Maja Husted Hubeishy

Objectives. We aimed to develop a booklet for people with low back pain (LBP) and their healthcare professionals (HCPs), which provides coherent, evidence-based patient education to support helpful pain-related behaviours tailored to individual needs.Methods. People with LBP, HCPs, educators, researchers, and a visual artist were included in a co-design process. Booklet content was developed in an iterative approach comprising three surveys and three in-person workshops. First, HCPs contributed suggestions for educational content in a survey. These were then organised into themes, drafted as text paragraphs and metaphors, and refined through three workshops and two subsequent survey rounds involving all stakeholder groups. Illustrations were sketched during workshops and discussed in surveys.Results. Three overarching themes were agreed on: (1) creating an alliance (HCPs and people with LBP working collaboratively), (2) explaining LBP, and (3) managing LBP. The booklet included these themes by combining suggestions for factual explanations, metaphors, and practical strategies for facilitating a collaborative approach to patient education. In the final survey, the texts for all of 17 outlined messages were endorsed by more than 90% (n = 27) respondents. Of 11 proposed metaphors for explaining LBP, one was excluded due to lack of consensus.Conclusions. We developed a booklet for people with LBP and for HCPs in a co-design process. The content covers topics previously identified as important for LBP education, while the booklet emphasises individualised education delivered through interaction and dialogue rather than generic information transfer. Future research should explore the booklet’s usefulness for supporting people with LBP in managing their condition, and a tailored implementation plan should be developed.Practice implications. The booklet “When Your Back Hurts – A Guide to Back Pain” is available as a source of current information about LBP meant to support an individualised clinical dialogue.

Objectives: Implementing motivational self-management support in low back pain care remains challenging due to barriers including health care providers’ limited confidence in addressing behavioral aspects of pain, people with low back pain’s expectations, and time constraints. To promote person-centered low back pain care, this project engaged people with low back pain, health care providers, and researchers in a co-design process to develop a dialogue tool aimed at supporting motivational conversations and facilitating self-management.Methods: Guided by Design Thinking principles, we conducted a co-design process informed by self-determination theory and structured around the 5A’s model for behavior change (Assess, Advise, Agree, Assist, Arrange). The process included fieldwork, workshops, prototype development, and iterative refinements. To inform refinements, acceptability, appropriateness, and feasibility of the dialogue tool were evaluated through surveys (n = 9 health care providers) and in semi-structured interviews with health care providers (n = 6) and people with low back pain (n = 4).Results: The final product was an analog tool comprising 7 dialogue sheets and 5 information postcards aligned with the 5A’s components. Both health care providers and people with low back pain found the prototype tool acceptable and feasible for structuring person-centered conversations about pain and self-management. The most frequently used elements were those to support a person-centered assessment of pain complexity (Assess) and to provide options for managing pain (Assist). Barriers included lack of experience and need of supplementary training in use of the dialogue tool.Conclusions: Using a co-design process, we developed an analog dialogue tool to facilitate a person-centered approach to support self-management of low back pain. Effects of the tool and strategies for implementation are still to be tested.Practice implications: The dialogue tool may support structured, person-centered conversations about pain beliefs, factors affecting pain, and self-management strategies linked to meaningful goals and activities.

Purpose: Musculoskeletal disorders (MSDs) are a leading cause of sickness absence from work and early retirement. While structured workplace dialogues about musculoskeletal pain are recommended, their implementation remains challenging. This study explored the implementation of the ‘Talk About Pain—Take Action Together’’ toolbox in two Danish public workplaces. Methods: Qualitative observational implementation study informed by reflexive thematic analysis was conducted. Two workplaces with physically demanding roles were included: one with researcher-initiated implementation during the study period and one with internally initiated implementation prior to the study. Data were collected through observations, memos, emails, and four focus group interviews with 10 participants including employees, managers, and occupational safety and health consultants. Results: Workplace 1 (WP1) implemented the toolbox, employing seven strategies: identifying and preparing champions, conducting a local needs assessment, distributing educational materials, reminding clinicians, tailoring strategies, organising implementation team meetings, and creating learning collaboratives. Key enablers included management engagement, ongoing exposure, and creating a safe environment, whereas lack of time was identified as a barrier. At workplace 2 (WP2), three strategies were employed: identifying and preparing champions, distributing educational materials, and conducting educational meetings. However, the toolbox was never fully implemented, hindered by time-related barriers, organisational restructuring, and unclear roles and responsibilities. Conclusions: Effective implementation of workplace MSD interventions requires management engagement, time allocation, and clear roles.

