‘Manage backs’ group intervention: applying a biopsychosocial explanation of low back pain at physiotherapy care pathway entry

Abstract

Background: Disability outcomes for people with low back pain (PLBP) depend on biopsychosocial maintaining factors (Foster et al 2014) and ensuring they are at the centre of decisions about self-management. Physiotherapists’ beliefs about pain and their ability to communicate biopsychosocial understanding are important to addressing patients’ unhelpful beliefs and promoting activation (Darlow et al; 2012; Overmeer et al, 2011). ‘Manage Backs’ (MB) transformed the LBP care pathway using a group intervention (GI) to promote self-management decision making and compared outcomes with traditional 1:1 physiotherapy. Methods: Eighty-five MB groups were delivered to 611 PLBP by a team of 12 physiotherapists across 6 localities. Clinical outcomes were QoL, activation and functional activity measures. Physiotherapists’ beliefs were measured using the HC-Pairs and PABS-PT. A five-dimension physiotherapy LBP competence framework was tested and psychology-led mentoring promoted fidelity to the MB model. A questionnaire captured competence and qualitative methods evaluated mentoring. Findings: Compared with those delivering 1:1 therapy (n=25), MB physiotherapists’ (n=9) beliefs (HC-Pairs and PABS-PT) changed significantly pre, during and post MB (p<0.05) and 80% rated competence improved. Interview analysis yielded themes about group process management and communication with PLBP. Clinical self-reported outcomes demonstrated improvements in all measures across both models with activation greater in MB. Estimated MB cost savings in the LBP care pathway were approximately £48,000pa. Discussion: PLBP benefited from a GI providing a biopsychosocial explanation of LBP at entry to physiotherapy. Mentoring maintained fidelity to the MB model. Physiotherapists’ beliefs and competence were key to PLBP’s self-management decision making and activation.