Physiotherapists have some hesitations and unmet needs regarding delivery of exercise programs for low back pain prevention in adults: A qualitative interview study

BACKGROUND: Although there is some qualitative research on physiotherapists' experiences of delivering low back pain treatment, we do not know the extent that these findings apply to low back pain prevention. OBJECTIVE: To explore physiotherapists' understanding, attitudes and experiences related to delivering low back pain prevention programs. DESIGN: Qualitative interview study. METHOD: Interviews from 25 Australian physiotherapists (56% female; 44% male) were analysed using framework thematic analysis. RESULTS: Theme 1 explored physiotherapists' hesitancy about 'low back pain prevention,' raising concerns this term might inadvertently entrench unhelpful beliefs. They preferred language about minimising the risk and impact of recurrences, and promoting an active lifestyle. Theme 2 emphasised that as pain receded, engaging patients could be challenging. Some discussed that person-centred care and individualised programs helped overcome this challenge. Several wanted more training in counselling skills, and more consistent external messaging about low back pain prevention. Theme 3 highlighted uncertainty about delivering high-value prevention care. Some perceived the programs as potentially placing unnecessary financial burden on some patients. Many physiotherapists were uncertain about how to support patients when they weren't in pain (i.e., remission) and wanted training in tailored exercise prescription. CONCLUSIONS: Many of the physiotherapists had some hesitations and unmet needs regarding delivery of exercise programs for secondary prevention of low back pain. Clinicians may find it useful to ask patients directly about their interest in prevention programs and work with interested patients to develop tailored, progressive programs that continue to be motivating, even during periods when there is no pain.