Quiet dissent: The attitudes, beliefs and behaviours of UK osteopaths who reject low back pain guidance – A qualitative study. (February 2017)

• Record Type: Journal Article
• Authors: Figg-Latham, Joanna; Rajendran, Dévan
• Is Part Of: Musculoskeletal science and practice. Volume 27(2017)
• Page Start: 97
• Page End: 105
• Publication Date: 2017-02
• Subjects: Clinical guidance -- Education -- Low back pain -- Osteopathy; Manipulation (Therapeutics) -- Periodicals; Physical therapy -- Periodicals; Neuromuscular diseases -- Treatment -- Periodicals; Musculoskeletal system -- Diseases -- Periodicals; Manipulation (Therapeutics); Neuromuscular diseases -- Treatment; Physical therapy; Manipulation, Orthopedic; Musculoskeletal Diseases -- therapy; Neuromuscular Diseases -- therapy; Physical Therapy Modalities; Electronic journals; Periodicals; 615.82
• DOI: 10.1016/j.math.2016.10.006
• Languages: English
• ISSNs: 2468-8630

Abstract

Abstract: Introduction: Clinical guidelines are derived from best research evidence and aim to: improve quality of non-specific low back pain (nsLBP) management and identify patients at risk of suffering chronic pain. However, guideline discordant attitudes and beliefs have been identified in healthcare students and practitioners, including osteopaths. Design: A qualitative approach with elements of grounded theory was used to explore underlying attitudes and beliefs of practitioners/students working in a British osteopathic education institution. All participants rejected guideline recommendations for managing nsLBP. A constant comparative method was used to code and analyse emergent themes from transcript data. Subjects: Purposive sampling identified 5 clinic tutors and 7 students; all participated in semi-structured interviews. Interpretation: Our central theme was a 'Precedence of Osteopathy' over medicine and other manual therapies. Three subthemes were: 1) beliefs about self; 2) perceptions of others; 3) attitudes to guidelines and research. Conclusion: Participants possess a strong professional identity fostered by their education. This bestows autonomy, authority and distinctness upon them. The central theme was modelled as a lens through which participants viewed research: the evidence pyramid appears inverted, explaining why participants value expert opinion above all other evidence. Guidelines and research are perceived to threaten professional identity. In contractual situations that oblige practitioners to follow guidelines management, perhaps reflecting a pragmatic response to health-care market forces, clinical practice is modified. Developing further understanding of osteopaths' attitudes and beliefs and behaviour in respect of evidence-based guidance in education is important to enhance the quality of clinical practice in osteopathy. Highlights: Dissenting osteopathic educators and students shun nsLBP guidelines. Professional identity is derived from perceived 'precedence of osteopathy'. Identity confers belief in expert opinion and rejection of research and guidelines. When contractually required clinicians can override beliefs and adhere to guidelines. Osteopathic education must integrate evidence-informed practice.