A comparison of rigid tape and exercise, elastic tape and exercise and exercise alone on pain and lower limb function in individuals with exercise related leg pain: a randomised controlled trial.

BACKGROUND: Exercise related leg pain (ERLP) is a common lower limb overuse injury characterised by pain located between the knee and ankle that occurs during activity. The high incidence of the condition, subsequent interference with participation in physical activity and substantial recovery time, highlights a need for effective interventions. Whilst many interventions have been described for the management of ERLP, currently there is a lack of high quality evidence for an effective intervention for the condition. METHODS/DESIGN: A single-blinded randomised controlled clinical trial will be conducted in a community setting. Forty-five female volunteers aged between 18 and 40 years with a history of insidious onset of pain located between the knee and ankle of at least one month duration that is aggravated by weight bearing activities will be recruited for the study. Suitable participants will be randomly allocated to one of three treatment groups for the 6 week intervention period: (i) exercise only, (ii) rigid anti-pronation tape and exercise, (iii) elastic anti-pronation tape and exercise. Outcomes will be measured at baseline, 1, 2 and 6 weeks using primary outcome measures of usual and worst pain visual analogue scale and global perceived improvement. Secondary outcome measures will include Foot and Ankle Ability Measure, Patient Specific Functional Scale and amount of activity in the previous week. In addition, participants will be contacted by phone to obtain primary and secondary outcome measures at 12, 18, 24 and 30 weeks. DISCUSSION: This article describes a single-blinded randomised controlled clinical trial that will utilise high quality methodologies in accordance with CONSORT guidelines. The results of this study will contribute to the limited knowledge regarding effective interventions for the management of ERLP. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12613000914763).

Patient acceptance of care of a novel care pathway for those at risk of poor outcomes from musculoskeletal pain: A mixed methods study.

OBJECTIVE: Investigate people's acceptance of specialist musculoskeletal care within a new care pathway for common musculoskeletal conditions (low back pain, neck pain/whiplash, knee osteoarthritis). DESIGN: Convergent parallel mixed methods design referencing the Theoretical Framework of Acceptability. The study included a subset of participants (n = 29) at-risk of poor outcomes from the intervention arm of the PAthway of CarE for common musculoskeletal conditions (PACE-MSK) trial. In the PACE-MSK arm, participants received specialist physiotherapist care as an adjunct to the care provided by their primary healthcare professional(s). One-to-one semi-structured interviews were conducted around 3-months after commencing in the trial. Quantitative data were collected at baseline and 3-month follow-up (health-related quality of life, pain self-efficacy, global perceived change, satisfaction). RESULTS: Five themes were identified (Expectations and beliefs shaped patient experience; Clinical expertise and competence influence acceptance; Person-centred care; Mechanisms facilitating beneficial responses to care; Gaps in care pathway implementation). There were positive individual changes in physical quality of life for 17/29 (59%) participants, mental health quality of life for 12/29 (41%), pain self-efficacy for 8/29 (28%) and global perceived change for 19/29 (66%). Management met expectations with the majority reporting high levels of satisfaction. Integrating the qualitative and quantitative data with the Theoretical Framework of Acceptability, there were complementary meta-inferences in the constructs of 'ethicality', 'intervention coherence', 'self-efficacy' and 'affective attitude'. Divergence was identified in 'perceived effectiveness'. DISCUSSION: In general, there was positive acceptance of the care pathway by participants. Specialist physiotherapists' care was perceived as a positive addition to usual care.

Patient experiences of referral practices and primary care physiotherapy for chronic nonspecific low back pain.

BACKGROUND: Low back pain (LBP) clinical practice guidelines recommend referral for patients with persistent LBP however discordance persists between recommended care and implementation in practice. Understanding patient experiences of referral practices and physiotherapy care could be important for optimizing LBP management in primary care settings. PURPOSE: This study explored referral experiences of people with nonspecific LBP in Australian primary care and their knowledge and experience of physiotherapy. METHODS: An interpretive descriptive qualitative framework was used with 17 participants interviewed from community-based physiotherapy practices. RESULTS: Four themes described the participants' experiences of referrals in primary care settings: 1) Referral practices ranged from formal to informal to non-existent; 2) Fragmented inter-and intra-professional LBP care management; 3) Patient perceived differences in the roles of physiotherapists and specialist physiotherapists; and 4) Patient nominated barriers and facilitators to optimal referral practices. CONCLUSION: Physiotherapists support people with LBP to improve strength and function, whereas the specialist physiotherapist's role was seen as more holistic. Referral pathways that align to clinical guideline recommendations for non-surgical management and treatment remain underdeveloped. Improved referral pathways to clinicians such as physiotherapists with additional credentialed skills and competence in musculoskeletal care could improve people's experiences of care and health outcomes.

Impact of an interactive workshop on specialist physiotherapists' practice when implementing a new clinical care pathway for people with musculoskeletal conditions.

BACKGROUND: A new pathway of care proposes early comprehensive assessment and targeted management by specialist musculoskeletal clinicians for people with musculoskeletal conditions at risk of poor outcomes. Adoption of this care pathway is likely to be influenced by beliefs and behaviours of specialist musculoskeletal clinicians. OBJECTIVE: To evaluate the effect of an interactive educational workshop about the proposed clinical care pathway on knowledge, beliefs and practice of specialist musculoskeletal physiotherapists. DESIGN: Mixed methods. METHODS: Fifty specialist musculoskeletal physiotherapists participated in a 2-day interactive educational workshop. Knowledge, beliefs and clinical practice behaviours were assessed immediately before the workshop and 3 months' later using surveys. RESULTS: Knowledge about key guideline messages improved and were maintained at follow-up. Most participants agreed to provide more targeted interventions to patients at risk of poor outcome (92%, 95% CI: 81%-98%) and utilise prognostic screening tools (84%, 95% CI: 71 to 93). However, only 56% (95% CI: 39%-68%) of participants believed implementing a shared care pathway was easy. At follow-up, participants' beliefs were more aligned with the proposed care pathway (i.e., shared care: 83%, 95% CI: 68%-93%). With respect to clinical practice, there were 16% more referrals back to the primary physiotherapist at 3 months than before the workshop. Barriers (practitioner, patient and system factors) to implementation of the care pathway were discussed. CONCLUSION: An interactive educational workshop influenced specialist musculoskeletal physiotherapists' knowledge, beliefs and clinical practice, but barriers need to be overcome to facilitate widespread implementation.