Journal of Interprofessional Care

ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijic20

What are private sector physiotherapists’

perceptions regarding interprofessional and
intraprofessional work for managing low back
pain?

Kadija Perreault, Clermont E. Dionne, Michel Rossignol, Stéphane Poitras &

Diane Morin

To cite this article: Kadija Perreault, Clermont E. Dionne, Michel Rossignol, Stéphane
Poitras & Diane Morin (2018): What are private sector physiotherapists’ perceptions regarding
interprofessional and intraprofessional work for managing low back pain?, Journal of
Interprofessional Care, DOI: 10.1080/13561820.2018.1451829

To link to this article: https://doi.org/10.1080/13561820.2018.1451829

Published online: 28 Mar 2018.

Submit your article to this journal

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=ijic20
JOURNAL OF INTERPROFESSIONAL CARE
https://doi.org/10.1080/13561820.2018.1451829

SHORT REPORT

What are private sector physiotherapists’ perceptions regarding interprofessional

and intraprofessional work for managing low back pain?
Kadija Perreaulta,b, Clermont E. Dionnea,b,c, Michel Rossignold,e, Stéphane Poitrasf, and Diane Moring,b
a
Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de réadaptation en déficience physique de Québec, Québec
City, Québec, Canada; bDepartment of Rehabilitation, Université Laval, Pavillon Ferdinand-Vandry, Québec City, Québec, Canada; cAxe Santé des
populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Hôpital du St-Sacrement, Québec City, Québec, Canada;
d
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Montréal, Canada; eInstitut national d’excellence en
santé et en services sociaux, Montréal, Québec, Canada; fSchool of Rehabilitation Science, Faculty of Health Sciences, University of Ottawa, Ottawa,
Ontario, Canada; gInstitut universitaire de formation et de recherche en soins, Université de Lausanne, Lausanne, Switzerland

ABSTRACT ARTICLE HISTORY

In the last decades, interactions between health professionals have mostly been discussed in the context Received 6 December 2016
of interprofessional teamwork where professionals work closely together and share a team identity. Revised 13 December 2017
Comparatively, little work has been done to explore interactions that occur between professionals in Accepted 9 March 2018
contexts where traditionally formal structures have been less supporting the implementation of inter- KEYWORDS
professional teamwork, such as in the private healthcare sector. The objective of this study was to Interprofessional; low back
identify private sector physiotherapists’ perceptions of interprofessional and intraprofessional work pain; physiotherapist;
regarding interventions for adults with low back pain. This was a cross-sectional survey of 327 private sector; survey
randomly-selected physiotherapists. Data were analysed using descriptive statistics. A majority of
physiotherapists reported positive effects of interprofessional work for their clients, themselves and
their workplaces. Proximity of physiotherapists with other professionals, clinical workloads, and client’s
financial situation were perceived as important factors influencing the implementation of interprofes-
sional work. Low back pain is a highly prevalent and disabling condition. The results of this study
indicate that integrating interprofessional work in the management of low back pain in the private
sector is warranted. Furthermore, the implementation of interprofessional work is viewed by practicing
physiotherapists as dependent upon certain client-, professional- and organizational-level factors.

Introduction low back pain. More specifically, we explored physiotherapists’

perceived degree of satisfaction with interprofessional work,
In recent years, physiotherapists, like other health professionals,
related beliefs, perceived effects, as well as obstacles and facilitators
have been encouraged to increase their interactions with other
to interprofessional work. Interprofessional work was viewed as
health professionals to offer efficient and effective person- and
encompassing different forms of interactions, including interpro-
family-centered services (Canadian Physiotherapy Association,
fessional networking, collaboration, coordination and teamwork
2012). Interprofessional teamwork and collaboration have mostly
(Reeves, Lewin, Espin, & Zwarenstein, 2010), between phy-
been recommended for the management of complex health pro-
siotherapists and other professionals, from the same and other
blems (World Health Organisation, 2010). Low back pain is one
organisations. Because we also explored interactions between
such problem and a major public health issue with enormous
physiotherapists and physiotherapy assistants, we also investi-
consequences for individuals and populations (Blyth, Van Der
gated perceptions regarding intraprofessional work.
Windt, & Croft, 2010). Low back pain is also a condition for which
physiotherapists are frequently consulted for treatment, especially
in the private healthcare sector in Canada, where at least 44% of Methods
physiotherapists worked in 2014 (Canadian Institute for Health
Data for this study were obtained through a validated survey
Information, 2014). In the last decades, interactions between
of physiotherapists working in the second most populated
health professionals have mostly been discussed in the context
Province of Canada, Quebec.
of interprofessional teamwork where professionals work closely
together and share a team identity. Comparatively, little research
has explored interactions in contexts where less formal structures Study sample
traditionally support the implementation of interprofessional
Participants were randomly selected among the 996 phy-
teamwork, such as in the private healthcare sector.
siotherapists member of the Order of physiotherapy of
Our objective was to identify perceptions of private sector
Quebec (OPPQ), who worked in the private sector and
physiotherapists regarding interprofessional work for managing

