Advancing practice for people with low back pain in the Kingdom of Saudi Arabia through exploring the clinical pathway and patients' characteristics

Abstract

Background: Low back pain (LBP) is a complex health problem affecting people in all countries. There is great heterogeneity between patients with LBP, suggesting the inadequacy of the “one-size-fits-all” approach. In the Kingdom of Saudi Arabia (KSA), the current management of LBP does not consider this heterogeneity and so may not be optimal. Aim: The thesis intends to advance knowledge to inform the subsequent development of new approaches to delivering back pain services by exploring the following issues: (i) LBP prevalence in the Saudi Arabian population; (ii) existing clinical pathways for patients with LBP in the KSA; (iii) psychosocial, disability and fatigue characteristics of patients with LBP; and (iv) healthcare professionals (HCPs) perspectives on advancing practice in the light of the evidence. Methods: A sequential exploratory mixed methods design was adopted, involving (i) systematic literature review, (ii) two cross-sectional studies; survey (participants; n= 600 patients with LBP and 100 HCPs), and assessment questionnaires (participants n= 300 LBP patient), and (iii) focus group study targeted at a HCPs. Results: In young adults, LBP prevalence was 64-89%. KSA’s clinical pathways for LBP revealed no specific first line of contact, no systematic optimization of appropriate expert resource at the right time and in the right place; minimal planning; and low adherence to evidence-based practice. Regarding patient with LBP characteristics, disability, fatigue, and psychological distress were positively correlated with LBP. Finally, HCPs recommend addressing strategic workforce management deficits, adopting a stratified model of care, and developing practical experience in using this model of care. In addition, facilitators and barriers to advancing practice through a stratified model for LBP were identified. Conclusion: A strategic action plan for advancing practice for LBP in the KSA was proposed. The plan focuses on scalable HCP training, reconfiguration of primary care services, emphasis on patient self-management and education, healthcare system simplification through interdepartmental communication, and implementation of a hybrid interdisciplinary and stratified model of care.