CLASSIFICATION SYSTEM GUIDED MANAGEMENT OF PATIENTS WITH LOW BACK PAIN IN PRIMARY CARE: CLINICIANS' AND MANAGERS' VIEWS, EXPERIENCES AND ATTITUDES

Background Evidence suggests classification system (CS) guided treatments are more effective than generalized and practice guidelines based treatments for low back pain (LBP) patients. This study evaluated clinicians9 and managers9 attitudes towards LBP classification and its usefulness in guiding LBP management. Methods Data from 3 semi-structured interviews with physiotherapy service managers and advanced spinal physiotherapy practitioner and a focus group (5 physiotherapists) in two NHS Health Boards, South Wales, UK, was thematically analysed. Results Five themes emerged. CS knowledge : Clinicians and managers know different CSs and agree with its usefulness. Clinicians have specific CSs knowledge, managers viewed classification related to referral pathways and prognosis. Current CS use : Clinicians classify using their experience and clinical reasoning skills shifting between multiple CSs. Managers are confident that staff provide evidence-based service though believe classification is not always practiced across services. CS advantages/disadvantages : Effectively targeting the right patients for right treatments using evidence-based practice is advantageous. Prevalence of “guru led” CSs developed for research and of limited clinical use is disadvantageous. Barriers: Patients9 treatment expectations, threat to clinical autonomy, lack of sufficiently complex CSs, lack of resources to up-skill clinicians and overall CSs fit into complex referral pathways. Enablers: CSs sufficiently complex & placed within clinical reasoning process, mentoring for inexperienced staff, positive engagement with all stakeholders and patients. Conclusion Clinicians and managers are aware of CSs and agree with its usefulness to guide LBP management. Clinicians classify LBP though there is no formalized CS process in place. Whilst clinicians view classification as the relationship between patients and physiotherapy managers have a broader, whole service view. Conflicts of interest: None Sources of funding: Wales School of Primary Care Research, Cardiff, UK This abstract has not been previously published in whole or substantial part nor has been presented previously at a national meeting.