TY - JOUR A1 - Adje, Mishael A1 - Steinhäuser, Jost A1 - Stevenson, Kay A1 - Mbada, Chidozie A1 - Alonge, Victor A1 - Karstens, Sven T1 - Developing tailored intervention strategies for implementation of stratified care to low back pain with physiotherapists in Nigeria: A Delphi study T2 - BMC Health Services Research N2 - Background: Stratified care approach involving use of the STarT-Back tool to optimise care for patients with low back pain is gaining widespread attention in western countries. However, adoption and implementation of this approach in low-and-middle-income countries will be restricted by context-specific factors that need to be addressed. This study aimed to develop with physiotherapists, tailored intervention strategies for the implementation of stratified care for patients with low back pain. Methods: A two-round web-based Delphi survey was conducted among purposively sampled physiotherapists with a minimum of three years of clinical experience, with post-graduation certification or specialists. Thirty statements on barriers and enablers for implementation were extracted from the qualitative phase. Statements were rated by a Delphi panel with additional open-ended feedback. After each Delphi round, participants received feedback which informed their subsequent responses. Additional qualitative feedback were analysed using qualitative content analysis. The criteria for consensus and stability were pre-determined using percentage agreement (≥ 75%), median value (≥ 4), Inter-quartile range (≤ 1), and Wilcoxon matched-pairs test respectively. Results: Participants in the first round were 139 and 125 of them completed the study, yielding a response rate of 90%. Participants were aged 35.2 (SD6.6) years, and 55 (39.6%) were female. Consensus was achieved in 25/30 statements. Wilcoxon’s test showed stability in responses after the 5 statements failed to reach consensus: ‘translate the STarT-Back Tool to pidgin language’ 71% (p = 0.76), ‘begin implementation with government hospitals’ 63% (p = 0.11), ‘share knowledge with traditional bone setters’ 35% (p = 0.67), ‘get second opinion on clinician’s advice’ 63% (p = 0.24) and ‘carry out online consultations’ 65% (p = 0.41). Four statements strengthened by additional qualitative data achieved the highest consensus: ‘patient education’ (96%), ‘quality improvement appraisals’ (96%), ‘undergraduate training on psychosocial care’ (96%) and ‘patient-clinician communication’ (95%). Conclusion: There was concordance of opinion that patients should be educated to correct misplaced expectations and proper time for communication is vital to implementation. This communication should be learned at undergraduate level, and for already qualified clinicians, quality improvement appraisals are key to sustained and effective care. These recommendations provide a framework for future research on monitored implementation of stratified care in middle-income countries. KW - Delphi survey KW - complex prognostic factors KW - implementation strategies KW - stratification KW - STarT-Back approach KW - musculoskeletal care KW - Rückenschmerz KW - Kreuzschmerz KW - Physikalische Therapie KW - Therapie KW - Intervention KW - Kommunikation KW - Nigeria Y1 - 2023 UR - https://hst.opus.hbz-nrw.de/frontdoor/index/index/docId/277 UR - https://nbn-resolving.org/urn:nbn:de:hbz:tr5-2779 VL - 23 SP - 1 EP - 14 PB - BMC ER -