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Title: Changing the practice of osteopaths, chiropractors and musculoskeletal physiotherapists, in relation to the management of low back pain
Author: Evans, David William
ISNI:       0000 0001 3451 506X
Awarding Body: Keele University
Current Institution: Keele University
Date of Award: 2007
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Background. Low back pain (LBP) is a common and costly problem. In western society, huge resources have been directed at providing solutions to this problem, yet this ' investment has shown relatively little return. One possible avenue for reducing the societal impact ofLBP is through improving the quality of healthcare. In the UK, the three professional groups of chiropractic, osteopathy and musculoskeletal physiotherapy are involved in the management of 15-20% of all people with LBP, yet previous research suggests that many do not follow 'best practice' recommendations for LBP. Methods. The fIrst study ofthis thesis was an exploratory study, based on'a Grounded Theory approach, in which data were collected using focus groups. The primary aim ofthis study was to develop a theoretical model of factors that influ,ence the behaviour of individual chiropractors, osteopaths and musculoskeletal physiotherapists when caring for . patients with LBP. The second study ofthe thesis was a pragmatic randomisedcontrolled trial that was designed to test whether the reported behayiQur and beliefs of these practitioners would change if exposed to a passively disseminated, printed educational package, relating to the management ofLBP. The data from this trial were also used to evaluate whether the previously developed theoretical model predicted reported behaviour in representative groups ofthese practitioners. Results. The theoretical model formed from the exploratory study consisted primarily of three meta-themes: professional identity, occupational beliefs and clinical behaviour. In the trial, a small but signifIcant overall change in the intended direction in both reported behaviour and beliefs was measured in the intervention group, in response to the educational package. A cross-sectional analysis ofthe baseline trial data showed professional identity, as marked by professional grouping, to be associated with distinct prof11es of attitudes, beliefs and reported behaviour. Furthermore, beliefs were strongly associated with reported behaviour at baseline. Hence, a portion ofthe theoretical model was supported by these data. By contrast, further exploration ofthe trial data showed that professional identity did not predict baseline-to-follow-up changes in the key reported behaviours measured, and beliefs and reported behaviour did not always change in unison. Conclusion. Attitudes, beliefs and the professional identities ofthe healthcare practitioners studied in this thesis are related to their reported behaviour. Behaviour may be changed through exposure to written educational material but, when used in isolation, this change is likely to be small
Supervisor: Not available Sponsor: Not available
Qualification Name: Keele University, 2007 Qualification Level: Doctoral
EThOS ID:  DOI: Not available