Visiting a Physiotherapist is Useful in the Early Phase of Low Back Pain

Background: The purpose was to examine physiotherapists' (PTs) core competences in direct access practice for low back pain (LBP) in the early phase of pain using tissue-structural classification, and the implementation of this practice after a continuing education with clients' and PTs' experiences. Methods: Although previous research has shown direct access in physiotherapy to be an important method in preventing the recurrence of LBP, data are still lacking on the level of required competences of PTs, classifications of LBP and implementation of direct access practice after a continuing education program. Results: PTs' core competences of clinical reasoning and critical reflection were on a good level when used tissue-structural classification and hypothetico-deductive method. PTs made accurate diagnostic subgroups for their LBP clients. The agreement between PTs and reviewers was 74% (kappa 0.63; 95% CI, 0.47 to 0.77). PTs also analyzed their clinical reasoning systematically from clients' history to choices of clinical tests and conclusions. They justified their manual skills and the adequacy of the LBP classification in use and suggested other alternatives for their performance. 80% of the clients were satisfied with the implementation of direct access in the early visit to PTs and with the information and advice they received. Three months after the physiotherapy, repeat visits were on a low level and only one of the employed was on sick leave. PTs reported their work meaningful which, according to a qualitative analysis, was connected with clients` satisfaction, reasonable division of labor, cooperation with their co-workers and an increase in professional appreciation. Conclusions: This research demonstrates the benefits, as outlined by clients and PTs, of direct access to physiotherapy in the early phase as well as the use of tissue-structural classification (nociceptive pain mechanism) as one of the classifications in this stage. Clinical reasoning and critical reflection competences in the assessment of clients were important during the sub classification and during the evaluation of PTs' own performance. Continuing learning of these competences should also be included in education programs. These results can be utilized in PTs' direct access practice as well as when planning the content of the education program.