Working hypothesis of expert physiotherapist's when managing low back pain patients

PURPOSE: According to the literature, expert physiotherapists possess a superior organization of knowledge, organized around working hypothesis, that includes specific patterns, which can be explicitly and intuitively recognized and more general abstract sets of semantic relations, which reflect meaningful links between aspects of the problem (Mayer 1992; Jones and Higgs 1995; Higgs and Jones 1995). This organization of knowledge allows for the solution of a typical problem almost automatically through recognition of clinical patterns. In these conditions, knowledge base becomes highly structured in the forms of semantic networks (referred as “schemas”). The purpose of this qualitative study was to describe the knowledge structure of expert physiotherapists when managing low back pain patients. Relevance: Elicitation and description of expert physiotherapists’ working hypothesis, both diagnostic and non- diagnostic will contribute to clarify the types of knowledge used in physiotherapy practice. Subjects: A sample of four expert physiotherapists was selected from a pool of registered physiotherapists of the Portuguese Manual Therapy Group, according to the following criteria: more than 10 years of experience in acute and recurrent low back pain, post- graduate education in areas related with management of low back pain problems and participation as lecturers or clinical supervisors in undergraduate and postgraduate courses related to neuromusculoskeletal dysfunctions. Methods and Material: This investigation uses a qualitative case study design. Data was collected through non- participant observation, semi- structured interview, memos and field notes, during the episode of care. The interviews were audio taped, transcribed and analysed. Data analysis process was organized according to Morse’s Model of qualitative data analysis (1994). After transcription of each interview, information received was coded. The coding process searches for working hypothesis according to Rivett and Higgs (1997) framework. Analysis: Coding categories were developed and revised while data analysis continues. Analysis of the data collected from video- observation and interview were reviewed by the sample that has been involved in the study. Both criterioa used in observation, and coding schema will be analysed by two external persons, who were not involved within the study. Results: The analysis of data showed evidence of working hypothesis generation in some specific themes. The majority of hypothesis formulated on the first session were related with areas or structures that could be responsible for patient’s symptoms and the mechanism by which a patient’s symptoms are being initiated and/ or maintained. In the following sessions the working hypothesis moved progressively to management and reassessment. Conclusions: This study provides some support for the view that understanding patient’s symptoms and its relationship with movement dysfunction seems to be the major concepts that organized expert’s reasoning in the management of low back pain patients