Implementation status and barriers to multimodal management of low back pain among physical therapists: A cross-sectional study

This study aimed to investigate the implementation of multimodal assessments and interventions for low back pain (LBP) among physical therapists and identify the reasons and participants’ background characteristics associated with non-implementation. A cross-sectional online survey was conducted among members of the Ishikawa Physical Therapy Association in Japan with clinical experience in managing patients with LBP. A total of 140 valid responses were analyzed. The questionnaire included multiple-choice items on respondent and patient characteristics, awareness of LBP-related factors (five domains: biomechanical, psychological, social, lifestyle, and metabolic; 18 sub-items), implementation and reasons for non-implementation of assessments and interventions, and types of interventions provided. Comparisons among the five domains showed that awareness and implementation were significantly higher for biomechanical factors than for the other domains, whereas for psychological and metabolic factors, they were significantly lower. The main reasons for non-implementation were a lack of knowledge or skills, limited time, and delegation to other professionals. Discriminant analysis showed that these reasons varied depending on work setting and patient characteristics. These findings suggest that physical therapy for LBP tends to focus on biomechanical factors, whereas psychological, lifestyle, and metabolic perspectives are less frequently integrated into practice. The results also indicate that educational and organizational factors, along with role boundaries and interprofessional considerations, may influence how these domains are addressed in clinical settings.