Physiotherapists' knowledge, attitudes and practices regarding clinical prediction rules for low back pain

Clinical Prediction Rules (CPRs) have been developed to assist in the physiotherapy management of low back pain (LBP) although little is known about the factors that may influence their implementation in clinical practice. This study used qualitative research methodology to explore the knowledge, attitudes and practices/behaviours of physiotherapists in relation to these tools. Four semi-structured focus groups involving 26 musculoskeletal physiotherapists were conducted across three Australian geographic regions. A fictitious LBP case scenario was developed and used to facilitate group discussion. Participant knowledge of CPRs was found to be mixed, with some clinicians never having previously encountered the term or concept. LBP CPRs were often conceptualised as a formalisation of pattern recognition. Attitudes towards CPRs expressed by study participants were wide-ranging with several facilitating and inhibiting views identified. It was felt that more experienced clinicians had limited need of such tools. Only a small number of participants expressed that they had ever used LBP CPRs in clinical practice. To optimise the successful adoption of an LBP CPR, researchers should consider avoiding the use of the term 'rule' and ensure that the tool and its interface are uncomplicated and easy to use. Understanding potential barriers, the needs of clinicians and the context in which CPRs will be implemented will help facilitate the development of tools with the highest potential to positively influence physiotherapy practice.