Methods and results

We conducted a multi-centre pragmatic randomised controlled trial, testing ‘SupportBack’, an accessible internet intervention developed specifically for primary care. We aimed to determine the effectiveness of the SupportBack interventions in reducing LBP-related physical disability in primary care patients. Participants were randomised to 1 of 3 arms: 1) Usual care + internet intervention + physiotherapy telephone support, 2) Usual care + internet intervention, 3) Usual care alone. Utilising a repeated measures design, the primary outcome for the trial was disability over 12 months using the Roland Morris Disability Questionnaire (RMDQ) at 6 weeks, 3, 6 and 12 months. Results: 826 were randomised, with follow-up rates: 6 weeks = 83%; 3 months = 72%; 6 months = 70%; 12 months = 79%. Analysis is ongoing, comparing each intervention arm versus usual care alone. The key results will be presented at the conference.

Objectives

To establish a quality standard in the field, core recommendations are presented alongside additional considerations and a reporting checklist for control interventions.

Methods and Results

This qualitative study used a multi-site, ethnographically-informed methodology. Data collection included observation of 24 Pilates sessions at eight sites across the South of England, and 19 semi-structured interviews with Pilates teachers and clients with persistent low back pain. Data were audio-recorded, transcribed verbatim and analysed thematically. From the interviews and observations, ten themes emerged, of which four related to components of the relationship: (1) ‘being known’; (2) support; (3) teacher expertise; and (4) mastery of exercises, facilitated by the teacher. Key influences on the relationship were identified in four themes: (5) professional identity of Pilates teachers; (6) health perceptions; (7) social influences such as group dynamic; and (8) service perceptions. An additional two themes described the perceived impact of the relationship: (9) feelings of safety; and (10) ‘feeling good’.

Patients and methods

Twenty-five audio-recordings of patients with back pain and physiotherapists in a primary care outpatient department were collected, transcribed, coded and thematically analysed using a Framework approach to identify the content of advice given.

Methods and results

In this qualitative study, based on the principles of interpretative phenomenological analysis, 14 participants with a clinical presentation of sciatica of likely nerve root origin were purposively recruited from an NHS, Primary Care Musculoskeletal Service in the UK. Individual, semi-structured interviews were used to collect data, which were audio-recorded and transcribed verbatim. Data were managed using a framework approach and analysed thematically.

Sciatica was experienced as a protracted journey of acute exacerbations of uncontrolled and incapacitating symptoms that were overwhelming and difficult to make sense of. Adversely affecting almost all aspects of life, participants struggled to maintain their physical, functional and financial independence; their important relationships; social networks and the roles and activities that provided joy and purpose. The impact of sciatica was a ‘life on hold’; an altered sense of self and an uncertain future. For three participants, the experience of sciatica was sufficiently distressing for them to contemplate suicide.

Methods and results

In this qualitative study, based on the principles of interpretative phenomenological analysis, 14 participants with a clinical presentation of sciatica of likely nerve root origin, who had recently undergone investigations, were purposively recruited from an NHS, Primary Care Musculoskeletal Service in the UK. Individual, semi-structured interviews were used to collect data, which were audio-recorded and transcribed verbatim. Data were managed using a framework approach and analysed thematically.

Although patients reported wanting investigations to understand the cause of symptoms and inform management, access to them was difficult and protracted. When investigations revealed potentially relevant findings, patients experienced relief, validation, empowerment and decisive decision-making. Disappointment emerged, however, regarding treatment waiting times and options, and long-term prognosis. When investigations failed to identify relevant findings, patients were unable to make sense of their symptoms, move forward in their management or relinquish their search to identify the cause.

Methods and Results

Recruitment has taken place over 15 months. Invitation letters or emails were sent to individual practitioners identified using online search tools and professional networks. Recruitment rates were analysed descriptively. Within the private sector, response rates (number participating/number invited) are: acupuncturists 3% (49/1561), osteopaths 6% (53/912), physiotherapists 4% (40/1048). Private sector practitioners have each recruited on average 1, 4, and 2 patients into the study respectively. Within the NHS, the response rates are: acupuncturists 100% (2/2), osteopaths 8% (1/13), physiotherapists 63% (44/70). NHS practitioners have each recruited on average 4, 3, and 2 patients respectively.

Methods:

The internet intervention delivers a 6-week, tailored programme focused on graded goal setting, self-monitoring, and provision of tailored feedback to encourage physical activity/exercise increases or maintenance. 22 patients with back pain from primary care took part in ‘think aloud’ interviews, to qualitatively explore the intervention, provide feedback on its relevance and quality and identify any extraneous content or omissions.

Background:

Empathy is considered essential to creating a positive experience within healthcare for both the patient and clinician, improving adherence, creating trust and improving patient experience. However, little is known about how clinicians acquire and display empathic communication skills during musculoskeletal consultations.

Background

During initial consultations, patients take on average, 92 seconds to outline their problem, if given the chance. Few achieve this, with clinicians interrupting (25–69% of cases) in as little as 12 seconds, either with an ‘overlap’, (a projection error of when a turn ends), or an ‘interruption’ (a start-up before the speaker's talk is complete). The prevalence and impact of these in back pain consultations is unknown.

Methods and Results

Eighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the OPTION instrument. This measures 12 decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the shared decision-making competency.

The mean OPTION score was 24.0% (range 10.4%–43.8%). Providing patients with a list of treatment options was the only behaviour exhibited by every clinician, however in 73.8%, this was not demonstrated beyond a perfunctory level. Failure to offer the choice of doing nothing, or deferring the decision precluded clinicians from attaining a higher OPTION score.