1. ‘Specialist before physiotherapist’: physicians’ and physiotherapists’ beliefs and management of chronic low back pain in Ghana – A qualitative study.
- Author
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Ampiah, Josephine Ahenkorah, Moffatt, Fiona, Diver, Claire J., and Ampiah, Paapa Kwesi
- Abstract
AbstractPurposeMaterials/MethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONThis study provides an understanding of the chronic low back pain (CLBP) beliefs and management practices of physicians/doctors and physiotherapists in Ghana, and the mechanisms underlying their beliefs and practices.Thirty-three individual semi-structured interviews, involving eighteen physiotherapists and fifteen physicians involved with CLBP management, were carried out. Interviews were audio recorded, transcribed, and analysed using Straussian grounded theory principles and critical realist philosophy.Five categories were derived: The predominance of bio-medical/mechanical beliefs, maladaptive beliefs, maladaptive practices, limited involvement of physiotherapists and other healthcare professionals (HCPs) and evidence-based beliefs and practices. The predominant mechanisms underlying the HCPs beliefs and practices were: the healthcare environment (professional roles/identity hinged around paternalistic and biomedical care, fragmented CLBP management, limited physiotherapy/HCPs’ knowledge) and sociocultural environment (sociocultural/patients’ expectations of passive therapy and paternalism).The CLBP beliefs and practices of HCPs involved with CLBP in Ghana is modelled around a professional identity that is largely hinged on paternalism and bio-medical/mechanical understandings. Lack of collaboration and sociocultural expectations also play a significant role. There is the need for a reconstitution of Ghanaian HCPs’ CLBP beliefs and management approaches to align with evidenced-based approaches (e.g., imaging should not be universally prescribed, biopsychosocial and patient-centred care).The burden of low back pain is substantial globally, with an increasing burden identified in low-to-middle income countries.This study highlights a predominance of non-evidence-based understandings around chronic low back pain and its management among Ghanaian healthcare professionals, although some evidence-based approaches were also identified.Ghanaian healthcare professionals need to engage with current evidence for chronic low back pain management, incorporate psychological factors and consider non-specific chronic low back pain as a possible diagnostic label.Professional, structural, and sociocultural inclinations towards paternalism, passive therapies, biomedical and fragmented approaches to chronic low back pain management need to be addressed. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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