Feasibility study and process evaluation of MRI plus physiotherapy vs. physiotherapy alone in non-specific chronic low back pain among patients in Saudi Arabia

Alhowimel, Ahmed; Alotiabi, Mazyad; Coulson, Neil; Radford, Kathryn

Abstract

© 2020, The Author(s). Aim: To determine the feasibility of conducting a definitive randomised control trial (RCT) to answer the following questions: (1) Is early physiotherapy treatment acceptable and feasible for patients and direct healthcare providers? and (2) Is early physiotherapy intervention associated with better disability and psychosocial outcomes compared with the practice of routine MRIs? Methods: In a feasibility RCT in Riyadh City from 01 March 2018 until 29 July 2018, chronic low back pain (CLBP) patients presenting to spine clinics were randomised to receive an MRI (intervention) plus physiotherapy rehabilitation or physiotherapy alone (control group). The acceptability of randomisation to the control group (non-MRI) was tested during the recruitment by qualitatively interviewing study participants and referring physicians. Moreover, interviews with study participants explored the broader social, political, economic, and environmental (context) aspects that may influence trial delivery and intervention implementation. Results: The recruitment target was not met: 16/24 (66%) participants were recruited in 4 months (12.4% of those screened); 33% declined. The process evaluation identified numerous factors that may affect the success of a definitive RCT in Saudi Arabia. These were research resources, the lack of research infrastructure to support recruitment to trials, limited research capacity in terms of knowledge and skills of the healthcare team, and limited funding. Conclusion: A definitive RCT to test the influence of MRI diagnosis on the psychosocial and disability outcomes in people with CLBP treated with physiotherapy in Saudi Arabia is feasible. However, the lack of research infrastructure, research capacity, the impact of MRI on patient outcomes, and a lack of clinical equipoise in the treatment and management of CLBP in Saudi Arabia pose major barriers to clinical trials.

Citation

Alhowimel, A., Alotiabi, M., Coulson, N., & Radford, K. (2020). Feasibility study and process evaluation of MRI plus physiotherapy vs. physiotherapy alone in non-specific chronic low back pain among patients in Saudi Arabia. Pilot and Feasibility Studies, 6(1), Article 188. https://doi.org/10.1186/s40814-020-00731-w

• Journal Article Type: Article
• Acceptance Date: Nov 18, 2020
• Online Publication Date: Nov 30, 2020
• Publication Date: Dec 1, 2020
• Deposit Date: Jan 7, 2021
• Publicly Available Date: Jan 12, 2021
• Journal: Pilot and Feasibility Studies
• Electronic ISSN: 2055-5784
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 6
• Issue: 1
• Article Number: 188
• DOI: https://doi.org/10.1186/s40814-020-00731-w
• Keywords: Medicine (miscellaneous)
• Public URL: https://nottingham-repository.worktribe.com/output/5101006
• Publisher URL: https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-020-00731-w
• Additional Information: Received: 10 August 2020; Accepted: 18 November 2020; First Online: 30 November 2020; : Ethical approval was obtained from the Research Ethics Committee of the Faculty of Medicine and Health Science at the University of Nottingham (Ethics Reference Number: OVS 18082016) and from King Fahad Medical City in Riyadh, Saudi Arabia (IRB: H-01-R-R-012). Additionally, all participants have signed participation consent before recruitment.; : Not applicable; : The authors declare that they have no competing interests.