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Independent prescribing by advanced physiotherapists for patients with low back pain in primary care: protocol for a feasibility trial with an embedded qualitative component
  1. Timothy David Noblet1,2,
  2. John F Marriott3,
  3. Alison B Rushton1
  1. 1 CPR Spine, School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  2. 2 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
  3. 3 School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Mr Timothy David Noblet; tdn818{at}


Introduction Low back pain (LBP) is the most prevalent musculoskeletal condition in the UK. Guidelines advocate a multimodal approach, including prescription of medications. Advanced physiotherapy practitioners (APPs) are well placed to provide this care in primary care. Physiotherapist independent prescribing remains novel, with the first prescribers qualifying in 2014. This feasibility trial aims to evaluate the feasibility, suitability and acceptability of assessing the effectiveness of independent prescribing by APPs for patients with LBP in primary care, to inform the design of a future definitive stepped-wedged cluster trial.

Method and analysis (1) Trial component. An APP (registered prescriber) will complete the initial participant consultation. If prescription drugs are required within the multimodal physiotherapeutic context, these will be prescribed. Patient-reported outcome measures will be completed prior to initial assessment and at 6 and 12 weeks to assess feasibility of follow-up and data collection procedures. Accelerometers will be fitted for 7 days to assess physical activity, sedentary behaviour and feasibility of use. (2) Embedded qualitative component. A focus group and semistructured interviews will be used to evaluate the views and experiences of the participants and APPs respectively, about the feasibility, suitability and acceptability of the proposed full trial. A Consolidated Standards of Reporting Trials diagram will be used to analyse feasible eligibility, recruitment and follow-up rates. Descriptive analysis of the data will be completed to evaluate procedures. Thematic analysis will be used to analyse and synthesise the qualitative data.

Ethics and dissemination This feasibility trial is approved by the Health Research Authority (HRA). Ethical approval was sought and granted via the Integrated Research Application System (IRAS) ID 250734.

Data will be disseminated via publication in peer reviewed journal and conference presentation. It is anticipated that the results of this study will be used in conjunction with ethical evaluation, economic and risk analyses, as well as consultation with key stakeholders including the British health consumer when contemplating change, enhancement or redesign of the essential full randomised controlled trial.

Trial registration number ISRCTN15516596, Pre-results.

  • non-medical prescribing
  • physiotherapist prescribing
  • low back pain
  • advanced physiotherapy practitioners
  • primary care
  • first contact practitioners

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  • Contributors TDN is a clinical advanced practice physiotherapist and PhD candidate at the University of Birmingham (UK). ABR is a reader in musculoskeletal rehabilitation sciences and lead supervisor. JFM is a professor of clinical pharmacy and co-supervisor. Both supervisors ensured the rigour of methods and analyses. All authors have contributed to the content of this article. TDN wrote the first draft of this article and has worked with all authors to develop subsequent drafts. All authors gave final approval prior to publication. Patients and the general public were involved in the design of this study via PPI evaluation groups.

  • Funding Health Education England funding has allowed for the procurement of accelerometers and the associated IT programmes to ensure that innovative physical measures can be evaluated alongside patient-reported outcome measures. The Private Physiotherapy Educational Fund has allowed for the procurement of x3 tablet computers for use in data collection and 7.5 hours per week of the principal Investigators time for 18 months.

  • Competing interests None declared.

  • Ethics approval This trial is approved by the Health Research Authority (HRA). Ethical approval was sought via the Integrated Research Application System (IRAS) ID 250734.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.