden of low back pain. Low back pain, as all other musculoskeletal pain conditions is multidimensional where biomedical and psychological factors need to be accounted for, as well as the patient's social context. From the healthcare provider perspective, this requires skills that often goes beyond the basic training where clinicians need to be able to assess and manage the multiple domains in a patient-centered manner. In Denmark, people living with disabling low back pain can be referred to a municipality-based rehabilitation program. This study seeks to investigate whether providing physiotherapists an evidence-based educational course on the management of low back pain will change patient-related outcomes. Likewise, we will investigate potential barriers and facilitators for implementing the skills the physiotherapists acquire in clinical practice. If the project shows a favorable effect, it will allow for upscaling the intervention within and across municipalities. Moreover, a positive outcome may provide indications of what type of continuing education resources should be made available to help clinicians better manage complicated low back pain problems.

Conditions

Low Back Pain

Keywords

Chronic low back pain; Rehabilitation; Physiotherapy

Outcome Measures

Primary Outcomes (1)

• Disability

  Change in disability measured on the Roland Morris Disability Questionnaire between baseline and follow up. Questionnaire designed to capture disability in low back pain patients (0-24 where 0 = no loss of function and 24 = complete loss of function)

  At baseline and 3 months after starting rehabilitation

Secondary Outcomes (4)

• Pain intensity

  At baseline and 3 months after starting rehabilitation

• Emotional and cognitive functioning

  At baseline and 3 months after starting rehabilitation

• Sick leave from work

  At baseline and 3 months after starting rehabilitation

• Patient Assessment of Transitions in Healthcare

  3 months after starting rehabilitation

Other Outcomes (2)

• Checklist to determine the competency of clinicians

  Up to 24 weeks after the project period has ended

• Barriers and facilitators for implementing new knowledge in clinical practice - qualitative interview

  Up to 24 weeks after the project period has ended

Study Arms (2)

Pre-Education group

Patients in this group undergo rehabilitation for back pain in a municipality setting with physiotherapists before the physiotherapists have participated in an educational intervention

Procedure: Standard physiotherapy for low back pain in a municipality setting

Post-Education group

Patients in this group undergo rehabilitation for back pain in a municipality setting with physiotherapists after they have participated in an educational intervention

Procedure: Standard physiotherapy for low back pain in a municipality setting

Interventions

Standard physiotherapy for low back pain in a municipality setting PROCEDURE

Patients (N=100) referred to a municipality-based rehabilitation for low back pain are included. The physiotherapists choose the rehabilitation strategy based on what they consider relevant for the patients. After the first 100 patients have been discharged from municipality care, the physiotherapists will participate in an educational intervention (12 sessions) focusing on the management of low back pain within a multidimensional framework. In the educational intervention, the participants will learn how to identify the presence of unhelpful thoughts and emotions and how to address these as part of the intervention. The course will thus be a mix of theoretical and practical teaching, including case supervision and feedback. Following the educational intervention, an additional 100 patients referred to the rehabilitation program will be included. The intervention is aimed at the physiotherapists where the patients will receive the best available care, before or after the intervention.

Post-Education group; Pre-Education group

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Physiotherapists working in a municpality setting (N=25) in the region of southern Denmark. Minimum one year clinical experience in working with spine-related disorders

You may qualify if:

• referred to municipality care from the Spine Clinic of Southern Denmark
• Between 18-65 years
• Speaks and comprehends Danish
• A score over 40 on the Orebro Musculoskeletal Pain Questionnaire
• Low back pain as dominating cause for referral

You may not qualify if:

• A current diagnosis of psychiatric illness that precludes participation in rehabilitation
• A neurologic disorder or other disease that may affect the ability to participate in a municipality based rehabilitation program
• A neurological deficits related with radiographically confirmed lumbar spinal stenosis or radicular pain correlating with the clinical presentation
• Recent (within 6 months) history of a stabilizing operation of the low back

Sponsors & Collaborators

• Aalborg University Hospital: lead
• Spine Centre of Southern Denmark: collaborator

Study Sites (1)

Spine Center of Southern Denmark

Middelfart, 5500, Denmark

Location

MeSH Terms

Conditions

Low Back Pain

Condition Hierarchy (Ancestors)

Back Pain; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Thorvaldur S Palsson, PhD

  Aalborg University Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head of research,

Study Record Dates

• First Submitted: February 3, 2023
• First Posted: April 3, 2023
• Study Start: March 1, 2023
• Primary Completion: April 1, 2025
• Study Completion: December 1, 2025
• Last Updated: August 14, 2024

Record last verified: 2024-08

Data Sharing

• IPD Sharing: Will not share

Locations

DK (1)