Attitudes and diagnostic practice in low back pain: A qualitative study amongst Greek and British physiotherapists

Table 1 Physiotherapists’ profile

Characteristics	Greek PTs (n = 125) [% (n)]	British PTs (n = 29) [% (n)]	P value (χ2 test)
Sex
Male	57.6 (72)	24.1 (7)	0.053
Female	39.2 (49)	51.7 (15)
Missing data/not reported	3.2 (4)	24.1 (7)
LBP clinical experience (yr)
< 1	3.2 (4)	3.4 (1)	0.0021
1-5	28 (35)	3.4 (1)
6-10	28 (35)	24.1 (7)
> 11	40.8 (51)	65.2 (19)
Type of work
NHS based	35.2 (44)	75.8 (22)	0.671
Private practitioner	49.6 (62)	6.8 (2)
Community work (private)	10.4 (13)	3.4 (1)
Other (educational, etc.)	4.8 (6)	6.8 (2)

¹χ² test is statistically significant at the 0.05 level. PTs: Physiotherapists; LBP: Low back pain; NHS: National Health Service.

Table 2 Percentage agreements amongst the Greek and British physiotherapists

Opinions/statements	Greek PTs (%)	British PTs (%)	P value (χ2 test)
PTs’ attitudes towards assessment
I take a small history the first time (within the first assessment), so as to proceed to the therapy straightaway	15.8	0	0.325
I take a very detailed history the first time trying to locate the patient’s problem	91	96.6	0.998
Throughout my formal assessment, I don’t take into account the patient’s psychosocial status because I believe that the biomedical dimension is the patient’s main problem	17.1	3.6	0.476
I let the patient talk (without interruptions) about his problem. This helps the impression I gain about his psychosocial status	72.2	44.8	0.0391
I use notes/assessment forms	61.8	79	0.084
The patient’s symptoms are what guides history taking and clinical assessment i.e., if symptoms look like a nerve root problem, then the clinical examination will focus more on neurological/ neurodynamic examination	53.7	96.6	0.0012
Once doctors have excluded any red flags/serious pathology from their patient, they then are not interested in further distinguishing, diagnosing or sub-classifying the patient’s back pain	77.3	58.6	0.562
I believe that physiotherapy assessment should include the assessment of non-musculoskeletal nature of back pain (i.e., red flag type questions and clinical tests)	77	100	0.128
I pay attention to the doctor’s medical diagnosis	42.6	96.6	< 0.0012
I pay attention to the doctor’s referral card	13.8	62.1	< 0.0012
I alter my examination based on whether my patient is acute or chronic	97.3	69	< 0.0012
I reassess each patient (looking for exacerbation or improvement) before and/or following every treatment procedure (thus, within each treatment session)	44.9	89.7	0.0041
I reassess each patient (looking for exacerbation or improvement) following every treatment session only	70	86.2	0.745
I reassess each patient (looking for exacerbation or improvement) following 4-5 treatment sessions only	72	41.4	0.0111
Patients’ attitudes towards assessment
You start getting a feel of the patient’s psychosocial problems, after you start develop a relationship with the patient (that is, following several treatment sessions)	58.1	13.8	0.0021
All patients’ have the attitude that the PT should follow exactly what is written on the referral card	21	20.7	0.867
A large proportion of our patients from Mediterranean cultures "hurt everywhere" (and nowhere very specifically), compared to other cultures who are much more precise with the site of their pain	39.5	10.3	0.092
The type of job the patient has (whether he works in the private or public sector) seems to be important in terms of the amount of "sick leave" taken for episodes of LBP	81.5	34.5	< 0.0012
I feel patients have a very "passive" attitude regarding physiotherapy treatment	37.8	44.8	0.407
There is a poor understanding among patients about what physiotherapy is and what it entails	57.7	34.5	0.066
There a difference in concordance between rural and urban LBP patients	50.5	65.5	0.476
Diagnostic issues
Diagnosis in a medical privilege exclusively and doesn’t form part of physiotherapy at all	90.9	17.2	< 0.0012
I believe diagnosing a condition should be part of physiotherapy practice	90.9	10.3	< 0.0012
Formal assessment of the patient prior to commencement of treatment is not performed by a large number of PTs	75.6	89.7	0.441
I believe more emphasis should be given in assessment at undergraduate level than in treatment techniques	92.7	6.9	< 0.0012
Performing an X-ray on a patient with LBP is obligatory	57	72.4	0.291
Legally, physiotherapists are "executers" and they cannot interfere greatly in treatment planning (alter it)	40.3	0	0.0021
In general there is an overuse of medical investigations	60.9	3.4	< 0.0012
In general there is more emphasis on laboratory investigations at the expense of the clinical investigations	77.4	58.6	0.0241

¹χ² test is statistically significant at the 0.05 level;

²χ² test is statistically significant at the 0.001 level. PT: Physiotherapist; LBP: Low back pain; X-ray: Radiograph.