title: Exercise prescription for patients with non-specific chronic low back pain: a qualitative exploration of decision making in physiotherapy practice.
abstract: BACKGROUND
  Providing an effective exercise prescription process for patients with non-specific chronic low back pain (NSCLBP) is a challenging task. Emerging research has indicated that partnership in care and shared decision making are important for people with NSCLBP and calls for further investigation into the approaches used to prescribe exercise.
  
  
  OBJECTIVE
  To explore how shared decision making and patient partnership are addressed by physiotherapists in the process of exercise prescription for patients with NSCLBP.
  
  
  METHODS
  A qualitative study using a philosophical hermeneutic approach.
  
  
  METHODS
  Eight physiotherapists were each observed on three occasions undertaking their usual clinical activities (total n=24 observations). They conducted brief interviews after each observation and a later in depth semi-structured interview. Iterative hermeneutic strategies were used to interpret the texts and identify the characteristics and processes of exercise prescription for patients with NSCLBP.
  
  
  RESULTS
  The findings revealed how physiotherapy practice often resulted in unequal possibilities for patient participation which were in turn linked to the physiotherapists' assumptions about the patients, clinical orientation, cognitive and decision making processes. Three linked themes emerged: (1) I want them to exercise, (2) which exercise? - the tension between evidence and everyday practice and (3) compliance-orientated more than concordance based.
  
  
  CONCLUSIONS
  This research, by focusing on a patient-centred approach, makes an important contribution to the body of evidence relating to the management of NSCLBP. It challenges physiotherapists to critically appraise their approaches to the prescription of exercise therapy in order to improve outcomes for these patients.
authors.affiliation: Orthopaedic Assessment Service, Somerset Partnership NHS Foundation Trust, 48 Parkfield Drive, Taunton, Somerset TA1 5BU, UK. Electronic address: robert.stenner@sompar.nhs.uk.
authors.forename: Rob
authors.initials: R
authors.lastname: Stenner
authors.affiliation: Faculty of Health & Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, UK. Electronic address: swinkelsannette@gmail.com.
authors.forename: Annette
authors.initials: A
authors.lastname: Swinkels
authors.affiliation: Faculty of Health & Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, UK. Electronic address: theresa.mitchell@uwe.ac.uk.
authors.forename: Theresa
authors.initials: T
authors.lastname: Mitchell
authors.affiliation: Faculty of Health & Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, UK. Electronic address: shea.palmer@uwe.ac.uk.
authors.forename: Shea
authors.initials: S
authors.lastname: Palmer
mesh_terms: D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D018802:Patient-Centered Care / Q000379:methods*; D059825:Physical Therapists / Q000523:psychology*
keywords: Back pain; Decision making; Exercise; Patient-centred care