Introduction
Methods
Design and setting
Questionnaire
Prior to data collection
Sociodemographics and practice information
Attitudes and beliefs
Guideline adherence
Question | Vignette | Response options on questionnaire | Authors’ classification of responses |
---|---|---|---|
Treatment(s) offered at this visit | Vignette 1 and 3 | ‘no intervention’ or ‘chiropractic adjustment’ | Strictly in line with the guideline recommendations |
‘no intervention’ or ‘chiropractic adjustment + one other treatment option | Broadly in line with the guideline recommendations | ||
2 treatment options other than ‘no intervention’ or ‘chiropractic adjustment’ | Not in line with the guideline recommendations | ||
Vignette 2 | ‘no intervention’ or ‘chiropractic adjustment’ and/or ‘exercise’ | Strictly in line with the guideline recommendations | |
‘no intervention’ or ‘chiropractic adjustment’ and/or ‘exercise’ + one other treatment option | Broadly in line with the guideline recommendations | ||
2 treatment options other than ‘no intervention’ or ‘chiropractic adjustment’ and/or ‘exercise’ | Not in line with the guideline recommendations | ||
Vignette 4, 5, 6 | ‘no intervention’ or ‘chiropractic adjustment’, ‘exercise’ and/or ‘psychological evaluation’ | Strictly in line with the guideline recommendations | |
‘no intervention’ or ‘chiropractic adjustment’, ‘exercise’ and/or ‘psychological evaluation’ + one other treatment option | Broadly in line with the guideline recommendations | ||
2 treatment options other than ‘no intervention’ or ‘chiropractic adjustment’, ‘exercise’ and/or ‘psychological evaluation’ | Not in line with the guideline recommendations | ||
Advice to return to work | All vignettes | Return to work | Strictly in line with the guideline recommendations |
Return to part-time or light duties | Broadly in line with the guideline recommendations | ||
Be off work for a further … weeks (stating number of weeks) | |||
Be off work until pain has improved | Not in line with the guideline recommendations | ||
Be off work until pain has completely resolved | |||
Advice to stay active | All vignettes | Perform usual activities | Strictly in line with the guideline recommendations |
Perform activities within the patient’s tolerance | Broadly in line with the guideline recommendations | ||
Perform only pain free activities | Not in line with the guideline recommendations | ||
Limit all physical activities until the pain disappears | |||
Investigations ordered at this visit | Vignette 1 and 3 | ‘no referral for diagnostic imaging’ | Strictly in line with the guideline recommendations |
Other options except ‘no referral for diagnostic imaging’ | Not in line with the guideline recommendations | ||
Vignette 2, 4, 5, 6 | ‘no referral for diagnostic imaging’ | Strictly in line with the guideline recommendations | |
Referring for radiographs | Broadly in line with the guideline recommendations | ||
Referring for MRI scan | Not in line with the guideline recommendations |
Use of diagnostic imaging
Knowledge of Practice guidelines
Analysis of data
Attitudes and beliefs
Adherence to guidelines in relation to attitudes and beliefs
Results
Descriptive statistics
Attitudes and Beliefs
Overall (n = 158) | High biomedical class (n = 18) | Mid biomedical class (n = 117) | Low biomedical class (n = 23) | |
---|---|---|---|---|
Biomedical | ||||
Mean | 49 | 63 | 49 | 37 |
Min – max score | 29–76 | 58—71 | 41—58 | 29—41 |
95% CI | 61—65 | 48—50 | 36—39 | |
Biopsychosocial | ||||
Mean | 23 | 22 | 23 | 24 |
Min – max score | 14—35 | 17—29 | 16—29 | 18—29 |
95% CI | 20—23 | 22—24 | 23—26 |
Characteristics of respondents
Total (n = 158) | High biomedical class (n = 18) | Mid biomedical class (n = 117) | Low biomedical class (n = 23) | |
---|---|---|---|---|
Sex (%) | ||||
Female | 38.3 | 22.2 | 38.5 | 39.5 |
Male | 61.7 | 77.8 | 61.5 | 65.2 |
Age: mean (SD) | 42.7 (12.7) | 40.6 (8.5) | 38.7 (10.9) | 47.9 (16.3) |
