Clinical reasoning and critical reflection in physiotherapists’ examinations of patients with low back pain in its early phase : a qualitative study from physiotherapists’ point of view

Aim: The aim of this study was to deepen the current understanding of physiotherapists’ decision-making process and more specifically, to investigate their reflections on their clinical reasoning when examining low back pain patients. Method: Data were collected in interviews with six physiotherapists, were the stimulated recall method was used. Interviews were audio-recorded and transcribed and then analysed by content analysis. Results: Physiotherapists critically analysed and reflected their choices and decisions in clinical reasoning with patient’s symptoms, onset of pain, clinical test choices and results. They stopped to consider the adequacy of tests for drawing conclusions and their…

Orthopedic manual therapy on low back pain with working adults : clinical tests, subclassification and clinical trial of low back pain

Inter- and intra-tester reliability of selected clinical tests in examining patients with early phase lumbar spine and sacroiliac joint pain and dysfunction

AbstractOf all patients with low back pain (LBP), 85% are diagnosed as “non-specific lumbar pain”. It has been postulated that the only reliable test is a straight leg raise test for detecting sciatic pain, and for other diagnostic subgroups, tests are of varying value. Only a few standardized tests exist to test function, inspection, mobility, pain, muscle flexibility or stability for patients with early phase lumbar spine and sacroiliac joint pain and dysfunction in the non-laboratory setting. The aim of this study was therefore to examine the inter- and intra-tester reliability of selected standardized clinical tests. Fifteen eligible, consecutive and voluntary LBP patients (aged 18–56 y…

Physiotherapists’ experiences of direct access for clients with musculoskeletal pain and dysfunction: a qualitative study

Aims: The aim of this study was to qualitatively analyse physiotherapists’ experiences and perspectives for delivering services directly, without prescription or referral, for clients with musculoskeletal pain or dysfunction. Methods: This was a qualitative study where data were collected from questionnaires given to 34 physiotherapists, 18 of them being in direct access for 6 years and 16 for 6 months. There were 15 structured questions and 3 open-ended ones. The answers were analysed with quantitative and qualitative methods. Results: The data analysis of the open-ended questions showed that physiotherapists had positive experiences of direct access. This practice brought meaningfulness, …

Knowledge translation from continuing education to physiotherapy practice in classifying patients with low back pain

Physical therapists have used continuing education as a method of improving their skills in conducting clinical examination of patients with low back pain (LBP). The purpose of this study was to evaluate how well the pathoanatomical classification of patients in acute or subacute LBP can be learned and applied through a continuing education format. The patients were seen in a direct access setting.The study was carried out in a large health-care center in Finland. The analysis included a total of 57 patient evaluations generated by six physical therapists on patients with LBP. We analyzed the consistency and level of agreement of the six physiotherapists' (PTs) diagnostic decisions, who par…

Outcome comparison among working adults with centralizing low back pain: Secondary analysis of a randomized controlled trial with 1-year follow-up

Our purpose was to examine if adults with centralizing pain might achieve better treatment outcomes when treated by individually designed therapy than “given advice only to stay active”. One hundred and nineteen working adults with first or a recurrent episode of low back pain (LBP) were classified as centralizers and were randomly allocated to orthopaedic manual therapy (OMT; n=42), the McKenzie (n=48) or “advice only to stay active” (Advice-only; n=29) groups. Back and leg pain were assessed by the visual analogue scale, disability with the Roland–Morris questionnaire and functional status with an activities of daily living (ADL) index. Immediately after the treatment period, LBP decrease…

Orthopaedic manual therapy, McKenzie method or advice only for low back pain in working adults: a randomized controlled trial with one year follow-up.

OBJECTIVE: To examine the effects of 2 manual therapy methods compared with one counselling session with a physiotherapist with "advice-only to stay active" for treating low back pain/leg pain and disability. DESIGN: A randomized, controlled trial with a 1-year follow-up. SUBJECTS: A total of 134 subjects with low back disorders. METHODS: Participants with acute to chronic first or recurrent low back pain, excluding those with "red flag" criteria, were assigned randomly to one of the 3 intervention groups: an orthopaedic manual therapy group (n=45), a McKenzie method group (n=52), and an "advice only to be active" group (advice-only) (n=37). Data on leg and low back pain intensity and disab…