• Semi-Structured Interview [ Time Frame: 4 weeks ]
  Semi-structured interviews with the participating physiotherapists will explore the experience using the PNT.
• Change in the Health Care Providers Pain and Impairment Relationship Scale [ Time Frame: 0 weeks, 4 weeks and at 1 month follow-up ]
  The HC-PAIRS is selected to assess the pain-related attitudes and beliefs of physiotherapists. It is a validated tool with adequate psychometric properties and has already been used in the selected population. It measures attitudes and beliefs on a scale of 13 to 91 with higher scores on this scale indicating stronger beliefs that LBP validates disability.
• The Pain Self-Efficacy Questionnaire [ Time Frame: 4 weeks ]
  The PSEQ is selected to capture the patients' levels of confidence in carrying out day-to-day tasks despite the presence of pain. It assesses the confidence of people with any type of chronic pain in activity despite pain. It covers enjoying activities, household daily activities, social life, coping in general, work, leisure activities, coping with pain without medication, accomplishing goals, living a normal lifestyle, and becoming more active, all 'despite pain'. Each is rated on a 7 point scale from 0 = not at all confident to 6 = completely confident. The total score, ranging from 0 to 60, is calculated by adding the scores for each item. Higher scores reflect stronger self-efficacy beliefs.

• Semi-Structured Interview [ Time Frame: 4 weeks ]
  Semi-structured interviews with the participating physiotherapists will explore the experience using the PNT.
• Change in the Health Care Providers Pain and Impairment Relationship Scale [ Time Frame: 0 weeks, 4 weeks and at 1 month follow-up ]
  The HC-PAIRS is selected to assess the pain-related attitudes and beliefs of physiotherapists. It is a validated tool with adequate psychometric properties and has already been used in the selected population
• The Pain Self-Efficacy Questionnaire [ Time Frame: 4 weeks ]
  The PSEQ is selected to capture the patients' levels of confidence in carrying out day-to-day tasks despite the presence of pain.

Chronic pain is the largest cause of disability globally and affects up to 28 million people in the UK alone. Nearly half of those who experienced chronic pain in Europe reported receiving insufficient pain management. Conventional treatments commonly used in physiotherapy continue to show only moderate effects in pain management. A potential avenue to improve the global effect of treatments may lie in exploring non-specific treatment moderators such as the therapeutic alliance (TA). Findings suggest that it is linked with engagement in rehabilitation and is a strong predictor of treatment outcomes and adherence. This study aims to evaluate and compare the quality of practice with or without the Pain Navigator Tool (PNT). Understanding the impact of the PNT on therapeutic alliance would open an avenue to improve chronic pain management, reduce healthcare-related expenses and increase the quality of life in the population studied. In addition, exploring the experience of the physiotherapists with using the PNT will provide an in-depth understanding of its use and applicability in similar settings.

The aims of this study are to:

1. To evaluate and compare the quality of practice with or without the PNT in patients with chronic low-back.
2. To collect preliminary data on the usability and practicality of the PNT for physiotherapists.

Physiotherapists working in an MSK outpatient clinic and are able to read and speak English to a level allowing satisfactory completion of the study procedures.

Patients with chronic low back pain attending an MSK outpatient clinic.

• Chronic Low-back Pain
• Self Efficacy
• Therapeutic Alliance
• Communication

Inclusion Criteria:

Patient:

• Participant aged >18 years
• Low-back pain for more than three months
• Able to read and speak English to a level allowing satisfactory completion of the study procedures
• Initial appointment with a participating physiotherapist

Physiotherapist:

• 2 years of experience in treating patients with chronic pain
• Currently working in an MSK outpatient clinic
• Able to read and speak English to a level allowing satisfactory completion of the study procedures

Exclusion Criteria:

Patient:

• Low-back pain is not the primary reason for physiotherapy appointment
• Return appointment with physiotherapist