CONTACT Kadija Perreault kadija.perreault.1@ulaval.ca Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de
réadaptation en déficience physique de Québec, 525 Wilfrid-Hamel, Québec City, Québec G1M 2S8, Canada.
© 2018 Taylor & Francis
2 K. PERREAULT ET AL.
accepted to be contacted for research purposes on their mem-
bership renewal form. Furthermore, the physiotherapists had
to 1) work at least one day/week, 2) have a clientele compris-
ing at least 20% of persons with low back pain, 3) practice in
the same workplace in the previous three months, 4) treat
mainly adults, and 5) be able to complete a questionnaire in
French. Three hundred twenty-seven physiotherapists from
243 different workplaces participated in this study. The
response rate was 67.7%, excluding physiotherapists we did
not attempt to contact (n = 387), we could not reach (n = 67),
were ineligible (n = 106) or refused/did not participate (n
= 109).
Data collection and analysis
The survey was created based on a previous study (Perreault,
Dionne, Rossignol, & Morin, 2014), available questionnaires and
study objectives; its content was validated with a group of
experts. It included 69 questions covering physiotherapists’
socio-demographic and professional characteristics, interprofes-
sional and intraprofessional work, as well as workplace charac-
teristics. To facilitate participation, the survey was administered
online, via telephone or on paper. All physiotherapists com-
pleted the questionnaire online, except three: one over the
phone, one on paper and another started online and finished
on paper. Descriptive statistics were computed to synthesize the
data.1
Ethical considerations
The study received ethical approval from the Ethics Committee
of the Institut de réadaptation en déficience physique de Québec
(# 2010–190).
Results
Demographics
Participants were mainly women (63.3%), had a Bachelor’s
degree as their baseline training (92.0%), and had a mean of
12.3 years (SD = 9.4) experience as a physiotherapist. Adults
with low back pain represented 38.5% (SD = 13.5) of their
clientele on average.2
Physiotherapists’ perceptions
Physiotherapists were mostly satisfied with their interactions
with other professionals (Table 1). Satisfaction was higher for
interactions with family physicians (64.5%) than specialists
(42.5%), for instance. The majority of physiotherapists con-
sidered that interprofessional and intraprofessional work had
positive effects on client outcomes, their work satisfaction,
quality of services offered and making physiotherapy known
by other professionals. For over 40% of physiotherapists,
interprofessional work was thought to have positive impacts
on their workplace by increasing references at the clinic.
The majority of physiotherapists considered they had suf-
ficient training and knowledge to interact with other profes-
sionals. Most of them thought that low back pain required
interactions with other professionals, while 30.3% thought it
required more interactions than other conditions. The major-
ity of physiotherapists reported that their own and other
professionals’ workloads were obstacles to interprofessional
work. A client’s precarious financial situation and health
professional shortage were also viewed as obstacles by many
physiotherapists; while personally knowing the other profes-
sionals, the complexity of the clients’ conditions and physical
proximity were considered facilitators by a majority of
physiotherapists.
Discussion
Health professionals’ perceptions regarding interprofessional
and intraprofessional work are factors that influence their actual
involvement in such work (Reeves et al., 2010; San Martín-
Rodríguez, Beaulieu, D’Amour, & Ferrada-Videla, 2005;
Supper et al., 2015). This study explored private sector phy-
siotherapists’ perceptions regarding interprofessional and intra-
professional work for managing low back pain.
It is generally understood that professionals are mostly
in favor of implementing interprofessional work in health-
