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Introduction: Low back pain (LBP) remains the leading cause of disability. The Low Back Pain and Disability Drivers Management (PDDM) model aims to identify the domains driving pain and disability to guide clinical decisions. The objectives of this study were to determine the feasibility of conducting a pragmatic controlled trial of the PDDM model and to explore its effectiveness compared to clinical practice guidelines' recommendations for LBP management., Methods: A pilot cluster nonrandomised controlled trial. Participants included physiotherapists and their patients aged 18 years or older presenting with a primary complaint of LBP. Primary outcomes were the feasibility of the trial design. Secondary exploratory analyses were conducted on LBP-related outcomes such as pain severity and interference at 12-week follow-up., Results: Feasibility of study procedures were confirmed, recruitment exceeded our target number of participants, and the eligibility criteria were deemed suitable. Lost to follow-up at 12 weeks was higher than expected (43.0%) and physiotherapists' compliance rates to the study protocol was lower than our predefined threshold (75.0% vs. 57.5%). A total of 44 physiotherapists and 91 patients were recruited. Recommendations for a larger scale trial were formulated. The PDDM model group demonstrated slightly better improvements in all clinical outcome measures compared to the control group at 12 weeks., Conclusion: The findings support the feasibility of conducting such trial contingent upon a few recommendations to foster proper future planning to determine the effectiveness of the PDDM model. Our results provide preliminary evidence of the PDDM model effectiveness to optimise LBP management., Clinical Trial Registration: Clinicaltrial.gov, NCT04893369., (© 2023 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd.)

Study Design: Individual semistructured qualitative interviews., Objective: To evaluate barriers to use of management recommendations, aimed at preventing low back pain (LBP) disability, with general practitioners (GPs), occupational therapists (OTs), and physiotherapists (PTs) working in Quebec (Canada), and identify areas of convergence and divergence between health professions., Summary of Background Data: Studies have demonstrated inadequacies of practices of clinicians with regard to LBP management and prevention of persistent disability. Barriers to use of evidence by clinicians should be evaluated to understand these inadequacies and develop implementation strategies., Methods: Sixteen PTs, 8 OTs, and 8 GPs were recruited with different levels of experience and practice location (urban or rural). They were asked to follow management recommendations (Clinic on Low-back Pain in Interdisciplinary Practice [CLIP] guidelines), with a minimum of 2 patients. Individual semistructured interviews were used to identify barriers to use of management recommendations aimed at preventing LBP disability. Barriers between health professions were compared., Results: Barriers to use were lesser for OTs and greater for GPs, with divergences among PTs. OTs agreed with the guidelines, found them compatible with their current practice, and thought that using them would prevent persistent disability. GPs and PTs thought that the guidelines did not provide enough information on the pathophysiological management of LBP. GPs thought that it would be difficult to implement the guidelines in everyday practice. All 3 groups thought that management recommendations could conflict with patient expectations., Conclusion: To address identified barriers, a process of care is proposed by fitting tasks to the most compatible providers. The task of GPs could focus on pain management through medication, red flag screening, encouragement to stay active, and reassurance. The tasks of PTs could center on pain management, general exercise, and encouragement to stay active. The tasks of OTs could focus on disability prognosis, yellow flags management, and return to activity parameters. The efficacy of this process of care to prevent persistent LBP disability should be assessed in a trial.

Objective: Identify barriers and facilitators related to the use of low-back pain guidelines as perceived by occupational therapists (OTs)., Methods and Participants: A qualitative approach was used. Nine OTs with varied characteristics were randomly selected. Participants were asked to use the guidelines with at least two clients. Semi-structured interviews were done to identify barriers and facilitators related to use. Transcripts of the interviews were analyzed., Results: Participants agreed with the guidelines, found them compatible with their current practice, and believed using them would help in preventing persistent disability. Some questioned if their work organization, based on group therapy, would limit their use of the guidelines. Because of the guidelines' biopsychosocial perspective, they anticipated problems regarding client expectations and collaboration with other health professionals., Conclusions: Participating OTs raised few barriers related to them. Barriers were mostly related to client expectations, work organization and peers. It appears the guidelines would be easily implemented by OTs, but environmental elements could limit this.

