"I could 100% see myself getting hurt if I did it wrong": a qualitative exploration of exercise perceptions in people with chronic low back pain.

PURPOSE: Traditionally, a specific "core" exercise focus has been favoured for chronic low back pain (CLBP) which contrasts holistic exercise approaches. This study aims to explore the perceptions of exercise in people with CLBP and whether exercise itself can convey implicit messages regarding its use in CLBP management in the absence of a clinical narrative. MATERIALS AND METHODS: Participants were asked about their CLBP history, views of exercise for CLBP, and current exercise behaviours through online semi-structured interviews. Then, participants watched the interviewer perform the deadlift, Jefferson curl, and bird dog and were asked if they thought each individual exercise was beneficial for CLBP, and why. Data were analysed using reflexive thematic analysis through a critical realism and social constructivism lens. RESULTS: All participants (n = 16) viewed all exercises as beneficial for health and pain relief, but perceived efficacy varied. "Core" exercises were deemed crucial for CLBP relief, while spinal flexion and external load were often perceived as potentially injurious. Distrust towards healthcare practitioners also influenced exercise perceptions. CONCLUSION: People with CLBP perceive different exercises to either relieve pain or improve health. Healthcare practitioners can influence these perceptions, highlighting the need for consideration of exercise perceptions in clinical contexts.

Exercise itself can convey implicit messages to people with chronic low back pain irrespective of an accompanying clinical narrative.'Core' exercises are perceived as beneficial whereas exercises involving spinal flexion or loading may be perceived as dangerous.Exercise for reducing pain is perceived as distinctly different from gym related exercises or other exercises for improving health.Healthcare practitioners must consider their client's exercise perceptions when using exercise as an intervention for chronic low back pain.

Navigating complexities: clinicians' experiences and systemic challenges in the implementation of evidence-based practice for chronic low back pain - a qualitative study.

PURPOSE: Implementation of evidence-based practice (EBP) for chronic low back pain (CLBP) is poor. This study aimed to investigate the factors that influence exercise-based clinicians' implementation of EBP for people with CLBP. MATERIALS AND METHODS: Semi-structured interviews were conducted with 40 clinicians (20 physiotherapists and 20 accredited exercise physiologists). Interviews explored clinicians' definition of EBP, understanding of EBP in CLBP management, barriers and enablers to EBP, and the impact of these factors on EBP implementation. Interviews were analysed using reflexive thematic analysis. RESULTS: A complex interplay among clinician factors, systemic factors, and patient interactions was identified. Clinicians encountered challenges stemming from their misconceptions about EBP, which influenced their perspective(s) on its implementation. Clinicians expressed the challenges of implementing EBP when navigating patient expectations and beliefs, experiencing external pressures from funders and business models, and the subsequent impacts on their well-being. Continuing professional development, support from community, and workplaces that prioritised EBP enhanced clinicians' ability to make decisions that accommodate for the complexities of CLBP and better align with EBP. CONCLUSION: A variety of factors impact exercise-based clinicians' implementation of EBP. The interaction between these factors greatly influences clinicians' ability to engage in and implement EBP in clinical practice.

The interplay among clinician, patient, and health system/structural level factors affects exercise-based clinicians' implementation of evidence-based practice for chronic low back pain.Clinicians are well positioned to identify issues in clinical practice and initiate appropriate changes that could improve evidence-based practice.Clinicians could provide feedback on continuing professional development to ensure it is accessible and applicable to clinical practice.Clinicians could encourage workplaces to prioritise time and/or funding for sufficient engagement in evidence-based practice.

On the Overlap of Commercial Sexual Exploitation and Intimate Partner Violence: An Exploratory Examination of Trauma-Related Shame.

Every year, millions of people experience intimate partner violence (IPV) and commercial sexual exploitation (CSE), with researchers increasingly discussing the overlap between these two forms of interpersonal violence. However, researchers have not yet used quantitative methods to examine the link between IPV and CSE or to explore potential mechanisms underlying the overlap, including child maltreatment risk factors and psychological mechanisms. One potential mechanism is trauma-related shame, a symptom of post-traumatic stress disorder commonly experienced by both victims of CSE and IPV. The current study explores trauma-related shame, childhood maltreatment, and IPV and their associations with CSE using a sample of 174 primarily Black women. Binomial logistic regression is used to analyze the impact of IPV, child abuse and neglect, and trauma-related shame on CSE. Results indicate that IPV and trauma-related shame are both significant predictors of CSE. Implications for future research and the incorporation of shame in trauma-related treatment are discussed.