Background: Low back pain (LBP) is the primary contributor to disability worldwide, leading to a significant healthcare burden. Implementing evidence-based practice (EBP) can reduce this burden, as healthcare professionals (HCPs) working evidence-based reduce the number of treatments, the use of imaging and medication compared to HCPs not working evidence-based. Clinical practice guidelines have been published to help HCPs implement research evidence into practice. Unfortunately, studies have consistently shown a lack of adherence to guidelines in LBP care. This study aimed to investigate the implementation outcomes of a tailored programme for implementing key recommendations from LBP guidelines among Danish physiotherapists and chiropractors working in primary care. Methods: This study was conducted as a 'pre-post' implementation study among 80 physiotherapists and chiropractors from 15 primary care clinics. The implementation object was the two key guideline recommendations: 1) screening of psychosocial risk factors and 2) patient education, including reassuring information. The programme comprised multipronged strategies and was designed as a step-by-step implementation process comprising 16 hours of activities distributed over 16 weeks. Adoption was measured as changes in self-reported behaviour and perceptions of the professional role and culture from baseline to follow-up at 16 weeks. Acceptability and appropriateness of the programme were measured weekly using a four-point Likert scale. Feasibility was measured at 16-week follow-up using a five-point Likert scale. Fidelity was measured as the number of strategies and implementation support delivered as planned and registered by the research team. Results: An increase in the adoption of screening of psychosocial factors and offering patient education, including reassuring information, was seen in 38% and 33% of participants, respectively. Most participants reported that the programme was partly or overall acceptable and appropriate. The feasibility of the implementation programme was assessed as moderate to high, and the fidelity of the implementation programme was determined as high. Conclusion: The tailored implementation programme enhanced the adoption of the guidelines and changed the participants’ professional identity and culture. Most participants found the programme partly or overall acceptable and appropriate. The programme was feasible, but the perspective requires refinements, as most participants rated it moderately feasible. Trial registration: Central Denmark Region, Registered November 11, 2021, act no. 1–16-02–93-19.

Background: Standing frames are commonly used by healthcare professionals in their practice with children with cerebral palsy (CP) who do not have an independent standing function. A better understanding of healthcare professionals' attitudes and experiences with standing frames may impact practice and rehabilitation. Therefore, this study aimed to investigate the standing frame practice among healthcare professionals and expand their attitude and experience with the use of standing frames for children with CP.Methods: This is an explanatory sequential mixed methods study. A cross‐sectional survey was conducted, providing quantitative data on 210 healthcare professionals' use of standing frames. The quantitative data were descriptively analysed. Subsequently, the results from the survey were followed up with five focus group interviews of healthcare professionals (n = 14). The qualitative data were analysed using thematic analysis, enabling integration between the quantitative and qualitative data.Results: When quantitative and qualitative data are integrated, expansion between the two datasets occurred. The quantitative dataset emphasised the use of GMFCS levels as a guideline for recommending standing frames, whereas the qualitative data showed that the healthcare professionals' recommendations were based on individual needs. Furthermore, the healthcare professionals expanded the quantitative data, showing that the healthcare professionals' considerations regarding age and dosage were based on clinical experience, and saw the standing frame as having many benefits.Conclusion: The healthcare professionals had a child‐centred approach, where the child's need for using a standing frame was assessed based on the functional level, stage of development, cognitive level and clinical assessment. All of these considerations showed that the use of standing frames for children with CP was individualised, thereby making it difficult to make unified descriptions.