Introduction: A new set of clinical practice guidelines (CPGs) for the management of low back pain (LBP) and prevention of persistent disability entitled "Clinic on Low back pain in Interdisciplinary Practice" (CLIP) was developed in the province of Quebec, Canada. The literature shows that simply disseminating CPGs does not necessarily lead to their adoption by clinicians. To improve adherence to CPGs among healthcare professionals, the literature suggests that there is a need to identify and address the factors impeding or facilitating their use. The aim of this study was therefore to identify the barriers to and facilitators of CLIP CPG use, as perceived by physiotherapists (PTs)., Methods: A descriptive study using a qualitative method was conducted with a sample of 16 PTs from a variety of professional backgrounds. Each participant used the CPGs over a 6-week period with two patients suffering from LBP, and then participated in a semi-structured interview in which he or she was asked to identify the barriers and facilitators experienced., Results: The participating PTs identified many barriers and facilitators pertaining to the guidelines themselves, the users and the environment. Four key nodes emerged from these barriers and facilitators during data analysis. It appears that the clinicians' understanding of the CPGs, the level of compatibility between their practices and the CLIP CPG recommendations, the level of CPG relevance as perceived by the clinicians, and their level of agreement with the CPGs, all affected their use of the guidelines., Conclusions: In order to increase CLIP CPG use, the implementation strategy to be developed should take into account the barriers and facilitators that were identified in this study.

Background: Low-back pain is responsible for significant disability and costs in industrialized countries. Only a minority of subjects suffering from low-back pain will develop persistent disability. However, this minority is responsible for the majority of costs and has the poorest health outcomes. The objective of the Clinic on Low-back pain in Interdisciplinary Practice (CLIP) project was to develop a primary care interdisciplinary practice model for the clinical management of low-back pain and the prevention of persistent disability., Methods: Using previously published guidelines, systematic reviews and meta-analyses, a clinical management model for low-back pain was developed by the project team. A structured process facilitating discussions on this model among researchers, stakeholders and clinicians was created. The model was revised following these exchanges, without deviating from the evidence., Results: A model consisting of nine elements on clinical management of low-back pain and prevention of persistent disability was developed. The model's two core elements for the prevention of persistent disability are the following: 1) the evaluation of the prognosis at the fourth week of disability, and of key modifiable barriers to return to usual activities if the prognosis is unfavourable; 2) the evaluation of the patient's perceived disability every four weeks, with the evaluation and management of barriers to return to usual activities if perceived disability has not sufficiently improved., Conclusion: A primary care interdisciplinary model aimed at improving quality and continuity of care for patients with low-back pain was developed. The effectiveness, efficiency and applicability of the CLIP model in preventing persistent disability in patients suffering from low-back pain should be assessed.

Purpose: The objective was to estimate the psychometric properties of the Modified-Modified Schober Test (MMST)., Design: This study compared range of motion measurements of lumbar flexion in low back pain (LBP) patients using the MMST with measurements calculated on X-rays as the gold standard, and compared the measurements taken by two independent examiners., Method: This study was conducted at the main hospital in the Outaouais area, Quebéc, Canada. Thirty-one subjects with LBP from private and public clinics participated in the study. After a warm-up session, measurements with the MMST were taken in neutral position and an X-ray technician took an exposure in the same position., Results: Pearson's correlation test (r) between measurements made with the MMST and the gold standard, intra-class correlation coefficient (ICC), minimum metrically detectable change (MMDC) and confidence interval (CI) were used to analyze the data. The MMST demonstrated moderate validity (r=0.67; 95%CI 0.44-0.84), excellent reliability (intra: ICC=0.95; 95%CI 0.89-0.97; inter: ICC=0.91; 95%CI 0.83-0.96) and a MMDC of 1 cm., Conclusions: In our sample of LBP patients, the MMST showed moderate validity but excellent reliability and MMDC.

Purpose: The purpose was to estimate the criterion validity of the Back Range of Motion (BROM II) and Electronic Digital Inclinometer (EDI-320) devices. METHODS. This study compared the range of motion measurements of low back pain (LBP) patients taken with the BROM II and EDI-320 with measurements using the double inclinometer (DI) method as the gold standard. Forty subjects with LBP volunteered for the study. The subjects were asked to do three forward flexion movements. A measurement was taken with each of the three different devices for each movement. Results: The BROM II demonstrated good linear relationship (Pearson r = 0.78; 95% CI: 0.78–0.94) and the EDI-320 very good linear relationship (Pearson r = 0.88; 95% CI: 0.62–0.89) with the gold standard, the DI. Conclusions: The Pearson correlation value indicates good validity of the EDI-320 in our sample of LBP patients. Although a good correlation was established for the BROM II, the significant difference of the mean ROM reported for this instrument compared to the gold standard data suggests that the BROM II actually measures ROM differently. Our results suggest that the EDI 320 is clinically useful in providing objective and valid data for outcome measures in a population with LBP. More research is needed on the BROM II before we can make final conclusion on its use in clinical settings as an outcome measure. [ABSTRACT FROM AUTHOR]