Experiences and perspectives of self-management for low back pain in clinical practice: implications for support and education

Monaghan, Jenni (2015) Experiences and perspectives of self-management for low back pain in clinical practice: implications for support and education. Doctoral thesis, Northumbria University.

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Abstract

Pain is multidimensional and self-management is advocated to manage the biopsychosocial impact of this on individuals’ lives. Thus, these individuals’ perspectives regarding self-management have been explored. This study aimed to firstly explore how self-management was understood in the context of low back pain through the experiences of people living with low back pain and physiotherapists’. This then led to informing the development of an education programme for physiotherapists to support self-management. The study used a mixed method approach, which involved three phases being carried out over a period of time with each informing the subsequent phase. Phase 1, a qualitative synthesis examined primary qualitative research focusing on people living with low back pain and physiotherapist experiences of self-management of low back pain. The synthesis informed phase 2, two qualitative studies addressing areas of paucity found within the literature. The final phase, a feasibility study involved the development of an education programme for physiotherapists who completed pre and post outcome measures. Focus groups were also used in evaluating the intervention. The qualitative synthesis revealed a limited amount of literature regarding physiotherapists’ views and experiences of self-management of low back pain. A large proportion of studies that related to physiotherapy focusing on people living with low back pain experiences of self-management concentrated on strategies, in particular exercise with limited relation of this to daily life. The primary qualitative studies highlighted some difficulties physiotherapists faced when supporting the management of the biopsychosocial impact of LBP. Further, at times self-management could be used as a last resort. In relation to this, half of the people interviewed living with low back pain found this to be restricting their daily activities and were fearful and concerned regarding worsening pain in the future. These findings suggested people were not managing the biopsychosocial impact of low back pain and physiotherapists at times viewed influences on the pain experience as separate rather than integrated. Pain neurophysiology education linked to clinical practice was used to demonstrate the integrated nature of the pain experience, be relevant to physiotherapists and ultimately facilitate biopsychosocial self-management through enhancing understanding of the multidimensional nature of pain. Collectively, this thesis has developed understanding of self-management from the physiotherapist perspective, illuminating the support required for physiotherapists and revealed physiotherapists value pain neurophysiology education linked to practice however further support is required to implement this in clinical practice.

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