A Qualitative Investigation of Physical Therapists' Experiences and Feelings of Managing Patients With Nonspecific Low Back Pain

Background. Physical therapists' management of patients with nonspecific low back pain (NSLBP) has been found to be associated with their beliefs and attitudes toward NSLBP, as well as with guideline recommendations. Greater knowledge of physical therapists' experiences and feelings of treating patients with NSLBP may help to explain these associations and increase our understanding of some of the challenges physical therapists face when treating patients with NSLBP in clinical practice. Objectives. The objective of this study was to understand more about how the personal experiences and feelings of physical therapists might influence their decision making when treating patients with NSLBP. Design. This was a qualitative study using a phenomenological hermeneutical approach and practitioner-as-researcher model. Methods. Eleven semistructured interviews with physical therapists were conducted and analyzed using the hermeneutical circle to identify key themes relating to their experiences and feelings in treating patients with NSLBP. Results. Three linked themes emerged: (1) physical therapists believe that NSLBP has an underlying mechanical and recurring nature, (2) physical therapists' attitude toward managing NSLBP is to empower patients to exercise and self-manage their pain and functional problems, and (3) physical therapists experience feelings of tension between the advice and treatment they feel is best for their patient and the patient's own beliefs and attitudes. Conclusions. The experiences and feelings of physical therapists treating patients with NSLBP include conflict among their pain beliefs, attitudes, and working partnerships with patients. Treatment decisions may be influenced when physical therapists modify their beliefs and attitudes to reduce this sense of conflict. Improving physical therapist communication skills may help decrease feelings of conflict, enhance working relationships, and encourage a more consistent approach toward patients with NSLBP.