Exercise-based biopsychosocial management of chronic low back pain

Abstract

Chronic low back pain carries a large global burden of disease. Currently, exercise is recognised as a key treatment for chronic low back pain. However, management of chronic low back pain presents exercise-based practitioners with numerous, confusing, and conflicting treatment options. Broadly, these options can be classified under biomedical or biopsychosocial treatment paradigms. An overarching problem within chronic low back pain literature is the understanding of if practitioners are applying best practice approaches, and if not, how this can be improved. Based on these evident gaps in our understanding of the management of chronic low back pain, this thesis investigated the following: How do exercise-based practitioners currently manage chronic low back pain, and what attitudes and beliefs underpin this management? What does a pragmatic biopsychosocial exercise-based approach to chronic low back pain look like, and what role does exercise play in this intervention? Can education targeted at current gaps in practice by exercise-based practitioners, combined with pragmatic understanding of biopsychosocial exercise prescription, improve clinical decision making? This thesis examined chronic low back pain at the level of the patient and of the practitioner. This thesis found exercise not to be a significant factor in the design of combined exercise and education interventions for chronic low back pain. This finding allows practitioners to move away from systemised approaches to exercise for chronic low back pain and explore prescriptions optimal for the individual patient, rather than optimal for back pain in general. However, this thesis also found practitioners with biomedical beliefs, even when concomitant with biopsychosocial beliefs, are less likely to apply these contemporary approaches. Indeed, targeted education does improve clinical decision-making through a reduction in biomedical beliefs, which increases the care provided to patients. This improvement in clinical decision-making through a reduction in biomedical beliefs, and no change to biopsychosocial, may suggest the relative importance of biomedical beliefs on approaches to chronic low back pain.

Date of Award	2021
Original language	English