{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:30:21Z","timestamp":1790368221793,"version":"4.1.0"},"reference-count":45,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K24 AG069176\u201006"],"award-info":[{"award-number":["K24 AG069176\u201006"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008460","name":"National Center for Complementary and Integrative Health","doi-asserted-by":"publisher","award":["K23 AT010487\u201004"],"award-info":[{"award-number":["K23 AT010487\u201004"]}],"id":[{"id":"10.13039\/100008460","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008460","name":"National Center for Complementary and Integrative Health","doi-asserted-by":"publisher","award":["K24 AT011561\u201002"],"award-info":[{"award-number":["K24 AT011561\u201002"]}],"id":[{"id":"10.13039\/100008460","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;amp;R"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical practice guidelines encourage primary care providers (PCPs) to recommend nonpharmacologic treatment as first\u2010line therapy for low back pain (LBP). However, the determinants of nonpharmacologic treatment use for LBP in primary care remain unclear, particularly in low\u2010income settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To pilot a framework\u2010informed interview guide and codebook to explore determinants of nonpharmacologic treatment use in primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this qualitative interview study, we enrolled PCPs and community health workers (CHWs) from four primary care clinics at a safety net hospital. A semistructured interview guide informed by the Consolidated Framework for Implementation Research (CFIR) guided inquiry on barriers\/facilitators to nonpharmacologic treatments for LBP (eg, acupuncture, chiropractic care, physical therapy). We included questions on whether current CHW roles may address barriers to nonpharmacologic treatment use. Interviews were audio\u2010recorded, transcribed verbatim, and independently coded by four investigators. An a priori codebook composed of CFIR determinants and known CHW roles guided deductive content analysis to identify major themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight individuals (six PCPs, two CHWs; age range: 32\u201351 years, five female) participated in hour\u2010long interviews. Half had worked at the hospital for \u226515\u2009years and all reported seeing patients with LBP (range: 2\u201320 patients per week). All participants identified the following CFIR factors as barriers\/facilitators: nonpharmacologic treatment characteristics (perceived cost, relative advantage compared to other treatments); outer setting (patient needs\/resources, limited connections with community\u2010based nonpharmacologic treatment) and PCP characteristics (attitudes\/beliefs about nonpharmacologic treatments). Although participants indicated several CHW roles could be adapted to address barriers (eg, care coordination, resource linking, case management), other roles seemed less feasible (eg, targeted health education) in our health care system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Preliminary insight on key determinants of nonpharmacologic treatments for LBP should be further examined in large multisite studies. Future studies may also determine whether a CHW\u2010led strategy can improve nonpharmacologic treatment access and clinical outcomes in primary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.13183","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T06:24:28Z","timestamp":1714631068000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Primary care barriers and facilitators to nonpharmacologic treatments for low back pain: A qualitative pilot study"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3240-6756","authenticated-orcid":false,"given":"Eric J.","family":"Roseen","sequence":"first","affiliation":[{"name":"Section of General Internal Medicine, Department of Medicine Boston University Chobanian &amp; Avedision School of Medicine and Boston Medical Center  Boston Massachusetts USA"},{"name":"Department of Rehabilitation Sciences MGH Institute of Health Professions  Boston Massachusetts USA"},{"name":"New England Geriatric Research Education and Clinical Center Boston Veterans Affairs Healthcare System  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Joyce","sequence":"additional","affiliation":[{"name":"School of Physical Therapy Massachusetts College of Pharmacy and Health Sciences  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Winbush","sequence":"additional","affiliation":[{"name":"Section of General Internal Medicine, Department of Medicine Boston University Chobanian &amp; Avedision School of Medicine and Boston Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Pavco\u2010Luttschwager","sequence":"additional","affiliation":[{"name":"Section of General Internal Medicine, Department of Medicine Boston University Chobanian &amp; Avedision School of Medicine and Boston Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia E.","family":"Morone","sequence":"additional","affiliation":[{"name":"Section of General Internal Medicine, Department of Medicine Boston University Chobanian &amp; Avedision School of Medicine and Boston Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert B.","family":"Saper","sequence":"additional","affiliation":[{"name":"Department of Wellness and Preventive Medicine Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Bartels","sequence":"additional","affiliation":[{"name":"Mongan Institute, Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kushang V.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie J.","family":"Keysor","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences MGH Institute of Health Professions  Boston Massachusetts USA"},{"name":"Department of Physical Therapy MGH Institute of Health Professions  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan F.","family":"Bean","sequence":"additional","affiliation":[{"name":"New England Geriatric Research Education and Clinical Center Boston Veterans Affairs Healthcare System  Boston Massachusetts USA"},{"name":"Department of Physical Medicine and Rehabilitation Harvard Medical School  Boston Massachusetts USA"},{"name":"Spaulding Rehabilitation Hospital  Boston Massachusetts 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