care. The results of this study specifically show that phy-
siotherapists in the private sector are mostly satisfied with
their actual experiences of interacting with professionals
from their own and other professions. Interactions with
medical specialists were, for instance, less satisfying than
those with family physicians. This may be because phy-
siotherapists are more used to working in close physical
proximity with family physicians (e.g., physiotherapy clinics
are often adjacent to medical clinics) than with specialists.
It may also be that the former are easier to reach than the
latter which facilitates more frequent interactions. The great
majority of physiotherapists reported that their interactions
had positive effects, mainly for them and for their clients, a
finding in line with the promotion of interprofessional
work in recent decades.
However, these interactions were not necessarily viewed as
more important for low back pain than for other conditions, a
result we also found in our previous qualitative study
(Perreault et al., 2014). This resonates with the finding that
although low back pain is viewed as a complex problem, it
may also be a short-term non-disabling condition not requir-
ing interactions with different professionals, although higher
complexity was viewed as a facilitator for interprofessional
work. This finding may also reflect the view that, according
to a client-centered or patient-centered approach, interactions
need to be adapted to each client’s needs and reality, not
necessarily based on a specific clinical condition.
In another vein, perhaps surprisingly, physiotherapists felt
they had sufficient knowledge and training to take on inter-
professional and intraprofessional work. This may result
from the perceived lack of relevance of receiving specific
training regarding interprofessional/intraprofessional work
or of the lack of knowledge regarding competencies needed
to enact interprofessional and intraprofessional work.
Alternatively, the physiotherapists’ satisfaction regarding
their interactions with other health professionals may explain
why they did not report the need to improve their
Table 1. Physiotherapists’ perceptions regarding their interprofessional and intraprofessional work (n = 327).
n (%)
Variables Totally satisfied Rather satisfied Not satisfied nor dissatisfied Rather dissatisfied Totally dissatisfied Not applicable Missing
Satisfaction regarding interactions with different professionals*
Family physicians 21 (6.4) 190 (58.1) 62 (19.0) 33 (10.1) 4 (1.2) 6 (1.8) 11 (3.4)
Medical specialists 11 (3.4) 128 (39.1) 86 (26.3) 46 (14.1) 9 (2.8) 34 (10.4) 13 (4.0)
Physiotherapists 125 (38.2) 144 (44.0) 15 (4.6) 4 (1.2) 1 (0.3) 25 (7.6) 13 (4.0)
Physiotherapy assistants 79 (24.2) 99 (30.3) 21 (6.4) 2 (0.6) 0 (0.0) 113 (34.6) 13 (4.0)
Other professionals 67 (20.5) 137 (41.9) 44 (13.5) 11 (3.4) 1 (0.3) 52 (15.9) 15 (4.6)
Totally agreed Rather agreed Did not agree or disagree Rather disagreed Totally disagreed Missing
Perceived effects*
Improved the clinical conditions of clients 61 (18.7) 184 (56.3) 62 (19.0) 5 (1.5) 2 (0.6) 13 (4.0)
Improved client satisfaction 92 (28.1) 191 (58.4) 28 (8.6) 2 (0.6) 2 (0.6) 12 (3.7)
Improved physiotherapist’s work satisfaction 55 (16.8) 165 (50.5) 85 (26.0) 7 (2.1) 3 (0.9) 12 (3.7)
Improved the response to clients’ biopsychosocial needs 78 (23.9) 172 (52.6) 48 (14.7) 13 (4.0) 4 (1.2) 12 (3.7)
Increased physiotherapy references to the clinic 22 (6.7) 120 (36.7) 132 (40.4) 21 (6.4) 19 (5.8) 13 (4.0)
Helped make physiotherapy known from other professionals 36 (11.0) 148 (45.3) 95 (29.1) 23 (7.0) 13 (4.0) 12 (3.7)
Negatively impacted the quality of services offered 2 (0.6) 8 (2.4) 10 (3.1) 118 (36.1) 175 (53.5) 14 (4.3)
Totally agreed Rather agreed Did not agree or disagree Rather disagreed Totally disagreed Missing
Beliefs
Had sufficient knowledge on other professionals’ fields of practice 60 (18.3) 187 (57.2) 49 (15.0) 16 (4.9) 3 (0.9) 12 (3.7)
