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Abstract Background and aim Clinical prediction rules (CPRs) are mathematical tools that are intended to guide clinicians in clinical decision making or predict a future outcome, but they seem rather unknown, under-utilized, or avoided by clinicians. This study aimed to assess knowledge, attitude, and practice of CPRs in low-back pain (LBP) among physiotherapists. Methods A cross-sectional study involving 45 consenting specialist musculoskeletal physiotherapists from three public-funded teaching hospitals in Nigeria was carried out. An adapted validated questionnaire on facilitators and barriers to CPRs utilization, and a socio-demographic proforma were used to collect data. Descriptive and inferential statistics were employed to analyze data. Alpha level was set at p 0.05). However, there was a significant association between the utilization of CPRs and years of experience (χ2 = 10.339 p = 0.016). Conclusion Most Nigerian physiotherapists had above-average knowledge, but a negative attitude and low utilization of CPRs in LBP. Clinicians’ years of clinical experience influence the usage of CPR. There is a need to incorporate training in CPRs into undergraduate and continuous professional development programmes.

Abstract Background Stratified models of care are valuable for addressing psychosocial factors which influence the outcome of patients with musculoskeletal disorders. Introducing such models in undergraduate training has the potential to propagate this knowledge with evidence and foster its implementation. The objective of this paper is to explore the perception and changes in the fear-avoidance beliefs of physiotherapy students participating in a developed blended learning course on stratified care. Methodology A mixed-methods with a convenient sample of two consecutive cohorts were given a blended learning course on stratified care for patients with low back pain. The blended learning course comprised scientific rudiments and application of stratified care in clinical practice conceptualised using the KERN’ 6-step approach. The exam scores, perceptions, performance on self-reflection-tests and pre- and post-scores on The Tampa Scale for Kinesiophobia for Physiotherapists’ (TSK-PT) were obtained. After gaining clinical experience, participants were invited to discuss their clinical experiences and perceptions in workshops. The quantitative data was analysed explorative-descriptively. The qualitative data was analysed following an inductive coding system with constant comparisons. Results Ninety-one participants consented to the evaluation (mean age = 22.9 ± 1.6 years), 66% were female. Exam scores correlated with time spent in training (r = 0.30) and scores on self-reflection-tests 1 and 2 (r = 0.40 and r = 0.41). Participants in both cohorts described the learning resources as promoting their interest in the subject (72% and 94%), up-to-date (91% and 93%) and helpful (91% and 97%). The fear-avoidance scores for participants decreased from 53.5 (± 9.96) to 40.1 (± 12.4) with a large effect size (d = 1.18). The regression model [F (2, 49) = 1151.2, p

Abstract Background Stratified care approach involving use of the STarT-Back tool to optimise care for patients with low back pain is gaining widespread attention in western countries. However, adoption and implementation of this approach in low-and-middle-income countries will be restricted by context-specific factors that need to be addressed. This study aimed to develop with physiotherapists, tailored intervention strategies for the implementation of stratified care for patients with low back pain. Methods A two-round web-based Delphi survey was conducted among purposively sampled physiotherapists with a minimum of three years of clinical experience, with post-graduation certification or specialists. Thirty statements on barriers and enablers for implementation were extracted from the qualitative phase. Statements were rated by a Delphi panel with additional open-ended feedback. After each Delphi round, participants received feedback which informed their subsequent responses. Additional qualitative feedback were analysed using qualitative content analysis. The criteria for consensus and stability were pre-determined using percentage agreement (≥ 75%), median value (≥ 4), Inter-quartile range (≤ 1), and Wilcoxon matched-pairs test respectively. Results Participants in the first round were 139 and 125 of them completed the study, yielding a response rate of 90%. Participants were aged 35.2 (SD6.6) years, and 55 (39.6%) were female. Consensus was achieved in 25/30 statements. Wilcoxon’s test showed stability in responses after the 5 statements failed to reach consensus: ‘translate the STarT-Back Tool to pidgin language’ 71% (p = 0.76), ‘begin implementation with government hospitals’ 63% (p = 0.11), ‘share knowledge with traditional bone setters’ 35% (p = 0.67), ‘get second opinion on clinician’s advice’ 63% (p = 0.24) and ‘carry out online consultations’ 65% (p = 0.41). Four statements strengthened by additional qualitative data achieved the highest consensus: ‘patient education’ (96%), ‘quality improvement appraisals’ (96%), ‘undergraduate training on psychosocial care’ (96%) and ‘patient-clinician communication’ (95%). Conclusion There was concordance of opinion that patients should be educated to correct misplaced expectations and proper time for communication is vital to implementation. This communication should be learned at undergraduate level, and for already qualified clinicians, quality improvement appraisals are key to sustained and effective care. These recommendations provide a framework for future research on monitored implementation of stratified care in middle-income countries.

Background Stratified care has the potential to be efficient in addressing the physical and psychosocial components of low back pain (LBP) and optimise treatment outcomes essential in low-income countries. This study aimed to investigate the perceptions of physiotherapists and patients in Nigeria towards stratified care for the treatment of LBP, exploring barriers and enablers to implementation.Methods A qualitative design with semistructured individual telephone interviews for physiotherapists and patients with LBP comprising research evidence and information on stratified care was adopted. Preceding the interviews, patients completed the Subgroups for Targeted Treatment tool. The interviews were recorded, transcribed and analysed following grounded theory methodology.Results Twelve physiotherapists and 13 patients with LBP participated in the study (11 female, mean age 42.8 (SD 11.47) years). Seven key categories emerged: recognising the need for change, acceptance of innovation, resistance to change, adapting practice, patient’s learning journey, trusting the therapist and needing conviction. Physiotherapists perceived stratified care to be a familiar approach based on their background training. The prevalent treatment tradition and the patient expectations were seen as major barriers to implementation of stratified care by the physiotherapists. Patients see themselves as more informed than therapists realise, yet they need conviction through communication and education to cooperate with their therapist using this approach. Viable facilitators were also identified as patients’ trust in the physiotherapist and adaptations in terms of training and modification of the approach to enhance its use.Conclusion Key barriers identified are the patients’ treatment expectations and physiotherapists’ adherence to the tradition of practice. Physiotherapists might facilitate implementation of the stratified care by communication, hierarchical implementation and utilisation of patients’ trust. Possibilities to develop a consensus on key strategies to overcome barriers and on utilisation of facilitators should be tested in future research.