Physiotherapists’ perceptions of implementing evidence-based practice for patients with low back pain through the Enhanced Transtheoretical Model Intervention: a qualitative study

Background: Physiotherapists have been urged to implement evidence-based practice for the management of low back pain (LBP). However, recent evidence suggests that many fail to do so, specifically in accordance with eliciting and addressing psychosocial factors that impact pain. The Enhanced Transtheoretical Model Intervention (ETMI) for the Treatment of patients with LBP was developed in Israel according to the clinical guidelines and demonstrated clinically and cost-effectiveness. Objectives: This study’s purpose is to explore physiotherapists’ perceptions of implementing evidence-based practice through the ETMI approach. Design: Qualitative study. Methods: Qualitative semi-structured interviews were conducted with 26 physiotherapists. The interviews were audio-recorded, transcribed, coded, and analyzed thematically to identify prevalent themes. Results: Three main themes were identified from the transcripts, consisting of barriers and facilitators of implementing the intervention, and a meta-theme referring to shifts in the perceptions of professional role and identity. Conclusion: The findings suggest that physiotherapists believed that implementing ETMI and adopting a psychosocial approach to LBP can be achieved by overcoming issues around communication skills, patient reassurance, and inter-professional collaboration. Therapists also highlighted the need for physiotherapy training to gain skills in combined physical and psychological approaches.