دانلود رایگان مقاله انگلیسی توانایی های فیزیوتراپیست ها برای شناسایی عوامل روان شناختی و خودباوری آنها در مدیریت کمر درد مزمن - NCBI 2018

Background. In the management of chronic low back pain (LBP), identifying and dealing with more patients who are at high risk and who have psychological barriers to recovery is important yet difficult. Objectives. 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 FourDimensional 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.

Limitations

Study design. It must be acknowledged that the data was measured only at the intake session. The study could not capture how therapists’ perceptions evolved over the course of ongoing treatment. This limitation may result in an underestimation of physical therapists’ ability to risk stratify, or assess psychological factors. It could also be premature to measure therapists’ self-reported competence after the intake session. Additionally, our study cannot evaluate the prognostic accuracy of therapist intuition or the SBT because of the lack of direct measures of chronicity. Furthermore, we used the SBT as a risk stratification instrument in physical therapist practice, but it has been noted that the SBT may perform better in general practice than in physical therapy or chiropractic settings.

these patients was based on our experience that mental illnesses are very often not sufficiently reported on these referral sheets. Therefore, we expected that unreliable reports of mental illness would bias our estimates on therapists’ ability to recognize psychological factors. However, this exclusion criteria impacts the generalizability of our results to actual clinical practice where the prevalence of co-morbid mental illness is high in patients with chronic LBP.