Physiotherapists’ beliefs on dosage and management of activity and training in patients with low back pain: a qualitative survey

Physical activity and training are recommended for the management of low back pain. In this context, physiotherapists need to regulate and control physical loads according to scientific principles, clinical guidelines, and individual prerequisites and aims (e.g., reducing the risk for symptom exacerbation, building strength, and/or reducing fear of movement). However, in relation to this, little is known concerning physiotherapists’ conceptualizations and implementation in actual health service settings. The aim of this study was to explore physiotherapists’ beliefs and actions regarding load control of aerobic activities and resistance training in clinical practice. In this study (ethics approval: Bochum University of Applied Sciences; DRKS00027850), we conducted semi-structured interviews with a purposive sample of seven physiotherapists. The analysis followed a structuring qualitative content analysis approach (Kuckartz, 2018). The categories and subcategories were built using primarily deductive methods. Three main categories related to load control, load prescription, and pacing were built: (1) practical implementation of load control, (2) broader scope of the term load control, and (3) appraisal of patients’ movement and control competences. The physiotherapists’ statements and examples indicate that their conceptualization of load control does not fully meet the individualized multi-step ongoing circular process that is inherent to common scientific conceptualizations. Although most physiotherapists carefully support and guide their patients during exercises, their statements indicate that load control could be managed better in the health service and should be more individualized and structured. To improve physiotherapists’ competences in teaching load control and pacing, specific training programs may need to be developed.