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Abstract
Background Low back pain (LBP), a major public health problem, is the leading cause of disability worldwide (1). Current management recommendations include medical, psychological and physical treatments, complementary and alternative medicines (2,3). Initiatives to improve the management of LBP have been largely based on outcomes determined by health professionals. The relative success and requirement for health care interventions may differ from the patient's perspective.
Objectives To systematically review the literature about consumer perceived needs of allied health and complementary and alternative therapies (CAM) relating to LBP.
Methods A comprehensive systematic review of MEDLINE, EMBASE, CINAHL and PsycINFO was conducted to identify studies examining consumer perceived needs relating to allied health and CAM services in managing LBP (1990 - May 2015). Data regarding study design and methods were extracted. Emergent themes were identified and aggregated to provide a systematic review of the current literature.
Results 1779 manuscripts were identified, of which 39 were found to be relevant (figure 1). Of these, 25 used qualitative, 14 used quantitative and 1 used mixed methods. The quality of the literature was variable. Few studies directly addressed the review question. Many results were consistent, with the following main themes emerging from at least 2 studies:
1) CAM elicited conflicting views from consumers, with some willing to try CAM, believing it to be beneficial and CAM practitioners perceived to be more empathetic and understanding. Other consumers questioned the legitimacy of CAM and believed it offered only transitory benefits.
2) Chiropractic therapy was perceived to be effective by some consumers, but not others, who had concerns about side effects and were disappointed with the temporary effects.
3) Physiotherapy and exercise therapy were often preferred by patients for LBP. Consumers believed these to help with pain relief, prevent worsening of back pain and to improve mobility and function. Consumers strongly preferred physiotherapy to be individually tailored to their health needs and abilities.
This review identified a paucity of data examining LBP consumers' perceived needs of allied health and CAM in males, geriatric populations and patients from developing countries or non-English speaking backgrounds.
Conclusions Consumers with LBP perceive a role for physiotherapy but have inconsistent beliefs regarding CAM and chiropractic therapy. This review has highlighted significant gaps in the literature relating to consumers' needs of allied health and CAM for LBP. Health care practitioners need to understand consumers' beliefs regarding the multiple modes of therapy used by consumers to manage their LBP, to better align care provision. Incorporating this into care has the potential to improve outcomes for both consumers and the health system.
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Acknowledgement This work was supported by Arthritis and Osteoporosis Victoria. D Urqhuart and A Wluka are recipients of an NHMRC Career Development Fellowship (Clinical level 2).
Disclosure of Interest None declared