Low back pain is the primary reason for disability across the world and is very common in both Canada and the United Kingdom. To manage this condition, healthcare systems often use "care pathways," which are structured plans designed to ensure patients receive high-quality care that aligns with the best available medical guidelines.
A key part of these care pathways involves a specialized type of care called advanced practice physiotherapy, or APP. This is a higher level of physiotherapy provided by practitioners with extra training to manage individuals with more complex health problems. While the patient experience is recognized as an important way to measure the quality of healthcare, and studies have looked at patient experiences in other APP settings or with standard physiotherapy for low back pain, no research has specifically examined the patient experience of APP within these structured low back pain care pathways.
This study protocol outlines a plan to explore and understand how patients experience advanced practice physiotherapy within low back pain care pathways in the UK and Canada.
The research has several specific objectives:
- To map out how advanced practice physiotherapy is incorporated into the low back pain care pathways in both the UK and Canada.
- To gather the perspectives of advanced practice physiotherapists regarding the patient experience.
- To explore the experiences of the patients themselves.
- To bring together and analyze the physiotherapists' views on the patient experience and the patients' own reported experiences.
- To compare the patient experience of this specialized physiotherapy between the UK and Canada.
To achieve these goals, the researchers will conduct a qualitative study. This type of research focuses on understanding people's experiences and perspectives rather than just numbers. The study will use a "multiple case-study" approach, which means it will look in-depth at specific examples, or "cases." In this research, the cases are the low back pain care pathways in Ontario, Canada, and in England, United Kingdom.
Within each case, the study has a "nested" design, meaning it will examine smaller components—the individual advanced practice physiotherapists and patients. Participants will be recruited using a "non-probability" method, where they are selected based on their availability and willingness to join the study. The research is based on a "constructivist" philosophy, which means it assumes that people's understanding of their experiences is shaped by their unique contexts and interactions.
Data will be collected and analyzed in several ways. The structure of the low back pain care pathways will be examined using a method called "framework analysis." Information gathered from questionnaires with numerical answers will be summarized with descriptive statistics. The data from interviews and open-ended questionnaire questions will be analyzed using "thematic analysis" to identify common patterns and themes. The researchers will analyze the findings within each country first and then conduct a "cross-case" analysis to compare the results between Canada and the UK.
The findings from this study could have several applications. They may help improve patient-centered care, which is care that is respectful of and responsive to individual patient preferences, needs, and values. The results could also help shape educational programs and curricula for advanced practice physiotherapists. Furthermore, this work addresses a current gap in scientific knowledge and may lead to new theories about the patient experience that can inform future research.
