Implicit Biases Influencing Service Provision in Physical Therapy for Low Back Pain

Maude Laliberté¹, Barbara Mazer², Tatiana Orozco³, Gevorg Chilingaryan⁴, Bryn Williams-Jones¹, Matthew Hunt⁴ and Debbie Ehrmann Feldman⁵, ¹Université de Montréal, Montréal, QC, Canada, ²McGill University, School of Physical and Occupational Therapy, Faculty of Medicine, Montreal, QC, Canada, ³Université de Montréal, Montreal, QC, Canada, ⁴McGill University, Montreal, QC, Canada, ⁵School of Rehabilitation, Université de Montréal, Montreal, QC, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Health Care, low back pain and physical therapy

Session Information

Date: Monday, November 14, 2016

Title: Healthcare Disparities in Rheumatology - ARHP Poster

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: The management of physical therapy (PT) services may raise concerns about equity. Previous research suggests that certain individuals have less access to services and receive inferior quality care compared to others due to their age, gender or socio-economic status (SES). Insurance status may also influence the clinical practice of PT professionals. Our study aimed to determine whether patient-related factors (age, gender, SES) and the source of reimbursement for PT services (insurance status) influence waiting time, frequency and duration of PT treatment for low back pain.

Methods: We conducted an empirical cross-sectional online survey of Canadian PT professionals. 846 PT professionals completed a survey containing one of 24 different clinical vignettes (i.e., patient case scenarios with low back pain) chosen at random, and a 40-item questionnaire about how they would treat the fictional patient in the vignette, as well as details on their professional clinical practice. Each vignette described a patient with low back pain but with variations in patient characteristics (age, gender, SES) and insurance status (none, private insurance, workers’ compensation board (WCB)).

Results:

The age, gender and SES of patients did not make any difference in how participants would provide service. However, patients with no insurance coverage would wait longer (p=0.002) for access to PT in private clinics, while patients with WCB insurance would be seen more frequently (p<.0001) than patients with private insurance or no insurance, in both public and private clinics. However, when explicitly asked, study participants stated that insurance status, age or chronicity of the condition were not factors associated with treatment access, frequency or duration.

Conclusion: The study findings demonstrate an implicit professional bias in favour of preferentially treating patients with low back pain who have insurance; the resulting inequity in access highlights the urgent need for national guidelines to ensure equity in access to and provision of PT services.

Disclosure: M. Laliberté, None; B. Mazer, None; T. Orozco, None; G. Chilingaryan, None; B. Williams-Jones, None; M. Hunt, None; D. Ehrmann Feldman, None.

To cite this abstract in AMA style:

Laliberté M, Mazer B, Orozco T, Chilingaryan G, Williams-Jones B, Hunt M, Ehrmann Feldman D. Implicit Biases Influencing Service Provision in Physical Therapy for Low Back Pain [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/implicit-biases-influencing-service-provision-in-physical-therapy-for-low-back-pain/. Accessed .

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