Evidence map›Paper›PMID 29592802›Full record

ArticleBMC health services research2018

Physiotherapists' views of implementing a stratified treatment approach for patients with low back pain in Germany: a qualitative study.

Sven Karstens, Pauline Kuithan, Stefanie Joos, Jonathan C Hill, Michel Wensing, Jost Steinhäuser, Katja Krug, Joachim Szecsenyi

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In one paragraph

Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed.

  1. Trial
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  4. Article
  5. Article
  6. Article
  7. Article
  8. Physical Therapists' Opinion of E-Health Treatment of Chronic Low Back Pain.International journal of environmental research and public health · 2021
    Article
  9. Article
  10. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Sven KarstensDepartment of Computer Science; Therapeutic Sciences, Trier University of applied Science, Trier, Germany. karstens@hochschule-trier.de.ORCID 0000-0001-7403-3452
Pauline KuithanDepartment of Therapeutic Sciences, SRH Hochschule Heidelberg, Heidelberg, Germany; M.Sc. Sport Physiotherapy, German Sport University Cologne, Cologne, Germany.
Stefanie JoosInstitute of General Practice and Interprofessional Care, University Hospital of Tuebingen, Tuebingen, Germany.
Jonathan C HillResearch Institute of Primary Care and Health Sciences, Keele University, Keele/Stoke-on-Trent, UK.
Michel WensingDepartment of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Jost SteinhäuserInstitute of Family medicine, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany.
Katja KrugDepartment of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Joachim SzecsenyiDepartment of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe STarT-Back-Approach (STarT: Subgroups for Targeted Treatment) was developed in the UK and has demonstrated clinical and cost effectiveness. Based on the results of a brief questionnaire, patients with low back pain are stratified into three treatment groups. Since the organisation of physiotherapy differs between Germany and the UK, the aim of this study is to explore German physiotherapists' views and perceptions about implementing the STarT-Back-Approach.

methodsThree two-hour think-tank workshops with physiotherapists were conducted. Focus groups, using a semi-structured interview guideline, followed a presentation of the STarT-Back-Approach, with discussions audio recorded, transcribed and qualitatively analysed using content analysis.

resultsNineteen physiotherapists participated (15 female, mean age 41.2 (SD 8.6) years). Three main themes emerged, each with multiple subthemes: 1) the intervention (15 subthemes), 2) the healthcare context (26 subthemes) and 3) individual characteristics (8 subthemes). Therapists' perceptions of the extent to which the STarT-Back intervention would require changes to their normal clinical practice varied considerably. They felt that within their current healthcare context, there were significant financial disincentives that would discourage German physiotherapists from providing the STarT-Back treatment pathways, such as the early discharge of low-risk patients with supported self-management materials. They also discussed the need for appropriate standardised graduate and post-graduate skills training for German physiotherapists to treat high-risk patients with a combined physical and psychological approach (e.g., communication skills).

conclusionsWhilst many German physiotherapists are positive about the STarT-Back-Approach, there are a number of substantial barriers to implementing the matched treatment pathways in Germany. These include financial disincentives within the healthcare system to early discharge of low-risk patients. Therapists also highlighted the need for solutions in respect of scalable physiotherapy training to gain skills in combined physical and psychological approaches.

Indexed as

Attitude of Health PersonnelAdultFemaleFocus GroupsGermanyHumansLow Back PainMaleMiddle AgedPhysical TherapistsPhysical Therapy ModalitiesQualitative ResearchHealth services researchLow back painPhysical therapyQualitative researchStratified care

Identifiers

PMID29592802
PMCPMC5872532

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.