Physiotherapy training had prepared them sufficiently for interactions with other professionals 36 (11.0) 132 (40.4) 72 (22.0) 73 (22.3) 3 (0.9) 11 (3.4)
Other professionals viewed physiotherapists as professionals 107 (32.7) 179 (54.7) 23 (7.0) 7 (2.1) 0 (0.0) 11 (3.4)
Other professionals knew what physiotherapy is 45 (13.8) 157 (48.0) 70 (21.4) 41 (12.5) 2 (0.6) 12 (3.7)
Needed to interact with other professionals to adequately intervene with clientele with LBP† 52 (15.9) 126 (38.5) 91 (27.8) 38 (11.6) 9 (2.8) 11 (3.4)
Needed more interactions with other professionals to intervene with clientele with LBP than for 19 (5.8) 80 (24.5) 100 (30.6) 83 (25.4) 34 (10.4) 11 (3.4)
those consulting for other problems
Major facilitator Minor facilitator Not facilitator nor barrier Minor obstacle Major obstacle Not applicable Missing
Perceptions of obstacles and facilitators
The complexity of the client’s condition 95 (29.1) 76 (23.2) 76 (23.2) 44 (13.5) 18 (5.5) 4 (1.2) 14 (4.3)
Personally knowing the other professionals 203 (62.1) 80 (24.5) 24 (7.3) 0 (0.0) 1 (0.3) 7 (2.1) 12 (3.7)
Personal workload 12 (3.7) 23 (7.0) 83 (25.4) 120 (36.7) 68 (20.8) 7 (2.1) 14 (4.3)
Other professionals’ workload 5 (1.5) 18 (5.5) 81 (24.8) 117 (35.8) 85 (26.0) 8 (2.4) 13 (4.0)
Health professional shortage in region 4 (1.2) 7 (2.1) 107 (32.7) 75 (22.9) 54 (16.5) 67 (20.5) 13 (4.0)
Personal mode of remuneration 5 (1.5) 14 (4.3) 180 (55.0) 53 (16.2) 20 (6.1) 42 (12.8) 13 (4.0)
Client’s precarious financial situation 4 (1.2) 15 (4.6) 119 (36.4) 105 (32.1) 58 (17.7) 14 (4.3) 12 (3.7)
Physical proximity with other professionals 99 (30.3) 78 (23.9) 98 (30.0) 21 (6.4) 8 (2.4) 10 (3.1) 13 (4.0)
*In previous 12 months, regarding their interventions with adults with low back pain
†
LBP = low back pain
JOURNAL OF INTERPROFESSIONAL CARE
3
4 K. PERREAULT ET AL.
competencies in this domain. It is also possible that any
difficulties experienced regarding interprofessional/intrapro-
fessional work may be thought of as resulting from external
factors (e.g. other professionals’ knowledge) rather than from
their own lack of competencies.
Professional workload was one of the obstacles to inter-
professional and intraprofessional work identified by the phy-
siotherapists in our study. Time spent to discuss with a
physician on the phone, for example, may not be accounted
for in a physiotherapist’s workload, nor be associated with a
specific remuneration because many physiotherapists are paid
per client visit. Interactions with other professionals may
hence be left to occur when a client is late or does not show
up. Nonetheless, physiotherapists’ mode of remuneration was
not perceived as directly influencing interprofessional/intra-
professional work. Protecting time for interactions with other
professionals on an individual and organizational level may
still be a way to facilitate interactions. Clients’ precarious
financial situations is another reported obstacle that specifi-
cally relates to the private sector. Based on results of our
previous qualitative study, when physiotherapists know that
clients are financially tight, they may refrain from referring
them to another professional, thus limiting the opportunities
for interactions (Perreault et al., 2014). As for facilitators, as
alluded to previously, being in close physical proximity to
other professionals as well as personally knowing other pro-
fessionals were thought to support interactions. These find-
ings are coherent with the results of previous studies (e.g., San
Martín-Rodríguez et al., 2005; Supper et al., 2015).
Concluding comments
This study specifically addressed private sector physiothera-
pists’ perceptions of interprofessional and intraprofessional
work in the context of managing low back pain. As low
back pain is a complex, highly prevalent and disabling condi-
tion, integrating interprofessional and intraprofessional work
in its management in the private sector is warranted. Our
findings show that while physiotherapists are rather satisfied
with their interactions with other professionals and consider
