title: Clinical challenges of classification based targeted therapies for non-specific low back pain: What do physiotherapy practitioners and managers think?
abstract: BACKGROUND
  Classification of non-specific low back pain (NSLBP) was recommended to better target care and so maximise treatment potential. This study investigated physiotherapy practitioners' (PPs) and managers' (PMs) views, experiences and perceptions of barriers and enablers for using classification systems (CSs) to better target treatment for NSLBP in the NHS primary care setting.
  
  
  METHODS
  Qualitative focus group and interviews.
  
  
  METHODS
  Data from semi-structured interviews of three PMs and a focus group with five PPs, considered local opinion leaders in physiotherapy, was thematically analysed.
  
  
  RESULTS
  Five themes emerged (i) CS knowledge: PPs and PMs were aware of CSs and agreed with its usefulness. PPs were mostly aware of CSs informing specific treatments whilst PMs were aware of prognosis based CSs. (ii) Using CSs: PPs classify by experience and clinical reasoning skills, shifting between multiple CSs. PMs were confident that evidence-based practice takes place but believed CSs may not be always used. (iii) Advantages/disadvantages of CSs: Effective targeting of treatments to patients was perceived as advantageous; but the amount of training required was perceived as disadvantageous. (iv) Barriers: Patients' expectations, clinicians' perceptions, insufficiently complex CSs, lack of training resources. (v) Enablers: Development of sufficiently complex CSs, placed within the clinical reasoning process, mentoring, positive engagement with stakeholders and patients.
  
  
  CONCLUSIONS
  PPs and PMs were aware of CSs and agreed with its usefulness. The current classification process was perceived to be largely influenced by individual practitioner knowledge and clinical reasoning skills rather than being based on one CS alone. Barriers and enablers were identified for future research.
authors.affiliation: Cardiff University, School of Healthcare Sciences, Ty Dewi Sant, Heath Park, Cardiff, CF14 4XN, UK. Electronic address: sheeranL@cardiff.ac.uk.
authors.forename: Liba
authors.initials: L
authors.lastname: Sheeran
authors.affiliation: Cardiff University, School of Healthcare Sciences, Ty Dewi Sant, Heath Park, Cardiff, CF14 4XN, UK.
authors.forename: Philippa
authors.initials: P
authors.lastname: Coales
authors.affiliation: Cardiff University, School of Healthcare Sciences, Ty Dewi Sant, Heath Park, Cardiff, CF14 4XN, UK.
authors.forename: Valerie
authors.initials: V
authors.lastname: Sparkes
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D017116:Low Back Pain / Q000145:classification* / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D010808:Physical Examination / Q000379:methods; D059825:Physical Therapists / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities / Q000145:classification / Q000706:statistics & numerical data*; D008486:Physician Executives / Q000706:statistics & numerical data; D057285:Precision Medicine / Q000379:methods*; D036301:Qualitative Research; D012720:Severity of Illness Index; D006113:United Kingdom
keywords: Classification; Health practitioner opinions; Non-specific low back pain; Subgroups