Practice patterns of physiotherapists in the treatment of work-related back pain

Although physiotherapists (PTs) are one of the health professionals most involved in the treatment of back pain, their practice patterns have not been well studied. The study objectives were to identify the practice patterns of PTs treating workers suffering from acute/subacute back pain, with and without radiating pain below the knee, and to assess the relationship between these patterns and characteristics of PTs.

PTs working in private clinics in the province of Quebec, Canada were invited to participate. Each PT used a self-administered questionnaire to record, for each treatment session, treatment objectives, interventions used and education given to two workers with back pain, one without radiating pain (n = 189 PTs) and one with radiating pain (n = 136 PTs). Multiple correspondence analysis with hierarchical classification was used to identify practice patterns of PTs. Multinomial logistic regressions were used to assess the relationship between practice patterns and PTs characteristics.

For workers without radiating pain, 51.9% of PTs focused their treatment on soft tissue mobilizations/massage and heat, 24.3% focused on the McKenzie approach and related interventions, and 23.8% focused on exercises and function. Similar results were found for workers with radiating pain. Most of the PT characteristics were not related to practice patterns.

The practices of PTs appeared to be separated into three distinct patterns. These practice variations suggest that there may be disagreement or uncertainty among PTs in the management of work-related back pain. The lack of evidence for the majority of interventions used by PTs and the difficulties of integrating evidence into clinical practice may be possible explanations.