Patient experiences of referral practices and primary care physiotherapy for chronic nonspecific low back pain

ABSTRACT

Background

Low back pain (LBP) clinical practice guidelines recommend referral for patients with persistent LBP however discordance persists between recommended care and implementation in practice. Understanding patient experiences of referral practices and physiotherapy care could be important for optimizing LBP management in primary care settings.

Purpose

This study explored referral experiences of people with nonspecific LBP in Australian primary care and their knowledge and experience of physiotherapy.

Methods

An interpretive descriptive qualitative framework was used with 17 participants interviewed from community-based physiotherapy practices.

Results

Four themes described the participants’ experiences of referrals in primary care settings: 1) Referral practices ranged from formal to informal to non-existent; 2) Fragmented inter-and intra-professional LBP care management; 3) Patient perceived differences in the roles of physiotherapists and specialist physiotherapists; and 4) Patient nominated barriers and facilitators to optimal referral practices.

Conclusion

Physiotherapists support people with LBP to improve strength and function, whereas the specialist physiotherapist’s role was seen as more holistic. Referral pathways that align to clinical guideline recommendations for non-surgical management and treatment remain underdeveloped. Improved referral pathways to clinicians such as physiotherapists with additional credentialed skills and competence in musculoskeletal care could improve people’s experiences of care and health outcomes.

KEYWORDS:

• Low back pain referral pathways
• guideline recommendations
• inter and intra-professional
• primary care

Acknowledgments

The authors would like to thank the participants for their time and willingness to share their experiences in this study. EB is a recipient of PhD scholarship with dual contributions from Curtin University Research Training Program (RTP) stipend scholarship and from funding related to a NHMRC project grant (Grant number Application ID GNT1141377). TR is funded by an NHMRC Career Development Fellowship.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Curtin University of Technology [Research Training Program Scholarship]; National Health and Medical Research Council [APP1141377,Career Development Fellowship].