Management of CLBP in Saudi Arabia
All three groups of participants voiced concerns around the management of LBP in the Saudi Arabian healthcare system. In particular, the concerns were related to the lack of resources and doctors and a low level of trust in the primary healthcare service. Furthermore, the availability of local evidence-based clinical guidelines and protocols, considered vital to the provision of good quality of service, was identified as lacking by both doctors and physiotherapists.
Availability of clinical guidelines
The majority of physiotherapists and doctors were in agreement regarding the convenience of clinical guidelines for managing LBP.
Phys.4: ‘Although it is good to follow the guidelines to assure a good quality outcome, but I honestly don’t’.
Doctor.3 ‘Unfortunately we don’t have one (clinical guidelines). I think it could ensure the quality of the services’.
Clinical guidelines do not currently exist in Saudi Arabia nor is there an internationally adapted version available.
Doct.5: ‘We do not have clinical guidelines for chronic low back pain, and we are thinking of adapting international clinical guidelines’.
Instead, some of the physiotherapist participants acknowledged that in times of uncertainty, guidelines would sometimes be referred to.
Phys.1: ‘I use it (clinical guidelines) as a reference when I am not sure about something’.
Physiotherapy as first treatment
Interestingly, the interviews also identified the strong emphasis placed by many patients on the importance of early physiotherapy treatment in the care pathway. Many of the patients believed that they would experience improvement through physiotherapy alone without the need for medication and/or MRI scans.
PT.8: ‘We want to have physiotherapy from the beginning. Some patients could improve with physiotherapy alone’.
PT.2: ‘Physiotherapy should be our first contact to decrease the need for medication’.
Early physiotherapy intervention through primary care services was highlighted by both physiotherapists and doctors as critical for the patients.
Doct.4: ‘Physical therapy and primary healthcare providers are very important cornerstones in the treatment of the chronic back pain’.
Moreover, most of the doctor participants claimed that the majority of the cases could be treated by the GP (family doctor) and physiotherapist.
Doct.4: ‘70% of the cases that we see here could be treated by family doctors and physiotherapy’.
Several physiotherapist participants added that early physiotherapy intervention could be beneficial in reducing the need for further investigation.
Phys.1: ‘If physiotherapy was used as a first contact in these cases, we would not need MRI diagnosis for most of the cases’.
The healthcare system in Saudi Arabia
Both physiotherapist and doctor participants raised concerns surrounding the management of CLBP in the Saudi Arabian healthcare system. In particular, doctors voiced concerns surrounding the cases referred to secondary-level services and questioned the validity of their referral.
Doct.4: ‘The way patients get referred, the type of patients to be referred, and the validity of their medical reports are obstacles in improving care to the patients in secondary hospitals’.
These referrals might be the result of the lack of services at primary care levels.
Doct.4: ‘They have an excuse because primary level hospitals usually lack spinal surgeons’