What do physiotherapists find useful in e-learning interventions to improve their knowledge, attitudes and beliefs on low back pain management: a nested qualitative study from an educational randomized clinical trial.

backgroundPhysiotherapists encounter many barriers in their management of low back pain (LBP). However, little attention has been paid to what content physiotherapists find useful to improve their LBP management. We aimed to: (1) explore the experiences of physiotherapists regarding the educational content after completing either an "experimental" or "traditional" e-learning intervention, (2) identify in both interventions which content physiotherapists reported beneficial or lacking in order to enhance their management of LBP.

methodsA purposive, criterion-based sampling strategy was employed to process-evaluate the experiences of 269 Dutch-speaking physiotherapists who participated in an RCT consisting of two different interventions aimed to improve LBP management. Both interventions were based on the same clinical guidelines, but emphasized different aspects. While the traditional e-learning discussed these guidelines in a more theoretical approach, the experimental e-learning demonstrated them in a concrete, practical, and interactive way. An inductive thematic framework approach was used to analyse and categorise responses to seven open-ended questions in a post-intervention online.

resultsAll 269 physiotherapists' responses were analysed, identifying four broad themes. The first theme, 'Practical application', revealed contrasting views between groups: physiotherapists in the "experimental" intervention highly appreciated the inclusion of concrete communication strategies, whereas those in the "traditional" group criticized the absence of such content as a major shortcoming. Both groups emphasized the need for clearer examples of effective exercises to treat LBP. The second theme, 'Relevancy and adequacy of the intervention', highlighted divergent attitudes. While some participants valued content on red flags, spinal pathologies, and pain mechanisms, others considered such information irrelevant or outside their professional scope. The third theme, 'Knowledge', showed more consistency: participants in both interventions appreciated content that offered practical tools and biopsychosocial strategies. The final theme, 'Confirmation of practice', captured the view of physiotherapists who felt reassured that their current clinical approach aligned with scientific recommendations.

conclusionThese qualitative findings suggest that educational interventions to enhance LBP management may benefit from prioritising clear communication strategies, supporting physiotherapists' confidence in prescribing individualised exercise therapy, and considering tailored approaches that reflect differing views on spinal pathologies and red flags.