Patients’ conceptions of undergoing physiotherapy for persistent low back pain delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in cognitive functional therapy

Abstract

Purpose

To explore the conceptions of patients with persistent low back pain (LBP) of undergoing physiotherapy delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in Cognitive Functional Therapy (CFT).

Methods

As part of a feasibility implementation study exploring CFT in management of LBP in the Finnish primary healthcare system, we interviewed nine patients from four geographical areas in Finland after receiving care. We used a phenomenographic approach to explore the variation in their conceptions.

Results

The analysis revealed four descriptive categories: “hung out to dry,” “stuck,” “making sense and taking control,” and “holistic approach to care and living,” that varied based on six themes.

Conclusions

Although the participants accepted this approach to care well, there was significant variation in patients’ conceptions. Restricted access to care within the healthcare system and a lack of social support led some of them to feel they had been left alone to suffer with their pain. On the other hand, based on the results of this study, positive experiences of physiotherapy and good collaboration with the physiotherapist, wider social support outside of physiotherapy, a better understanding of the multidimensional nature of pain and the acquisition of self-management skills were reported as positive aspects of undergoing physiotherapy that may be related to positive treatment outcomes.

Implications for rehabilitation

• The participants of this study saw undergoing physiotherapy delivered within biopsychosocial framework as different from their previous physiotherapy experiences and for some the process ended with feeling empty-handed and for others it could be a turning point in their lives.

• This study encourages the health care providers to create flexible care pathways and ongoing support for more vulnerable individuals so that they don’t feel abandoned by the system.

• Professionals could also pay attention to building strong therapeutic alliance, help patients understand pain in biopsychosocial framework, take into consideration social support networks of the patients, and support patients toward effective self-management strategies.

Keywords:

• Phenomenography
• psychologically informed physiotherapy
• cognitive functional therapy
• conceptions
• low back pain
• physiotherapy
• primary health care

Acknowledgments

The researchers wish to thank all the interviewees who participated in this study, the physiotherapists who treated the patients and provided the videos, and Mikko Lausmaa, who played an essential role in organizing the workshops and took part in planning the whole research project.

Disclosure statement

Peter O’Sullivan and Riikka Holopainen have received fees for speaking at conferences and providing clinical workshops for health care professionals in the management of musculoskeletal disorders. Jaro Karppinen has received fees for lectures from MSD, Pfizer and Orion. Scientific advisory board: Axsome Therapeutics Inc. Arja Piirainen and Pirjo Vuoskoski have no conflicts of interest to declare.

Additional information

Funding

This work is supported by Signe and Ane Gyllenberg Foundation.