Physical Activity for Patients with Chronic Low Back Pain: What are Physical Therapists Prescribing? A Mixed-Methods Study

Background: The benefits of physical activity (PA) in the management of chronic low back pain (CLBP) are supported by systematic reviews and clinical practice guidelines. Physical therapists are in an ideal position to promote and prescribe PA to patients with CLBP. However, physical therapists’ practice of PA prescription to patients with CLBP are not well known. Methods: This study employed a mixed methods design. In 2019, 18 practicing physical therapists from mixed regions in the U.S. were interviewed about their experiences prescribing PA to patients with CLBP. These interviews were transcribed, coded, and analyzed thematically. The electronic health records (EHR) of physical therapists from a single health system were also examined for documentation of PA prescription including frequency, intensity, type, and time (FITT) components. Data were abstracted from the EHR for 18 patients with CLBP (n=56 encounters). Results: Five themes were identified in regards to physical activity prescription for patients with CLBP: 1) consideration of personal factors, 2) non-structured movement, 3) pain as a key player, 4) “Sellin’ it!”, and 5) physical activity prescriptions are conditional. Based on the EHR analysis, 67% (12/18) of the charts had documented PA history at baseline, however, only 5% (3/56) of sessions had documentation of PA prescription, of which none had all four FITT components, while 32% (18/56) of sessions had documented general movement discussions. Conclusion: Despite the universally acknowledged benefits of physical activity, the thematic analysis reveals a number of factors impact physical therapists’ specificity in prescribing PA to the CLBP population. The lack of FITT components and specificity of PA prescription observed in the documentation mirror this phenomenon. An emphasis on providing PA guidance based on therapist-perceived receptiveness of the patient is evident. Therefore, those who might benefit from physical activity prescriptions may not receive them