Exploring expectations and perceptions of different manual therapy techniques in chronic low back pain: a qualitative study

The attitudes and beliefs about manual therapy held by patients experiencing low back pain: a scoping review

BACKGROUND

Manual therapy (MT) is commonly used to manage low back pain (LBP) and involves a complex interaction between the practitioner and patient. Attitudes and beliefs about MT may play a role in the outcomes seen in patients experiencing LBP. However, knowledge of patients' attitudes and beliefs regarding MT is currently limited.

OBJECTIVE

To map the existing published literature on the attitudes and beliefs about MT in patients experiencing LBP.

DESIGN

Scoping Review.

METHOD

A systematic search was conducted across the PubMed, CINAHL, PsycINFO and Scopus databases. Study selection involved screening 1) title and abstracts and 2) full text articles. Data was analyzed to provide a descriptive summary of the studies and to develop themes of patients' attitudes and beliefs about MT.

RESULTS

A total of 767 records were identified from the initial search strategy. Following study selection, 14 articles were included for data analysis. Five themes related to patients' attitudes and beliefs about MT were developed from the existing literature. Attitudes and beliefs about MT are explored and measured inconsistently with only one validated tool available.

CONCLUSION

MT is believed to be a preferential and effective treatment with accepted levels of post-treatment soreness. This review indicated that patients believe that MT has a biomedical mechanism of action and is suitable for biomedical causes of LBP. Several gaps in the literature are present that require further investigation.

Patients' Perceptions and Outcome Measures after Undergoing the Enhanced Transtheoretical Model Intervention (ETMI) for Chronic Low Back Pain: A Mixed-Method Study

This study aimed to evaluate the outcome measures and perceptions of patients with chronic low back pain (CLBP) after being treated with the Enhanced Transtheoretical Model Intervention (ETMI). In this process evaluation mixed-methods study, 30 patients with CLBP electronically completed self-reported measures (function, pain, and fear-avoidance beliefs) before and after ETMI treatment. Subsequently, each patient participated in one-on-one, semi-structured interviews, which were audio-recorded, transcribed, coded, and analyzed thematically. Quantitative analysis showed significant improvements in function (p < 0.001), pain (p < 0.001), and fear-avoidance beliefs (p < 0.001) after receiving ETMI treatment, with a large effect size (Cohen’s d = 1.234). Moreover, the average number of physiotherapy sessions was 2.6 ± 0.6 for the ETMI intervention, while the annual average number in Maccabi is estimated at 4.1 ± 1.5. Three main themes emerged from the thematic analysis: (1) communication between the patient and the practitioner; (2) psychosocial treatment elements, and (3) ETMI as a long-term solution for CLBP. The findings of the current study highlight patients’ perceived need for an open and sincere dialogue and for receiving reassurance and encouragement about their LBP. Notably, they had no problem with the fact that they did not receive passive treatment. Accordingly, together with the significant improvement in post-treatment outcome measures, patients perceived the ETMI method as a practical tool for self-managing their back problems in the long term.