Country where working (%) | ||||
The Netherlands | 73.3 | 77.8 | 80.3 | 34.8 |
Belgium | 26.7 | 22.2 | 19.7 | 65.2 |
Practice type (%) | ||||
Solo practice | 31.1 | 55.6 | 39.3 | 65.2 |
Group practice | 46.7 | 38.9 | 47 | 26.1 |
Multidisciplinary | 17.8 | 5.6 | 11.1 | 8.7 |
Years in practice: mean (SD) | 17.2 (12.5) | 13.2 (6.5) | 12.5 (9.3) | 22.0 (15.2) |
Adherence to guidelines
Overall adherence: | Practice guideline adherence in the vignette (% (95% CI)) |
---|---|
For all six vignettes | 65.9 (61.5;70.1) |
For the three vignettes describing patients with acute low back pain | 68.2 (63.4;72.6) |
For the three vignettes describing patients with chronic low back pain | 62.3 (56.5;67.0) |
Uni-variable generalized mixed model (based on all six vignettes) | Adherence on the vignette (% (95% CI)) | OR (95% CI) |
---|---|---|
Latent profile classification: | ||
High biomedical class | 71.5 (57.8;82.0) | 2.6 (1.2;5.7) |
Mid biomedical class | 69.1 (63.8;73.9) | 2.3 (1.3;4.0) |
Low biomedical class (reference category) | 49.2 (36.8;61.7) |
Overall adherence: | Low back pain guideline adherence in the vignette (% (95% CI)) |
---|---|
For all six vignettes | 59.4 (55.2;63.4) |
For the three vignettes describing patients with acute low back pain | 39.4 (34.6;44.4) |
For the three vignettes describing patients with chronic low back pain | 81.6. (76.9;85.4) |
Uni-variable generalized mixed model (based on all six vignettes) on return to work | Adherence on the vignette (% (95% CI)) | OR (95% CI) |
---|---|---|
Latent profile classification: | ||
High biomedical class | 81.0 (70.7;88.3) | 4.4 (2.1;9.1) |
Mid biomedical class | 59.3 (54.5;64.0) | 1.5 (0.9;2.4) |
Low biomedical class (reference category) | 49.2 (38.5;60.0) |
Overall adherence: | Low back pain guideline adherence in the vignette (% (95% CI)) |
---|---|
For all six vignettes | 77.5 (72.3;81.9) |
For the three vignettes describing patients with acute low back pain | 68.1 (61.8;73.8) |
For the three vignettes describing patients with chronic low back pain | 83.8 (78.8;87.7) |
Uni-variable generalized mixed model (based on all six vignettes) on return to work | Adherence on the vignette (% (95% CI)) | OR (95% CI) |
---|---|---|
Latent profile classification: | ||
High biomedical class | 93.3 (83.5;97.5) | 7.6 (2.2;26.6) |
Mid biomedical class | 77.0 (70.8;82.3) | 1.8 (0.8;4.0) |
Low biomedical class (reference category) | 64.9 (47.6;79.1) |
Overall adherence: | Low back pain guideline adherence in the vignette (% (95% CI)) |
---|---|
For all six vignettes | 64.5 (58.7;69.9) |
For the three vignettes describing patients with acute low back pain | 55.9 (50.5;61.1) |
For the three vignettes describing patients with chronic low back pain | 73.4 (66.7;79.2) |
Uni-variable generalized mixed model (based on all six vignettes) on treatment | Adherence on the vignette (% (95% CI)) | OR (95% CI) |
---|---|---|
Latent profile classification: | ||
High biomedical class | 48.6 (38.9;73.7) | 0.7 (0.3;1.9) |
Mid biomedical class | 65.9 (58.9;73.9) | 1.0 (0.5;2.1) |
Low biomedical class (reference category) | 66.0 (27.0;79.4) |
Total | ||
---|---|---|
In what percentage of patients would you like to have diagnostic imaging? (mean %, SD) (n = 158) | 42.4 (27.6) |
Uni-variable linear regression | Difference (in %) compared to reference group | 95% CI |
---|---|---|
High biomedical class | − 25.3 | (− 41.7;− 8.9) |
Mid biomedical class | − 8.1 | (− 20.0; 3.8) |
Low biomedical class (reference category) |
Yes | No | |
---|---|---|
Are you familiar with practice guidelines in the management of low back pain patients? (%) (n = 158) | 69.0 | 31.0 |
Uni-variable logistic regression | % not familiar with practice guidelines (95%CI in %) | OR (95% CI) |
---|---|---|
High biomedical class (reference category) | 11.1 (2.8;35.5) | |
Mid biomedical class | 29.9 (28.7;38.8) | 3.4 (0.8;15.7) |
Low biomedical class | 52.2 (35.5;71.2) | 8.7 (1.6;46.9) |