Determinants of Care Seeking for Persons with Low Back and Neck Pain Treated By Physicians, Chiropractors or Physical Therapists

Low back and neck pain are frequent reasons for adults to seek healthcare. Three types of practitioners are commonly used in the United States: physicians, chiropractors and physical therapists. In this study, Andersen\u27s Behavioral Model of Health Services Utilization is used to examine care seeking and provider selection. Estimates of back and neck pain prevalence in the United States are presented as well as care seeking rates and care consumption estimates for patients who used the three providers of interest. Multivariate regression analyses are presented that model the variables that most influence care seeking and provider selection.Cases with the conditions of low back pain and neck pain were drawn from the Medical Expenditure Panel Survey Panel 6 participants. Episodes of care and non-care were defined and the provider used during an episode was identified.Determinants of care seeking for low back pain included MSA status, insurance coverage, perceived health status, number of comorbidities and number of episodes. Determinants of care seeking for neck pain included insurance coverage and number of episodes. When condition was included in the analysis, it was a determinant of care seeking. All of these variables are enabling factors or need factors in Andersen\u27s model.In the analysis of provider selection for low back pain, variables that determined the provider from whom care was sought included patient age, gender, race, ethnicity, marital status, MSA status, insurance coverage, perceived health status, if the condition was disabling and number of episodes. In the analysis of provider selection for neck pain, variables that determined the provider from whom care was sought included patient ethnicity, marital status, and if the condition was disabling.Andersen\u27s Behavioral Model adequately predicts care seeking in LBP and NP with enabling and need factors playing a predominant role. In terms of equity of access this finding indicates a problem of access to care for persons who were uninsured. In the case of provider selection, all the constructs from the model were found to have a role in prediction indicating that access may be inequitable in the case of some providers

Responding to stakeholder needs to engage rehabilitation professionals in the delivery of evidence-based health programming for adults with osteoarthritis

Although there are many evidence-based programs that promote healthy lifestyles and symptom modification for people with osteoarthritis, their delivery in rehabilitation clinical settings in the United States is limited. These programs can be a primary component of treatment or a discharge option to facilitate long-term mobility and pain management. The purpose of this perspective article is to describe a delivery model that brings one arthritis-appropriate, evidence-based intervention, the Arthritis Foundation's Walk With Ease program, to older adults seeking physical therapy related to their osteoarthritis. We embedded program delivery into a Doctor of Physical Therapy curriculum using a student health coaching approach and partnering with physical therapy clinics and other community agencies for participant referrals. This model of delivery is cost-effective, sustainable, and provides outcomes that meet goals of the national agenda for osteoarthritis. The model provides benefits for students in health professions education programs, community organizations and rehabilitation clinics, and adults living with osteoarthritis

Leadership Development of Rehabilitation Professionals in a Low-Resource Country: A Transformational Leadership, Project-Based Model

Background and rationale: This paper presents an overview of the activities and outcomes of the Leadership Institute (LI), a short-term leadership development professional development course offered to physiotherapists in a low-resource country. Previous studies have provided examples of the benefits of such programs in medicine and nursing, but this has yet to be documented in the rehabilitation literature. The prototype of leadership development presented may provide guidance for similar trainings in other low-resource countries and offer the rehabilitation community an opportunity to build on the model to construct a research agenda around rehabilitation leadership development. Pedagogy: The course used a constructivist approach to integrate participants’ experiences, background, beliefs, and prior knowledge into the content. Transformational leadership development theory was emphasized with the generation of active learning projects, a key component of the training. Outcomes: Positive changes after the course included an increase in the number of community outreach activities completed by participants and increased involvement with their professional organization. Thirteen leadership projects were proposed and presented. Discussion: The LI provided present and future leaders throughout Rwanda with exposure to transformative leadership concepts and offered them the opportunity to work together on projects that enhanced their profession and met the needs of underserved communities. Constraints and challenges: Challenges included limited funding for physiotherapy positions allocated to hospitals in Rwanda, particularly in the rural areas. Participants experienced difficulties in carrying out leadership projects without additional funding to support them. Lessons learned: While the emphasis on group projects to foster local advocacy and community education is highly recommended, the projects would benefit from a strong long-term mentorship program and further budgeting considerations. Conclusion: The LI can serve as a model to develop leadership skills and spur professional growth in low-resource settings. Leadership development is necessary to address worldwide inequities in health care. The LI model presents a method to cultivate transformational leadership and work toward improvements in health care and delivery of service