Patient Preference and Adherence (Jul 2024)
Biomedical Dogmas Still Influence the Delivery of Exercise Therapy in Chronic Low Back Pain Management: Mixed-Methods Study
Abstract
Lukas Kühn,1,2 Lara Kleist,1 Franziska Weißenstein,1 Kyung-Eun Anna Choi1,3 1Center for Health Services Research, Brandenburg Medical School, Rüdersdorf bei Berlin, 15562, Germany; 2Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, 16816, Germany; 3Health Services Research, Research Center MIAAI (Medical Image Analysis & Artificial Intelligence), Danube Private University, Faculty of Medicine/Dentistry, Krems-Stein, 3500, AustriaCorrespondence: Lukas Kühn, Email [email protected]: Non-specific, chronic low back pain (NSCLBP) is a leading cause of disability, prompting long-term rehabilitation. Positive patient beliefs and expectations towards lasting exercise engagement play a crucial role for a successful management of this condition. The aim was to investigate beliefs, unmet needs and expectations of NSCLBP patients for exercise-related health behaviour change in the context of rehabilitative care.Patients and Methods: In a mono-centric mixed-methods study, we conducted semi-structured interviews with NSCLBP patients and care providers. We recruited in a rehabilitation clinic which is specialized in orthopaedics and internal medicine. Interviews were analysed deductively by combining health behaviour change theories with Donabedian’s quality model of care. In a patient survey, disability (RMDQ), exercise behaviours, fear avoidance beliefs (FABQ), self-efficacy in chronic disease management (SES6G), process- and outcome-expectations (OEE-2) were queried and analysed descriptively.Results: Twenty-two interviews were conducted and 40 questionnaires completed. Qualitative results revealed that NSCLBP patients had persistent biomedical perspectives on their health condition, marked by strong preferences for biomedical diagnostics and beliefs in the superiority of specific exercise regimes. Based on met expectations and positive movement experiences, patients’ motivation was successfully fostered in the motivational phase of health behavior change. In the volitional phase, the postulated desire to receive self-management strategies was largely unmet. Psychosocial aspects of care were not widely accepted. The survey study sample showed a disability score (RMDQ) of M = 6.8 (± 4.6). Mean scores of validated scales reflecting on attitudes, beliefs and expectations of chronic NSCLBP management were at FABQ-pa M = 15.4 (± 6.0), FABQ-w M = 24.0 (± 12.1), SES6G M = 6.4 (± 2.3), and OEE-2 M = 2.7 (± 0.5).Conclusion: In this sample, patients’ understanding of NSCLBP was still dominated by biomedical dogmas and perspectives. Inpatient rehabilitation predominantly addressed expectations towards the motivational phase of exercise-related health behaviour change.Keywords: behaviour change, exercise, patient needs, musculoskeletal disorders, self-management
