Exercise Prescription for Patients with Non-specific Chronic Low Back Pain: a Qualitative Exploration of Decision Making in Physiotherapy Practice

Background: Providing an effective exercise prescription process for patients with non-specific chronic low back pain (NSCLBP) is a challenging task. Emerging research has indicated that partnership in care and shared decision making are important for people with NSCLBP and calls for further investigation into the approaches used to prescribe exercise. Objective: To explore how shared decision making and patient partnership are addressed by physiotherapists in the process of exercise prescription for patients with NSCLBP. Design: A qualitative study using a philosophical hermeneutic approach. Methods: Eight physiotherapists were each observed on three occasions undertaking their usual clinical activities (total n=24 observations). They conducted brief interviews after each observation and a later in depth semi-structured interview. Iterative hermeneutic strategies were used to interpret the texts and identify the characteristics and processes of exercise prescription for patients with NSCLBP. Findings: The findings revealed how physiotherapy practice often resulted in unequal possibilities for patient participation which were in turn linked to the physiotherapists? assumptions about the patients, clinical orientation, cognitive and decision making processes. Three linked themes emerged: (1) I want them to exercise, (2) Which exercise? - the tension between evidence and everyday practice and (3) Compliance-orientated more than concordance based. Conclusions: This research, by focusing on a patient-centred approach, makes an important contribution to the body of evidence relating to the management of NSCLBP. It challenges physiotherapists to critically appraise their approaches to the prescription of exercise therapy in order to improve outcomes for these patients.

Developing Professional Practice in L&D

The first theme of the book is ‘Directions’. This theme concerns the present and potential future expectations that L&D professionals may face in their practice. Chapter 1 is about ‘Developing professional practice in L&D’. In the first section, I discuss what is ‘professionalism’ and what it means for L&D professionals in terms of their development. In this chapter, I argue that expectations of L&D from senior management are growing. L&D professionals need to be able demonstrate ability to influence decision making by developing new competencies that enable them to provide senior management with new insight, which in turn increases L&D’s strategic credibility. In examining the diverse activities and tasks that L&D professionals currently, and may be expected to undertake in the future, four roles emerge; capacity and capability builders, boundary spanners, consultants and change agents. Capacity building primarily concerns creating space, time, and cultivating the right environment for the workforce to develop, which can be a challenge given how fire-fighting appears to be prevalent in many organizations today. Capability building involves enhancing knowledge, developing skills and competencies of the workforces, whilst boundary spanning involves networking and growing partnerships within and outside the organization. ‘Being a consultant’ is briefly touched upon as it is further discussed in Chapter 5, whilst the role of a change agent involves instigating and managing change. This chapter concludes with a discussion of twelve important knowledge, skill and capability areas that L&D professionals must develop to advance their practice.