Physiotherapists' telephone consultations regarding back pain: a method to analyze screening of risk factors

There is a gap between guidelines and clinical management of risk factors for prolonged disability in back pain. The aims of this study were to (1) evaluate the interrater reliability of a research protocol designed to analyze screening of physical and psychosocial risk factors for prolonged disability in back pain during telephone consultations; and (2) describe the overall content and the nature and extent of physical and psychosocial risk factors assessed by physiotherapists in telephone consultations for diagnostic screening of patients with back pain.

The material consisted of 17 initial telephone consultations regarding back pain recorded by five physiotherapists. A research protocol covering eight evidence-based risk factors was developed. Three raters performed separate analyses according to the protocol.

Intraclass correlation of how many risk factors that were investigated was 0.82 (p < .001.) Kappa values (pairwise) of which risk factors that were screened were 0.79, 0.73, and 0.66 (p < .001). A median of two risk factors were screened in each consultation; most frequent was signs of spinal pathology/radiating pain, followed by sick leave, disability, coping with pain, and negative beliefs. Rating of pain intensity, depression, and expectations of long-term pain were not screened.

The method of analysis appears reliable. It will be used in an intervention study that evaluates to what extent physiotherapists can learn to screen in concordance with guidelines in initial telephone consultations.