412 © 2007 The Authors. Journal compilation © 2007 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 13 (2007) 412–421 Journal of Evaluation in Clinical Practice ISSN 1356-1294 Blackwell Publishing LtdOxford, UKJEPJournal of Evaluation in Clinical Practice1356 1294© 2006 The Authors; Journal compilation © 2006 Society/Blackwell Publishing Ltd2006133412421Original Article Practice patterns of physio therapistsS. Poitras et al. Practice patterns of physiotherapists in the treatment of work-related back pain Stéphane Poitras PT PhD, 1 Régis Blais PhD, 2 Bonnie Swaine PT PhD 3 and Michel Rossignol MD 4 1 Research Fellow, Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada 2 Full Professor, Groupe de Recherche Interdisciplinaire en Santé, Université de Montréal, Montreal, Quebec, Canada 3 Associate Professor, École de Réadaptation, Université de Montréal, and Researcher, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montreal, Quebec, Canada 4 Associate Professor, Department of Epidemiology and Biostatistics, McGill University, and Researcher, Department of Public Health of Montreal, Montreal, Quebec, Canada Abstract Rationale and objectives Although physiotherapists (PTs) are one of the health profes- sionals most involved in the treatment of back pain, their practice patterns have not been well studied. The study objectives were to identify the practice patterns of PTs treating workers suffering from acute/subacute back pain, with and without radiating pain below the knee, and to assess the relationship between these patterns and characteristics of PTs. Methods PTs working in private clinics in the province of Quebec, Canada were invited to participate. Each PT used a self-administered questionnaire to record, for each treatment session, treatment objectives, interventions used and education given to two workers with back pain, one without radiating pain (n = 189 PTs) and one with radiating pain (n = 136 PTs). Multiple correspondence analysis with hierarchical classification was used to identify practice patterns of PTs. Multinomial logistic regressions were used to assess the relationship between practice patterns and PTs characteristics. Results For workers without radiating pain, 51.9% of PTs focused their treatment on soft tissue mobilizations/massage and heat, 24.3% focused on the McKenzie approach and related interventions, and 23.8% focused on exercises and function. Similar results were found for workers with radiating pain. Most of the PT characteristics were not related to practice patterns. Conclusions The practices of PTs appeared to be separated into three distinct patterns. These practice variations suggest that there may be disagreement or uncertainty among PTs in the management of work-related back pain. The lack of evidence for the majority of interventions used by PTs and the difficulties of integrating evidence into clinical practice may be possible explanations. Introduction Clinical practice variations among health professionals treating similar health problems have been frequently demonstrated in a number of fields [1]. Practice variation studies allow the assess- ment of the level of consensus between health professionals in the management of a particular health problem, and the level of inte- gration of scientific evidence into clinical practice by comparing practice patterns to current evidence [2]. The demonstration of practice variations with the acknowledgement of uncertainty by health professionals has also been shown to be an effective method to guide practices towards evidence-based guidelines [3]. In the field of back pain treatment, practice variations have mostly been studied among physicians through surgery and hospi- talization rates [3–6] and general management [7]. Although physiotherapists (PTs) are one of the health professionals most involved in the treatment of this health problem [8,9], their prac- tice patterns have not been well studied. The interventions used by PTs in the treatment of back pain have been previously described [9–19], but the methodology or analyses used in these studies did not allow for the identification or comparison of practice patterns among PTs. In order to compare practices among PTs, one must assure that patient characteristics are similar. Patients selected through Keywords back pain, occupational health, physiotherapy, practice variations, rehabilitation Correspondence Stéphane Poitras Direction de santé publique de Montréal 1301 Sherbrooke East Montréal Québec H2L 1M3 Canada E-mail: stephane.poitras@mcgill.ca Accepted for publication: 14 November 2005