title: Perceptions of health professionals towards the management of back pain in the context of work: a qualitative study.
abstract: BACKGROUND
  Musculoskeletal complaints have a significant impact on work in terms of reduced productivity, sickness absence and long term incapacity for work. This study sought to explore GPs' and physiotherapists' perceptions of sickness certification in patients with musculoskeletal problems.
  
  
  METHODS
  Eleven (11) GPs were sampled from an existing general practice survey, and six (6) physiotherapists were selected randomly using 'snowball' sampling techniques, through established contacts in local physiotherapy departments. Semi-structured qualitative interviews were conducted with respondents lasting up to 30 minutes. The interviews were audio recorded and transcribed verbatim, following which they were coded using N-Vivo qualitative software and analysed thematically using the constant comparative methodology, where themes were identified and contrasted between and within both groups of respondents.
  
  
  RESULTS
  Three themes were identified from the analysis: 1) Approaches to evaluating patients' work problems 2) Perceived ability to manage 'work and pain', and 3) Policies and penalties in the work-place. First, physiotherapists routinely asked patients about their job and work difficulties using a structured (protocol-driven) approach, whilst GPs rarely used such structured measures and were less likely to enquire about patients' work situation. Second, return to work assessments revealed a tension between GPs' gatekeeper and patient advocacy roles, often resolved in favour of patients' concerns and needs. Some physiotherapists perceived that GPs' decisions could be influenced by patients' demand for a sick certificate and their close relationship with patients made them vulnerable to manipulation. Third, the workplace was considered to be a specific source of strain for patients acting as a barrier to work resumption, and over which GPs and physiotherapists could exercise only limited control.
  
  
  CONCLUSIONS
  We conclude that healthcare professionals need to take account of patients' work difficulties, their own perceived ability to offer effective guidance, and consider the 'receptivity' of employment contexts to patients' work problems, in order to ensure a smooth transition back to work.
authors.forename: Gwenllian
authors.initials: G
authors.lastname: Wynne-Jones
authors.forename: Danielle
authors.initials: D
authors.lastname: van der Windt
authors.forename: Bie Nio
authors.initials: BN
authors.lastname: Ong
authors.forename: Annette
authors.initials: A
authors.lastname: Bishop
authors.forename: Jemma
authors.initials: J
authors.lastname: Cowen
authors.forename: Majid
authors.initials: M
authors.lastname: Artus
authors.affiliation: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire ST55BG, UK. t.sanders@keele.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Sanders
mesh_terms: D001291:Attitude of Health Personnel; D001416:Back Pain / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004608:Eligibility Determination; D005260:Female; D020793:Gatekeeping; D058005:General Practitioners / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007587:Job Description; D008297:Male; D016272:Occupational Health; D010465:Perception; D059825:Physical Therapists / Q000523:psychology*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D036301:Qualitative Research; D062707:Return to Work; D018582:Sick Leave; D014938:Work Capacity Evaluation; D017132:Workplace