Physical Therapy Management of Low Back Pain: A Survey of Physiotherapists' Current Assessment and Treatment Practices.

Purpose: The purpose of this study was to determine current physiotherapy practice for managing chronic low back pain (LBP). Method: We administered a cross-sectional survey to all physiotherapists working in Eastern Health (EH) Regional Health Authority, Newfoundland and Labrador, by email. To ascertain how physiotherapists assessed and treated patients with LBP, the survey included multiple-choice and open-ended questions, along with case vignettes. We explored the respondents' confidence about implementing all aspects of guideline-based care, as well as their use of treatment outcome measures. Results: A total of 76 physiotherapists responded to the survey (84% response rate); 56 (74%) reported that they treated patients with LBP as part of their regular practice. More than half had managed LBP for more than 10 years. The most frequently used treatments were self-management advice, followed by home and supervised exercise. The majority of respondents lacked confidence about implementing cognitive-behavioural treatment techniques. The Numeric Pain Rating Scale was the most commonly used outcome measure; disability outcome measures were not frequently used. Conclusions: The majority of LBP management in EH aligns with guideline recommendations. Increased uptake of guidelines recommending assessment and management of LBP using a bio-psychosocial approach will require training and support.

Objectif : déterminer les pratiques de physiothérapie actuelles pour traiter les douleurs lombaires chroniques. Méthodologie : les chercheurs ont distribué un sondage transversal par courriel à tous les physiothérapeutes de l'Autorité régionale de la santé de l'Est (SE) de Terre-Neuve-et-Labrador. Pour déterminer la manière dont les physiothérapeutes évaluent et traitent les patients ayant des douleurs lombaires, le sondage incluait des questions à choix multiples, des questions ouvertes et des scénarios de cas. Les chercheurs ont exploré la confiance des répondants envers l'adoption de tous les aspects des soins reposant sur des directives, de même qu'envers les mesures de résultat des traitements. Résultats : au total, 76 physiothérapeutes ont répondu au sondage, pour un taux de réponse de 84 %; 56 (74 %) ont déclaré traiter des patients ayant des douleurs lombaires dans le cadre de leur pratique régulière. Plus de la moitié traitaient des douleurs lombaires depuis plus de dix ans. Les traitements les plus utilisés étaient des conseils d'autogestion, suivis par des exercices à domicile et des exercices supervisés. La majorité des répondants n'avaient pas assez confiance pour adopter des techniques de thérapie cognitivo-comportementale. L'échelle numérique d'évaluation de la douleur était la mesure de résultat la plus utilisée, tandis que les mesures de résultats des incapacités étaient peu utilisées. Conclusion : à la SE, le traitement de la majorité des douleurs lombaires est conforme aux directives. Pour accroître les mises à jour des directives recommandant d'évaluer et de traiter les douleurs lombaires au moyen d'une approche biopsychosociale, il faudra une formation et un soutien.

What Do Patients with Chronic Spinal Pain Expect from Their Physiotherapist?

Purpose: Evidence has suggested that patients' expectations influence the clinical course when they present with low back pain (LBP). However, little empirical evidence has outlined the nature of these expectations. The aim of this study was to describe LBP patients' expectations of physiotherapy. Method: Seventy-nine adult patients who had LBP for more than 16 weeks and were referred for physiotherapy at two hospital physiotherapy departments in St. John's, Newfoundland and Labrador, were included. They filled out a questionnaire detailing their expectations of treatment. Results: Before treatment, more than 90% of patients expected a physical examination, tests or investigations, a diagnosis, reassurance and advice, and clear explanations of causation, symptom management, and benefits and risks of treatment. Approximately half hoped for a prescription or referral to a specialist, and about 60% hoped to discuss problems in their life. Conclusions: The findings of this study indicate that patients attend physiotherapy with clear expectations about what information should be provided. Most expected tests or investigations leading to diagnosis and an explanation of causation; this presents a challenge for clinicians, given the current understanding of LBP reflected in international practice guidelines. The fact that more than half of the patients wanted to discuss problems in their life points to the need for physiotherapists to consider LBP from a bio-psychosocial perspective.

