I expected to be pain free: a qualitative study exploring athletes' expectations and experiences of care received by sports chiropractors.

BACKGROUND: Knowledge about patient satisfaction and experience with care they receive can guide practitioners in establishing doctor-patient relationships and improve health outcomes. Although evidence suggests high patient satisfaction with chiropractic care in general, there is limited understanding of the expectations and experiences of athletes receiving sports chiropractic care. OBJECTIVE: To explore the athletes' expectations and experiences with care received from sports chiropractors, and their perceptions of relevant areas of future research. METHODS: A qualitative study was conducted through an interpretivist lens exploring the perspectives of elite and competitive athletes receiving care from sports chiropractors in Canada. Participants were purposively recruited and interviewed until saturation was reached. Two research team members independently analyzed the interview transcripts using a conventional approach to content analysis. Content was inductively coded and discussed by the research team to generate categories. RESULTS: We interviewed 18 participants between December 2018 and March 2020, 14 were national level athletes participating in sports ranging from paddling to combat sports. Reported reasons for seeking care included acute care, injury prevention, enhancing performance and maintenance care. Generated categories were organized under topics of experience with care, expectations of care, and research agenda. Participants experienced a variety of interventions, reassurance, varying treatment times, and reported positive impact on their athletic performance. They expected musculoskeletal assessment and treatment including at and beyond the injury site, symptom improvement, good communication and expertise from the chiropractor. Some participants suggested interpersonal and interprofessional communication can be improved, in particular the level of collaboration with other members of their health care team. Overall, participants reported a high level of trust and satisfaction with care received from sports chiropractors. From our participants' perspective, suggested areas of research should focus on injury mechanics and prevention, impact of care on performance, and interprofessional collaboration. CONCLUSIONS: In general, participants were very satisfied with care. Overall, participants' expectations and experiences aligned but changed over time. Addressing the findings of this study can be used to enhance the quality of care provided to athletes from sports chiropractors, as well as inform future research agendas. Further work assessing if athletes in other competitive levels have similar experiences and expectations is needed.

A Qualitative Study of Doctors of Chiropractic in a Nova Scotian Practice-based Research Network: Barriers and Facilitators to the Screening and Management of Psychosocial Factors for Patients With Low Back Pain.

OBJECTIVES: This study aimed to assess chiropractors' awareness of clinical practice guidelines for low back pain and to identify barriers and facilitators to the screening and management of psychosocial factors in patients with low back pain. METHODS: This qualitative study used semi-structured interviews informed by the Theoretical Domains Framework with 10 Nova Scotian chiropractors who were members of a practice-based research network. RESULTS: The participants correctly identified what the guidelines generally recommend and described the value of psychosocial factors; however, none of the participants could name specific clinical practice guidelines for low back pain. We identified 6 themes related to barriers and facilitators for chiropractors screening and managing psychosocial factors. The themes revolved around the participants' desire to fulfill patients' anatomy-focused treatment expectations and a perceived lack of training for managing psychosocial factors. Participants had concerns about going beyond the chiropractic scope of practice, and they perceived a lack of practical psychosocial screening and management resources. Social factors, such as the influence of other health care practitioners, were reported as both barriers and facilitators to screening and managing psychosocial factors. CONCLUSIONS: The participants in this study reported that they mostly treated with an anatomical and biomechanical focus and that they did not always address psychosocial factors identified in their patients with low back pain. Although these findings are limited to Nova Scotian chiropractors, the barriers identified appeared to be potentially modifiable and could be considered in other groups. Low-cost interventions, such as continuing education using evidence-informed behavior change techniques, could be considered to address these barriers.

Contemporary biopsychosocial exercise prescription for chronic low back pain: questioning core stability programs and considering context.

