{
  "abstract": "Background For many common musculoskeletal conditions such as low back pain, it is not possible to identify a structural cause of someone’s pain, mostly due to limitations in clinical tests and imaging. As a result, there appears to have been a shift away from labelling based on observed or purported pathology (specific labels) and towards labelling based on symptoms or clinical features (non-specific labels).Our research has shown that non-specific labels for low back pain (e.g. ‘lumbar sprain’ and ‘non-specific LBP’) reduce patients’ perceived need for imaging, surgery and a second opinion compared to specific labels (e.g. ‘arthritis’, ‘ degeneration’ and ‘disc bulge’). However, there is variation is what labels health professionals use when communicating diagnosis to people with non-specific low back pain (e.g. some use non-specific labels, others use structural labels) and little-to-no data regarding why health professionals use some labels over others.Objectives The aim of this study was to explore what influences physiotherapists’ use of labels for people with non-specific low back pain.Methods We conducted a qualitative interview study including currently practicing, registered physiotherapists who had treated at least one patient with low back pain in the previous 6 months. Demographic and professional characteristics were gathered using an online questionnaire. Following this, participants were purposively sampled for a one-on-one semi-structured interview, containing open-ended questions and vignettes, to explore physiotherapist’s views, attitudes, beliefs and approach to diagnostic labelling of people with low back pain. Interviews were transcribed verbatim and analysed using thematic analysis.Results We interviewed 14 participants, resulting in the generation of three themes and nine subthemes. The results reflect the role of three key drivers in choice of labels for low back pain: the patient, the physiotherapist, and existing guidelines and evidence. The theme ‘influence of patient-specific factors and the individuality of low back pain’ included subthemes of 1) physical assessment findings and direct contributors to low back pain, 2) indirect contributors to low back pain such as lifestyle, psychosocial factors and general health, 3) patient expectations and beliefs regarding labelling and their pain, and 4) the lack of a uniform approach and the individuality of low back pain. The theme ‘effect of a physiotherapist’s own perspectives, clinical reasoning and experience’ included subthemes of 1) beliefs regarding low back pain as both an idea and a label, 2) beliefs and attitudes towards the use of diagnostic labelling, and 3) a physiotherapist’s own experiences and training. Lastly, the theme ‘the role of evidence and guidelines’ included subthemes of 1) adherence to evidence and guideline-based practice, and 2) attitudes towards existing guidelines and evidence.Conclusions When choosing diagnostic labels for low back pain, physiotherapists are influenced by patient-specific factors, their own professional practice perspectives, and to a lesser degree, existing guidelines and evidence. Our findings could inform the development of education strategies to improve the appropriate use of diagnostic labels among physiotherapists.",
  "authors": [
    {
      "affiliations": [
        "School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia"
      ],
      "name": "Daniel Abouzeid"
    },
    {
      "affiliations": [
        "School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia"
      ],
      "name": "David Anderson"
    },
    {
      "affiliations": [
        "Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, Australia"
      ],
      "name": "Giovanni Ferreira"
    },
    {
      "affiliations": [
        "Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, Australia"
      ],
      "name": "Chirstopher Han"
    },
    {
      "affiliations": [
        "Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia"
      ],
      "name": "Hosam Alzahrani"
    },
    {
      "affiliations": [
        "Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, Australia"
      ],
      "name": "Chris Maher"
    },
    {
      "affiliations": [
        "Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Sydney, Australia"
      ],
      "name": "Joshua Zadro"
    }
  ],
  "title": "014 What influences physiotherapists’ use of diagnostic labels for low back pain? A qualitative study",
  "uid": "1bb504b6-c576-5bc9-af02-3353bc35c184"
}