Factors contributing to non-compliance with active physiotherapy guidelines among chronic low back pain patients in India

Introduction: Physiotherapists exhibit different degrees of adherence to clinical guidelines for low back pain (LBP). The preferences and expectations of their patients significantly influence physiotherapists' adherence to these guidelines. Therefore, it is crucial to have a comprehensive analysis of the patients' perspectives, which can identify the factors that prevent the implementation of an active approach.

Methods: We conducted semi-structured interviews with patients suffering from non-specific chronic LBP (CLBP). We transcribed the semi-structured interviews verbatim and conducted an inductive thematic analysis to uncover themes related to the participants' expectations and experiences of consultations with physiotherapists for CLBP.

Results: In total, we interviewed thirty-three individuals, with 14 women and 19 men (mean age 53 + 12 years). Our thematic analysis discovered six overarching themes that are relevant to patients' expectations and experiences. We identified several sub-themes under the "physiotherapist-related factors" and "patient-related factors" themes. Additional themes recognized were guideline-related factors, institution-related factors, healthcare-related factors, and health information. A significant number of participants expressed dissatisfaction with the short timeframe allocated by the physiotherapist.

Conclusions: Multiple participants expressed dissatisfaction with their experience, particularly about the quality of explanations and the nature of the exercises provided. This emphasizes the importance of patient education, and physiotherapists should consider suggesting active interventions that the family, society, and culture can more easily accept. Accordingly, the formulation of future guidelines for nations like India should take into account these patient expectations and perspectives.