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Title: Attitudes and beliefs of military physiotherapists and their influence on the management of chronic low back pain in military personnel
Author: Heywood, Jane
ISNI:       0000 0004 2719 9849
Awarding Body: University of Portsmouth
Current Institution: University of Portsmouth
Date of Award: 2010
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Aims: This study aims to explore the attitudes and beliefs of military physiotherapists and how these influence the management of military patients presenting with low back pain. The Armed Services require personnel who are physically fit and able to deploy operationally to inhospitable areas, including Afghanistan. Low back pain is a common condition, but within the Armed Services it can lead to medical downgrading, non-deployability and in extreme cases to medical discharge. Methods: The study was a mixed methods study undertaken in two phases. Phase 1 was a quantitative study, which utilised a valid and reliable measure of health care provider's attitudes and beliefs about functional expectations for chronic low back pain patients, the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS). Demographic data was also collected, which included; gender, rank, age range, physiotherapy experience (years), physiotherapy qualification to practice, military service (years), post registration training completed, post registration training being undertaken and self-reported number of patients seen monthly with low back pain. Statistical analysis was undertaken on the results to explore whether a statistically significant correlation existed between questionnaire score and any of the demographic factors identified. Phase 2 was a qualitative study in which semi-structured interviews were undertaken with 16 military physiotherapists. Whilst phase 1 would provide information relating to what beliefs the physiotherapists held Phase 2 would allow exploration of why these attitudes and beliefs prevailed. The transcripts were analysed using a method of thematic content analysis. Results: Results from phase 1 yielded 83 completed questionnaires, a response rate of 91 %. The military physiotherapists obtained a mean score of 50.78 (SD= 10.12) with scores ranging from 29 to 79. Higher scores on the HC-PAIRS indicate a greater acceptance of the notion that LBP is equated with disability. These results indicate the military physiotherapists were neutral to the acceptance of LBP as a legitimate cause of disability among military personnel. The results of non-parametric testing using Spearman's rho indicated a statistically significant correlation at the 0.05 level (2 tailed) between He-PAIRS score and length of military service, indicating an association between higher scores and greater length of military service. Analysis of semi-structured interviews undertaken in phase 2 resulted in the identification of six themes these were; military culture, occupational issues, continuing professional development, clinical reasoning, need for cure and labelling the patient. The importance of understanding the occupational demands on their patients were considered highly significant by all of the military physiotherapists interviewed. However, there appeared generally poor knowledge of the biopsychosocial model in the management of low back pain and over reliance on the medical model. Three quarters (12/16) of the military physiotherapists interviewed expressed frustration in their management of patients with low back pain. Similarly, the military physiotherapists displayed a poor awareness of current evidence based clinical guidelines for the management of low back pain. Conclusions: The results from phase 1 indicated that military physiotherapists, with the greatest length of military service were most likely to accept disability and reduced functional expectations as a consequence of chronic low back pain. In phase 2 the themes, military culture and occupational issues were significant in influencing the military physiotherapist's clinical management. The highly physical and arduous nature of military occupations resulted in investigative procedures being requested at an earlier stage than is recommended in the current evidence- based guidelines. Justification for early investigations was provided on the basis of the unique occupational factors combined with requirement to optimise the number of military personnel able to deploy operationally. The Armed Services are a hierarchal organisation; the structure should be utilised to improve the management of low back pain in military personnel. This would benefit both patients and the Armed Services, by reducing the disability caused by low back pain, whilst increasing number of operationally deployable service personnel.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available