Low back pain (LBP) 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 treatment plans designed to provide patients with high-quality care that follows established medical guidelines.
An essential part of these care pathways is a specialized form of treatment called advanced practice physiotherapy (APP). This is a higher level of physiotherapy provided by practitioners who care for individuals with more complex health needs than those seen in standard physiotherapy. A key way to measure the quality of any healthcare service is by evaluating the "patient experience"—that is, everything a patient observes, feels, and goes through while receiving care. Although the patient experience has been studied in some APP settings and for standard physiotherapy for LBP, no research has specifically examined what it is like for patients to receive APP within these structured LBP care pathways.
The primary goal of this research is to explore and understand the experiences of patients who receive advanced practice physiotherapy as part of a low back pain care pathway in the UK and Canada.
To achieve this, the study has several objectives:
- To map out and describe how APP is incorporated into LBP treatment plans in the UK and Canada.
- To gather the perspectives of advanced practice physiotherapists on what they believe the patient experience is like.
- To explore the first-hand experiences of the patients themselves.
- To bring together and analyze the viewpoints of both the physiotherapists and the patients.
- To compare the patient experience of APP in the UK with the patient experience in Canada.
This study will use a research approach known as a qualitative, exploratory, multiple case-study. "Qualitative" and "exploratory" mean the research will focus on understanding people's perspectives and experiences in an area where little is currently known, using non-numerical information like interview responses. "Multiple case-study" means the researchers will conduct an in-depth investigation of a few specific examples, or "cases."
The cases in this study will be LBP care pathways in Ontario, Canada, and England, United Kingdom. The study will have an "embedded" or "nested" design, meaning that within each main case (the care pathway), the researchers will also study smaller groups: the advanced practice physiotherapists and the patients. The study is based on a "constructivist paradigm," a research philosophy that assumes people's understanding of reality is shaped by their personal experiences and social interactions.
Participants—both physiotherapists and patients—will be selected through "non-probability sampling," which means they will not be chosen randomly. The researchers will gather different types of information and analyze it in specific ways. The structure of the LBP care pathways will be examined using "framework analysis," a method for organizing data into a set of categories. Any numerical data from questionnaires will be reported descriptively, for example, by using percentages or averages. Information from interviews and open-ended questionnaire answers will be reviewed using "thematic analysis," a process of identifying recurring patterns or themes in the responses. The researchers will perform both "within-case analysis" (analyzing each country's data separately) and "cross-case analysis" (comparing the findings between the UK and Canada).
This study is significant because its findings could help improve patient-centred care, which is healthcare that is tailored to an individual patient’s needs and preferences. The results may also be used to inform the design of educational programs and curricula for advanced practice physiotherapists. The research will address an existing knowledge gap in the scientific literature on APP. Finally, it may inform future research by developing "theoretical propositions," or initial ideas, about the patient experience of APP within LBP care pathways.