1. Introduction
Low back pain (LBP) is the top global cause of disability1 and the incidence rate varies from 0.024-7.0%2. The prevalence of LBP is higher among the
population groups with low socioeconomic status 3,4.
Data indicated that middle and low-income countries in Asia, Africa, and
the Middle East are becoming the epicenter of LBP related disabilities
due to an increased number of aged populations and poor health systems
in these regions 5. Previous studies found that the
poor referral system, less availability of essential services in the
rural areas, lack of proper guidelines for LBP intervention made the
situation worst especially in the Indian subcontinent6,7. There is a tremendous opportunity to reduce the
gap between existing and efficient intervention system for patients in
low-income countries by identifying the improvement opportunities.
There are a plethora of surgical,
pharmacological, and non-pharmacological treatment options for LBP
whereas, very few of them are effective to reduce LBP burden8,9. Physiotherapy is an effective treatment option
for LBP, but all the interventions are used in this method are not
equally beneficial 10,11. Frequently used modalities
for LBP in low and middle-income countries such as short wave diathermy,
ultrasound, interferential therapy, transcutaneous electric stimulation,
traction, and back support 6,12,13 are found
ineffective and not recommended 14–17. Guidelines
recommended mainly cognitive behavioral therapy, progressive relaxation,
and mindfulness-based stress reduction and combined packages of physical
and psychological intervention for LBP 14–16.
However, a systematic review and meta-analysis in 2019 concluded that
the rate of interventions provided by the physiotherapist for LBP that
were 35% recommended, 44% not recommended, and 72% had no
recommendations 18. Nonetheless, studies included in
this review mostly were from high-income countries. Thus very few are
known about the current practice pattern of the physiotherapist for LBP
in low-income countries such as Bangladesh.
Bangladesh is the 8th most populous and
12th densely populated country in the world with 160
million people 19. Unsurprisingly, there is a
substantial difference between the numbers of physiotherapists for per
million people in high-income and middle or low-income countries. In
contrast with 209 thousand and 52 thousand registered physiotherapist in
the US and UK for 329 million and 65 million people respectively20,21, there are currently only 1.7 thousand
registered physiotherapists for 160 million people in Bangladesh22. On the other hand, previous studies found a high
prevalence of LBP among different groups of the population in Bangladesh23–26. To ensure quality management by utilizing
limited resources for a large number of LBP patients in Bangladesh,
exploring the practice pattern of the treatment provider is warranted.
Furthermore, to make a promising guideline of a country to improve
health-care outcomes and potentially reduce costs by effectively
implementing known best practice recommendations, we must need to know
the practice pattern of physiotherapists’ dealing with LBP patients in
that particular country. The study aims to explore the LBP practice
pattern of Bangladeshi Physiotherapists considering their demographic
and professional factors.