How many exercises are given in the group programme? Please

tick.

It was mentioned that in Pilates there is not a set number of exercises given but

different exercises were added weekly during the 6-week programme. It was therefore suggested to change the question to: How many exercises on average are given in the group programme? Please tick.

Question 25:

An extra question added regarding the type of outcome measures used for the group programmes (Question 25).

The changes to the questionnaire following the pre-test were minimal. Only one question was removed and replaced with an alternative (Question 12). Generally, the feedback was positive. Questions were clear and related to the title and the research questions of the project. It was decided that a further pre-test was not required. The final version was then re-checked by one of the peer group before distribution.

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4.2.4 Questionnaire Content

The questionnaire was divided into two sections. It aimed to explore the processes of group exercise at individual physiotherapy departments and how physiotherapists manage CLBP by the utilisation of these programmes. The first section included clinical details about the responding physiotherapist and asked to provide information regarding their referral of patients to group programmes for the management of CLBP as well as the exercises they prescribe. Section 1 of the questionnaire aimed to

investigate five main questions below.

1) What are the referral rates to group programmes?

2) Is there any difference in referral rates between secondary care, community and independent practices?

3) Is there a relationship between grade or speciality and group programme referral? 4) How many and what types of exercises are given for CLBP patients by

physiotherapists?

5) Are therapists able to refer all patients suitable for group programmes for whom English is not their first language?

The second section of the questionnaire asked those therapists involved in the running or management of group programmes to provide specific details regarding the content of these programmes. Section 2 aimed to investigate four main questions below. 1) What are the most common group programmes in clinical Practice?

2) What is the content of these group programmes?

3) What is the nature of education provided in these programmes? 4) What outcome measures are used?

186 The main hypotheses for Stage 1 were:

Group programmes use single mode exercise regimens.

Exercises given by therapists are different to those in the group programme. Group programmes lack individual attention and a manual therapy component. Education provided is general and not specific to the patient.

This questionnaire was predominated by closed-ended questions with the use of a nominal, ranked or descriptive answer format. However, free response spaces were provided where applicable (Appendix 2, physiotherapy survey).

4.3 Ethics and R&D Approval

Ethical approval was not required for the Stage 1 as this did not involve patients. Permission to administer the questionnaire to the physiotherapy departments was granted by their Research and Development departments (R&D). Some physiotherapy departments were covered by the same R&D site. In total permission had to be

granted from six R&D departments including one for the Independent or Private physiotherapy practices. Copies of the approval letters can be found in Appendix 14. The whole approval process took approximately four months.

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4.4 Questionnaire Distribution

Convenience sampling was used for this self-report questionnaire but the aim was to survey different regions within the greater London area. A NHS Trust may

incorporate several physiotherapy departments. In recent times a number of NHS Trusts have merged forming a much larger organisation. Therefore, such

organisations may have a number of physiotherapy departments in a wide geographical area. For example, the researcher’s own organisation has five

physiotherapy departments which all cater for different populations of patients in the Greater London area. All potential physiotherapy departments were contacted prior to the study to determine whether they wish to participate. Not all departments contacted were willing to take part in the survey. Of a total of 17 departments contacted, two had not responded despite reminders and it was assumed that they did not wish to take part. The questionnaire was sent out to 13 NHS musculoskeletal out-patient

departments within 7 NHS trusts or ICOs in the greater London area who had all agreed to take part. This included eight departments in secondary care and five in the community. Two independent practices also took part in the survey. General MSK out-patient physiotherapists who manage CLBP patients completed the questionnaire. The number of questionnaires sent out varied between departments. Some

departments could only accommodate a small number of questionnaires due to the size of the department. Before distribution departments were contacted to confirm how many questionnaires they could or were willing to accept. This was a strategy for improving questionnaire response rate. This ranged from 1 to 23. In total 154

questionnaires were distributed. Questionnaires sent to each physiotherapy department were given a unique identification code to monitor response rate. The questionnaire package contained a hand signed covering statement, the questionnaire

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with cover sheet explaining the study and postage paid pre-printed return envelopes with each questionnaire. Three weeks after the initial distribution of the

questionnaires an e-mail reminder was sent out to all departments. At 8-weeks post distribution a final reminder by e-mail was sent to low responders. Data collection in