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.