This commentary explores the importance of considering the biopsychosocial model and contextual factors when prescribing exercise. Diverse exercise programs for patients with chronic low back pain (CLBP) produce similar outcomes, without one specific exercise protocol demonstrating clear superiority. One clear barrier to positive outcomes is poor exercise adherence. We suggest that there are certain common contextual factors present in all exercise prescription scenarios that may impact adherence and health-related outcomes. While challenging common core stability exercise prescription, we present an argument for enhancing and intentionally shaping the following contextual factors: the therapeutic alliance, patient education, expectations and attributions of therapeutic success or failure, and mastery or cognitive control over a problem. Overall, this commentary argues that to improve exercise adherence and outcomes in the CLBP population, the context in which exercise is delivered and the meaning patients embody need to be considered and shaped by clinicians.

Cet article explore l'importance de considérer le modèle biopsychosocial et les facteurs contextuels avant de prescrire des exercices. Divers programmes d'exercices pour les patients qui souffrent de lombalgie chronique produisent des résultats semblables, sans qu'un protocole d'exercices particulier démontre une supériorité claire. Un obstacle évident à l'atteinte de résultats positifs est le fait de ne pas persister à faire les exercices. Nous laissons entendre qu'il existe certains facteurs contextuels communs dans tous les scénarios de prescription d'exercices pouvant avoir des répercussions sur la persistance et les résultats axés sur la santé. Tout en contestant la prescription d'exercices communs de stabilisation du tronc, nous présentons un argument en faveur de l'accroissement et l'élaboration intentionnelle des facteurs contextuels suivants : l'alliance thérapeutique, la sensibilisation du patient, les attentes et les attributions du succès ou de l'échec thérapeutique, ainsi que la maîtrise ou le contrôle cognitif d'un problème. Dans l'ensemble, cet article soutient qu'afin d'améliorer la persistance à effectuer les exercices et les résultats au sein de la population atteinte de lombalgie chronique, le contexte dans lequel l'exercice est fourni et la signification exprimée par le patient doivent être pris en considération par les cliniciens.

'I didn't pay her to teach me how to fix my back': a focused ethnographic study exploring chiropractors' and chiropractic patients' experiences and beliefs regarding exercise adherence.

AIM: To inform future research and exercise prescription for patients with chronic low back pain (CLBP), this study explored chiropractors' and chiropractic patients' experiences and beliefs regarding the barriers and facilitators to prescribed exercise adherence. METHODS: A focused ethnographic approach was used involving 16 semi-structured interviews, including pilot interviews (n = 4) followed by interviews with chiropractors (n = 6) and chiropractic patients with CLBP (n = 6). RESULTS: Barriers and facilitators to prescribed exercise adherence revolved around four themes: diagnostic and treatment beliefs motivating behavior, passive-active treatment balance, the therapeutic alliance and patient-centered care, and exercise delivery. CONCLUSION: Exercise adherence may be facilitated in patients with CLBP with simple exercise prescription changes made by chiropractors. However, changing chiropractors' and patients' diagnostic and treatment beliefs that are barriers to exercise adherence appears challenging. Training chiropractors in pain neuroscience education and the intentional use of behavior change techniques warrants future investigation.

OBJECTIF: Pour fournir de l'information sur les recherches futures et les exercices prescrits aux patients souffrant de lombalgies (LC), cette étude consistait à examiner les expériences et les croyances de chiropraticiens et de patients qui constituent des obstacles à la fidélité ou des facteurs qui la favorisent. MÉTHODOLOGIE: Étude ethnographique comportant 16 entrevues semi-structurées et des entrevues pilotes (n = 4) suivies d'entrevues avec des chiropraticiens (n = 6) et des patients souffrant de LC (n = 6). RÉSULTATS: Les obstacles à la fidélité aux exercices prescrits et les éléments qui la favorisent sont liés aux quatre points suivants: croyances sur le diagnostic et le traitement motivant le comportement, équilibre entre traitement passif et traitement actif, alliance thérapeutique et soins centrés sur le patient et fourniture d'exercices. CONCLUSION: Chez les patients souffrant de LC, de simples changements d'exercices apportés par le chiropraticien pourraient favoriser la fidélité aux exercices. Cependant, il semble difficile de changer des croyances sur le diagnostic et le traitement qui s'opposent à l'observance. Un examen plus approfondi de la pertinence d'une formation en neurosciences de la douleur et du recours intentionnel à des techniques servant à changer le comportement serait justifié.