Physiotherapists' clinical reasoning about patients with non-specific low back pain, as described by the International Classification of Functioning, Disability and Health

Abstract

Purpose. To explore and describe what physiotherapists experience they need to know about patients with non-specific low back pain (NSLBP) to make decisions about intervention.

Method. Four focus groups containing a total of 21 physiotherapists were carried out in Sweden. Interviews were transcribed and qualitative content analysis performed. The manifest content was coded and categorised, and a theme emerged. Extracted symptoms and signs were linked to ICF codes.

Result. Physiotherapists' clinical reasoning represented a broad view on low back pain (LBP) including codes from all ICF components. The participants argued for individualisation of intervention to a specific patient's problems. A theme of case complexity emerged, involving three levels: easy case, characterised by impairment in body function with close relation to specific body structures; complex case, characterised by impairments in body function, particular mental functions, activity limitations and participation restrictions, particular management of activity level and very complex case, characterised by impairments in body function, activity limitations and participation restrictions, and contextual factors, with help-seeking behaviour as a particular feature.

Conclusion. The physiotherapists' clinical reasoning reflected a broad view on patients with NSLBP, with variations related to case complexity. The use of ICF codes contributed to understanding that the physiotherapists applied a broad perspective on NSLBP as a health condition as well as to knowledge about how physiotherapists' understand patients with NSLBP. Physiotherapists' use of the ICF in clinical practice might facilitate identification and assessment of specific patient's back pain problem as they occur in daily life and therefore be helpful in rehabilitation planning. Findings might also have an educational value.

Keywords:

• Clinical reasoning
• ICF
• low back pain
• physiotherapist

Acknowledgements

Authors would like to thank all participating physiotherapists for their willingness to share their experiences. Authors are grateful to PhD student Margareta Adolfsson and Professor Mats Granlund for fruitful discussions about the ICF. The study is funded by Futurum – the Academy for Healthcare, Jönköping County Council, Sweden. IJ and BH took an active part in the entire process, and PB in the results, discussion and writing. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.