Barriers and facilitators to the delivery of a biopsychosocial education and exercise programme for patients with chronic low back pain in Ghana. A qualitative study

Abstract

Purpose: Low back pain management has evolved with researchers advocating for a biopsychosocial management model. The biopsychosocial management model has been predominantly applied in high-income countries and underexplored in low- and middle-income countries including Ghana. This study aimed to explore the potential barriers and facilitators to patients with chronic low back pain (CLBP) and physiotherapists engagement with a biopsychosocial intervention (exercise and patient education) as part of a feasibility study.

Material and methods: This was a qualitative study embedded within a mixed-methods, sequential, feasibility study, in Ghana, applying semi-structured interviews. Two categories of participants involved in this study were, two trained physiotherapists, and six patients with CLBP, sampled within the feasibility study.

Results: Regarding the barriers and facilitators to the delivery of the BPS intervention, five interlinked themes emerged from the thematic analysis. These were: structure and process of delivery; patients’ expectations; patients’ health beliefs, autonomy, and engagement; external influences and personal and professional characteristics of physiotherapists.

Conclusion: The themes that emerged from this study demonstrated many positive facilitators based on participants’ improved understanding of LBP and the clarity and purpose of the biopsychosocial intervention. The results therefore demonstrate a potential to deliver the biopsychosocial intervention in a Ghanaian context.

IMPLICATIONS FOR REHABILITATION A biopsychosocial approach to managing chronic low back pain offers a promising alternative to patients and physiotherapists in Ghana.

A biopsychosocial approach to managing chronic low back pain has the potential to improve physiotherapists’ thoughts and attitudes, and have a positive influence on their professional development in Ghana.

A biopsychosocial approach to managing chronic low back pain has the potential to reverse patients’ maladaptive beliefs, improve their understanding of their condition, improve outcomes in Ghana.