them to have positive impacts for themselves, their clients and
their workplaces, multiple factors act as barriers to the imple-
mentation of interprofessional/intraprofessional work, some
of which specifically relate to the private sector. Personal and
physical proximity of physiotherapists with other profes-
sionals, clients’ financial situation, and workloads are among
the factors to consider regarding the implementation of inter-
professional and intraprofessional work in the private sector.
Notes
1. Further details on the survey as well as recruitment and data
collection procedures have been described elsewhere (Perreault,
Dionne, Rossignol, Poitras, & Morin, 2016).
2. Further socio-demographic and professional characteristics of
participants have been described elsewhere (Perreault et al., 2016).
Acknowledgments
The authors thank Isabelle Desrosiers for her assistance in recruiting
participants and collecting the data. We are grateful to the study parti-
cipants for their time and interest.
Declaration of interest
The authors report no conflicts of interest. The authors alone are
responsible for the content and writing of the article.
Funding
The study was supported in part by a B.E. Schnurr Memorial Fund
Research Grant administered by the Physiotherapy Foundation of
Canada (2010–2012), as well as from a clinical research partnership in
physiotherapy between the Quebec Rehabilitation Research Network
(REPAR) and the Ordre professionnel de la physiothérapie du Québec
(#10-11DMS-07). The first author received scholarships from the
Canadian Institutes of Health Research, the Institut de recherche
Robert-Sauvé en santé et en sécurité du travail and the Fonds de recherche
du Québec-Santé (FRQS). The second author was an FRQS senior
Research Scholar at the time of this study. None of the above-mentioned
organizations were involved in any part of this study.
References
Blyth, F. M., Van Der Windt, D., & Croft, P. (2010). Chapter 22:
Introduction to chronic pain as a public health problem. In P. Croft,
F. M. Blyth, & D. Van Der Windt (Eds.), Chronic pain epidemiology:
From aetiology to public health (pp. 365). Oxford, UK: Oxford
University Press.
Canadian Institute for Health Information. (2014). Physiotherapists in
Canada, 2014-data tables. Retrieved from: https://secure.cihi.ca/
estore/productSeries.htm?pc=PCC439
Canadian Physiotherapy Association. (2012). Position statement: Inter-
professional collaboration and practice. Retrieved from https://phy
siotherapy.ca/sites/default/files/positionstatements/inter-professional-
collaboration_en.pdf
Perreault, K., Dionne, C. E., Rossignol, M., & Morin, D. (2014).
Interprofessional practices of physiotherapists working with adults
with low back pain in Quebec’s private sector: Results of a qualitative
study. BMC Musculoskeletal Disorders, 15, 160. doi:10.1186/1471-
2474-15-160
Perreault, K., Dionne, C. E., Rossignol, M., Poitras, S., & Morin, D.
(2016). Inter-professional practices of private-sector physiotherapists
for low back pain management: Who, how, and when? Physiotherapy
Canada, 68(4), 323–334. doi:10.3138/ptc.2015-37
Reeves, S., Lewin, S., Espin, S., & Zwarenstein, M. (2010).
Interprofessional teamwork for health and social care. Oxford, UK:
Wiley-Blackwell.
San Martín-Rodríguez, L., Beaulieu, M.-D., D’Amour, D., & Ferrada-
Videla, M. (2005). The determinants of successful collaboration: A
review of theoretical and empirical studies. Journal of Interprofessional
Care, 19(Suppl sup1), 132–147. doi:10.1080/13561820500082677
Supper, I., Catala, O., Lustman, M., Chemla, C., Bourgueil, Y., &
Letrilliart, L. (2015). Interprofessional collaboration in primary
health care: A review of facilitators and barriers perceived by
involved actors. Journal of Public Health, 37(4), 716–727.
doi:10.1093/pubmed/fdu102
World Health Organisation. (2010). Framework for action on interprofes-
sional education & collaborative practice. Retrieved from http://apps.
who.int/iris/bitstream/10665/70185/1/WHO_HRH_HPN_10.3_eng.
pdf?ua=1