Background: Low back pain is still the leading cause of disability and societal burden, with 619 million prevalent cases worldwide in 2020. Most countries produce clinical guidelines to support healthcare professionals in evidence-based care regarding low back pain. However, several studies have identified relatively poor uptake of guidelines. Tailored strategies to facilitate the implementation of guidelines have been argued to increase uptake. This study aimed to develop a contextually tailored implementation programme to enhance evidence-based low back pain care among Danish physiotherapists and chiropractors in primary care. Methods: A theory-driven implementation programme development study was conducted using the Behaviour Change Wheel, with high healthcare professional involvement. Data collection included four workshops with seven physiotherapists and six chiropractors from primary care clinics. The development process consisted of [1] establishing a theoretical frame, [2] involving participants, [3] understanding the behaviour, [4] designing the implementation programme, and [5] final implementation programme. Results: The target behaviours selected (guideline recommendations) for the implementation programme were (i) screening of psychosocial risk factors and (ii) offering patient education. The barriers and facilitators for the selected behaviours were described and linked to intervention functions and behavioural techniques. Finally, the implementation programme comprised five strategies: webinars, e-learning videos, communication exercises, peer learning, and group dialogue meetings. In addition, the programme consisted of implementation support: champions, a physical material folder, a weekly email reminder, a specially designed website and a visit from an implementation consultant. An essential element of the overall programme was that it was designed as a step-by-step implementation process consisting of 16 h of education and training distributed over 16 weeks. Conclusions: A programme for implementing low back pain guideline recommendations was developed based on behaviour change theory and four co-design workshops involving healthcare professionals to overcome the contextually identified barriers. A theory-driven approach involving healthcare professionals was useful in identifying relevant target behaviours and tailoring the programme to consider contextual barriers and facilitators for implementation. The effectiveness of the final implementation programme will be evaluated in the project’s next phase. Trial registration: Central Denmark Region, Registered November 11, 2021, act no. 1-16-02-93-19.

Low back pain (LBP) is the leading cause of disability worldwide. Providing evidence-based practice (EBP) for patients with LBP is more cost-effective compared with non-EBP. To help health care pro... It is important that physiotherapists and chiropractors reflect on what constitutes their core task and professional identity if the implementation of the biopsychosocial model is to be successful....

Objective: The aim of the study was threefold: Firstly, to investigate the adherence to clinical practice guidelines for low back pain (LBP) among Danish physiotherapists with regard to three key domains: (a) activity, (b) work and (c) psychosocial risk factors. Secondly, to investigate whether adherence differed between physiotherapists working in private clinics (private physiotherapists) and physiotherapists working at public healthcare centres (public physiotherapists). Thirdly, to describe the physiotherapists' treatment modalities for patients with LBP.Methods: A cross‐sectional online survey was conducted with 817 physiotherapists working in the Central Denmark Region. Adherence to the guideline domains was assessed using two vignettes. The difference in adherence between the groups was assessed using the Chi‐squared test. Treatment modalities were reported using descriptive statistics.Results: A total of 234 physiotherapists responded, hereof 163 private physiotherapists and 71 public physiotherapists (response rate 29%). The proportions of physiotherapists managing the patients strictly in line with the guideline domains were 32% (activity), 16% (work) and 82% (psychosocial risk factors) for Vignette 1 and 6% (activity), 53% (work) and 60% (psychosocial risk factors) for Vignette 2. Public physiotherapists were more likely to manage patients strictly in line with guidelines for assessing the psychosocial risk factors compared to private physiotherapist (Vignette 1: 92% vs. 77% p = .030; Vignette 2:70% vs. 55% p = .035). Regarding the other two domains, there was no significant difference between the two groups in terms of adherence (p > .05). Concerning treatment modalities, the majority of physiotherapists instructed the patients in adopting an exercise program or informed the patients about the benign nature and prognosis of LBP.Conclusion: Overall, the participating Danish physiotherapists strictly adhered to only one out of three key domains. This underlines the importance of bringing focus on implementing the current guidelines' recommendations in clinical practice.