'It might help, but it won't fix me': a qualitative study of individuals' beliefs about manual therapy for low back...

Manual therapy is recommended for the management of low back pain (LBP). However, there are gaps in our knowledge about how individuals understand and view the role of manual therapy in the management of their LBP. Beliefs about manual therapy may influence behaviors and clinical outcomes. This study aimed to develop an in-depth understanding of the beliefs about manual therapy held by a group of individuals experiencing LBP.

Twenty-one participants with a history of LBP and varied experience of manual therapy participated in semi-structured interviews. The interviews were transcribed verbatim, and the dataset was analyzed using reflexive thematic analysis. A patient and public involvement group contributed to the design of the study.

Five themes were generated: (1) Manual therapy as movement. Manual therapy is predominantly believed to be a transient mechanical treatment aimed at addressing restriction in the back. (2) Self-management and manual therapy go 'hand in hand'. Self-management was seen as a fundamental and complementary element of manual therapy. (3) Helping me manage or trying to 'fix' my back. The participants who believed that manual therapy was an appropriate long-term treatment felt that it could help manage their LBP rather than provide a permanent 'fix'. (4) All or nothing: the value of the therapeutic alliance. Beliefs about the importance of the therapeutic alliance with a manual therapist varied considerably, with some participants being dismissive of its value. (5) In safe hands? Most participants had no concerns about the safety of manual therapy, conditional on their trust in the manual therapist. However, some participants expressed significant concerns about safety.

Participants' beliefs about their LBP and the role of manual therapy were shaped by a predominantly mechanical model. However, participants with greater experience of manual therapy often perceived the therapeutic alliance as beneficial for managing their LBP and addressing psychosocial factors. Manual therapists should be aware of unhelpful beliefs held by LBP patients that can potentially influence behaviors and outcomes. In addition, patients' beliefs about the risks and benefits of treatment should be explored to facilitate shared decision making around the use of manual therapy.