Collaborative Clinical Reasoning: Perceptions and Practices of General Practitioners, Physical Therapists, and Patients With Low Back Pain in Primary Care

Collaborative Clinical Reasoning: Perceptions and Practices of General Practitioners, Physical Therapists, and Patients With Low Back Pain in Primary Care

Low back pain is a major health problem in primary care and is associated with a substantial clinical, economic, and societal burden. Although evidence-based recommendations are available, its management remains heterogeneous, poorly coordinated, and often characterized by overmedicalization. In this context, interprofessional collaboration has been identified as a means of improving primary care but does not necessarily ensure a shared understanding of clinical situations. Collaborative Clinical Reasoning (CCR), defined as the process of developing a shared mental model among healthcare professionals and patient partners, remains insufficiently explored in primary care.

This exploratory qualitative study aims to explore the representations and definitions of Collaborative Clinical Reasoning among general practitioners, physiotherapists, and patient partners with low back pain in French-speaking Belgium. It also aims to examine how CCR is implemented in primary care practice and to identify perceived barriers and facilitators to its implementation.

Data will be collected through separate focus groups involving general practitioners, physiotherapists, and patient partners with low back pain. Qualitative data will be analyzed using inductive reflexive thematic analysis.

Inclusion Criteria:

A. General Practitioners

1. Be a general practitioner or a physician in postgraduate training in general practice.
2. Practice general medicine in French-speaking Belgium.
3. Practice general medicine in primary care.

B. Physiotherapists

1. Be a physiotherapist.
2. Practice physiotherapy in French-speaking Belgium.
3. Practice physiotherapy in primary care.

C. Patients with low back pain

1. Age ≥18 years.
2. Have low back pain (pain between the lower margin of the ribs and the gluteal fold, with or without pain in one or both legs).
3. Have consulted both a general practitioner and a physiotherapist for this condition in primary care in French-speaking Belgium.

Exclusion Criteria:

A. General Practitioners

1. Be on sick leave during the study (e.g., work incapacity)

B. Physiotherapists

1. Practice exclusively in a nursing home or a nursing home with skilled nursing care.
2. Be on sick leave during the study (e.g., work incapacity).

C. Patients with low back pain

1. Have a known specific lumbar pathology (e.g., fracture, infection, cancer, lumbar radiculopathy, etc).
2. Have a known general condition that may explain the low back pain (e.g., fibromyalgia, osteoporosis, rheumatologic disease, etc).
3. Have undergone back surgery within the past 12 months.
4. Be pregnant or have had a known pregnancy within the past 12 months.
5. Reside in a nursing home or a nursing home with skilled nursing care.