'Look up from the waiting list and see the bigger picture': a qualitative analysis of clinical specialist physiotherapist perspectives on low back pain care in Ireland

Introduction Healthcare systems are struggling to deliver high-quality low back pain (LBP) care. In 2012 specialist physiotherapist-led musculoskeletal (MSK) triage services were introduced in Irish hospitals to expedite patient care and alleviate pressure on elective orthopaedic/ rheumatology consultant clinics. Specialist physiotherapists have expertise to inform health service improvement and reform, but their perspectives of LBP healthcare delivery have received scant attention. Objectives To explore specialist physiotherapists' perspectives on LBP care in Ireland, the barriers and facilitators to quality LBP care and the development of MSK interface services in primary care settings. Design Cross-sectional observational study using an anonymous electronic survey with thematic framework analysis of response data from open-ended questions. Participants Thirty-four clinical specialist physiotherapists in Irish MSK triage services. Results Thematic analysis resulted in six overarching themes, grouped into two categories. One category pertained to LBP healthcare in Ireland with the following three themes: 1) Inadequate health services for patients with LBP; 2) Need for defined LBP clinical pathways; 3) Need for a multisectoral approach to spine health. Themes in the second category, pertaining to the development of community-based MSK interface services, were: 4) Concern regarding isolation from secondary care services; 5) Unrealistic expectations of MSK triage; 6) Improved communication and collaboration with primary care services. Conclusion Specialist physiotherapists have concerns regarding LBP health services and persistence of a biomedical, secondary care-led approach. They advocate for investment in primary care multi-disciplinary teams, enhanced integration across primary and secondary care, development of a national clinical pathway and a multisectoral approach. Contribution of paper center dot This study captures, for the first time, the perspectives of specialist physiotherapists on LBP healthcare delivery enabling a better understanding of the 'on-the-ground' issues in delivering quality LBP healthcare. center dot Opportunities for LBP healthcare service improvement are identified at micro, meso and macro health system levels. center dot The findings can be used to inform the development and implementation of a new national LBP clinical pathway and community -based MSK triage clinics. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of Chartered Society of Physiotherapy. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).