Article

In the management of chronic low back pain (LBP), identifying and
managing more patients who are at high risk and who have psychological barriers
to recovery is important yet difficult. Objective: The objective of this study
was to test physical therapists' ability to allocate patients into risk
stratification groups, test correlations between therapists' assessments of
psychological factors and patient questionnaires, and explore relationships
between psychological factors and therapists' self-reported competence to manage
patients with chronic LBP. Design: This was a pragmatic, observational study.
Methods: Patients completed the STarT Back Tool (SBT, for risk stratification),
the Four-Dimensional Symptom Questionnaire (distress, depression, anxiety), and
the Tampa Scale of Kinesiophobia (kinesiophobia) prior to the intake session.
After this session, physical therapists estimated patient prognostic risk using
the 3 SBT categories and rated patient psychological factors using a 0-to-10
scale. Finally, therapists reported their self-reported competence to manage the
patient. Intraclass and Spearman rank correlations tested correlations between
therapists' intuitive assessments and patient questionnaires. A linear-mixed
model explored relationships between psychological factors and therapists'
self-reported competence. Results: Forty-nine patients were managed by 20
therapists. Therapists accurately estimated SBT risk allocation in only 41% of
patients. Correlations between therapist perceptions and patient questionnaires
were moderate for distress (r = 0.602) and fair for depression (r = 0.304) and
anxiety (r = 0.327). There was no correlation for kinesiophobia (r = -0.007).
Patient distress was identified as a negative predictor of therapists'
self-reported competence. Limitations: This was a cross-sectional study,
conducted in only 1 center. Conclusions: Physical therapists were not very
accurate at allocating patients into risk stratification groups or identifying
psychological factors. Therapists' self-reported competence in managing patients
was lowest when patients reported higher distress.

Langue : ANGLAIS