Objectif : selon certaines données probantes, les attentes des patients influencent l'évolution clinique lorsqu'ils consultent pour des douleurs lombaires (DL). Cependant, peu de données empiriques exposent la nature de ces attentes. La présente étude visait à décrire les attentes des patients ayant des DL vis-à-vis de la physiothérapie. Méthodologie : au total, 79 patients adultes atteints de DL depuis plus de 16 semaines, qui avaient été dirigés vers l'un des deux départements de physiothérapie des hôpitaux de St. John's, à Terre-Neuve-et-Labrador, ont participé à l'étude. Ils ont rempli un questionnaire détaillant leurs attentes en matière de traitement. Résultats : avant le traitement, plus de 90 % des patients s'attendaient à subir un examen physique, des tests ou des investigations et à recevoir un diagnostic, des paroles rassurantes et des conseils ainsi que des explications claires sur la cause de leur douleur, la prise en charge des symptômes et les avantages ou les risques du traitement. Environ la moitié espérait recevoir une prescription ou être dirigée vers un spécialiste, et environ 60 % souhaitaient parler de leurs problèmes personnels. Conclusion : d'après les résultats de cette étude, les patients ont des attentes claires quant à l'information qu'ils devraient recevoir en physiothérapie. La majorité s'attendent à subir des tests ou des examens qui permettront de poser un diagnostic et d'expliquer la cause de leurs problèmes. Compte tenu des connaissances des DL énoncées dans les lignes de pratique internationales, c'est un défi pour les cliniciens. Puisque plus de la moitié des patients souhaitaient parler de leurs problèmes personnels, les physiothérapeutes devraient aborder les DL d'un point de vue biopsychosocial.

Process improvement of pap smear tracking in a women's medicine center clinic in residency training.

Application of Six-Sigma methodology and Change Acceleration Process (CAP)/Work Out (WO) tools to track pap smear results in an outpatient clinic in a hospital-based residency-training program. Observational study of impact of changes obtained through application of Six-Sigma principles in clinic process with particular attention to prevention of sentinel events. Using cohort analysis and applying Six-Sigma principles to an interactive electronic medical record Soarian workflow engine, we designed a system of timely accession and reporting of pap smear and pathology results. We compared manual processes from January 1, 2007 to February 28, 2008 to automated processes from March 1, 2008 to December 31, 2009. Using the Six-Sigma principles, CAP/WO tools, including "voice of the customer" and team focused approach, no outlier events went untracked. Applying the Soarian workflow engine to track prescribed 7 day turnaround time for completion, we identified 148 pap results in 3,936, 3 non-gynecological results in 15, and 41 surgical results in 246. We applied Six-Sigma principles to an outpatient clinic facilitating an interdisciplinary team approach to improve the clinic's reporting system. Through focused problem assessment, verification of process, and validation of outcomes, we improved patient care for pap smears and critical pathology.

Patient access and clinical efficiency improvement in a resident hospital-based women's medicine center clinic.

OBJECTIVES: To apply the Six Sigma tools of Change Acceleration Process and Work-Out and to improve patient access in an outpatient clinic in a hospital-based residency training program. STUDY DESIGN: Observational study. METHODS: Comparison of productivity in an obstetrics and gynecology clinic after implementation of the Six Sigma principles, with a comparable internal medicine clinic as a control group. Productivity from January 1 through December 31, 2005, was assessed in both clinics. After applying the Six Sigma tools to obstetrics and gynecology, outputs from both clinics from January 1 through December 31, 2006, were analyzed. RESULTS: Wait times for new obstetrical visits decreased from 38 to 8 days. The patient time spent in the clinic dropped from 3.2 to 1.5 hours. Initial gynecologic visits increased by 87% (from 453 to 850 per year), return gynecologic visits increased by 66% (from 1392 to 2311 per year), initial obstetrical visits increased by 55% (from 520 to 808 per year), repeat obstetrical visits increased by 45% (from 2239 to 3243 per year), and the mean patient satisfaction scores increased from 5.75 to 8.54 (on a 10-point scale). The gross clinic revenue increased by 73% in the first 6 months of 2006 over that of the previous year. By contrast, internal medicine patient wait times for new patients and for revisits, patient satisfaction scores, total number of clinic visits, and revenues remained unchanged. CONCLUSION: Application of the Six Sigma principles resulted in a team approach to solving the clinic's productivity issues.