What is the patient experience of a functional goal orientated back group?

Purpose

Chronic low back pain causes a significant physical, psychological and financial burden to a wide variety of the population and health care services.

Despite a large field of research, optimum long term management remains unknown. The NICE guidelines recommend group exercise for the management of low back pain.

Recently, functional rehabilitation including the restoration of normal movement patterns has gained increasing evidence in the literature. However, there is limited research outlining the effectiveness of a combined approach, involving functional rehabilitation in a group setting.

The aim of this study was to understand the patient experience of a functional goal orientated back group in a South Yorkshire NHS secondary care hospital

Approach

A content analysis of a back class feedback book from 2017-2019 was undertaken to form interview questions for a selection of patients on discharge from the class and a selection of patients one year post discharge.

A combination of one to one semi-structured interviews and focus groups were carried out, aiming to understand the patients experience.

Outcomes

Fourteen participants were interviewed in total.

Participants reported they valued the motivation from staff and other patients, the support and knowledge from the physiotherapists, the intensity of the exercise and felt increased confidence in their ability to self-manage.

Many patients reported improvements in pain and / or function despite many having failed one to one physiotherapy in the past. Participants interviewed immediately post discharge were highly motivated, stating intentions to continue the specific exercise programme long term.

However, none of the participants interviewed one year post discharge were continuing the specific exercise programme. Although, they were applying the principles they had learnt to daily function, such as; how to bend and lift.

It appears patients value the motivation, intensity of exercise and increased confidence to self-manage from a functional goal orientated back class. Participants on discharge are motivated and intend to continue exercise long term, however at one year patients interviewed did not carry out specific exercise, but applied to functional principles to daily life.

Implications

Further research is required to directly compare a functional back class with standard one to one physiotherapy as a first line treatment. It is unknown whether the specific exercises provided matter or whether it is the motivation and intensity of the exercise that is important. This would be required to generate implications for optimum future clinical practice.

Top three learning points

  1. I gained an insight into undertaking qualitative research for the first time and the complexity within the analysis process in order to gain a true understanding of the meaning behind the data.
  2. I learnt that patients valued their experience of a functional goal orientated back group due to motivation, intensity of exercise and increased confidence to self-manage.
  3. Finally I learnt the first hand benefit of research in order to justify treatment methods and the importance in continuing to progress current evidence based practice to continually improve patient care.

Fund acknowledgements

£1200 from CSP charitable trust towards dissertation module as part of the MSc Manual Therapy at Sheffield Hallam University.  

Additional notes

This work was presented at Physiotherapy UK 2019

Please see the attached Innovations poster below.

For further information about this work please contact Katie Boyes