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Physiotherapists' pain attitudes and beliefs towards chronic low back pain and their association with treatment selection: a cross-sectional study.

ABSTRACT: OBJECTIVES:The main aim of this study was to investigate physiotherapists' pain attitudes and beliefs towardss non-specific chronic low back pain (NSCLBP) and identify whether they are associated with treatment selection. DESIGN:Cross-sectional study. SETTING:Saudi Arabia (SA). PARTICIPANTS:An online survey was distributed to physiotherapists from April 2018 to January 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Biomedical and biopsychosocial treatment orientations were assessed using the Pain Attitudes and Beliefs Scale for Physiotherapists. (2) Frequent potential treatments used by physiotherapists for individuals with NSCLBP were identified through a 20-item survey. (3) The association between physiotherapists' pain attitudes and beliefs and treatment selection was investigated. Descriptive analysis, Pearson's correlation and multinomial logistic regression were used to analyse the data using SPSS (V.26). RESULTS:A total of 304 responses were included in the analysis. The biomedical (34.45±7.84) and biopsychosocial (31.74±5.67) treatment orientations were relatively low. The most frequent treatments used by physiotherapists were home exercises (87.1%), patient education (82.0%), specific back exercises (80.6%), electrotherapy (61.9%), soft tissue release (58.8%) and spinal mobilisation or manipulation (57.8%). Physiotherapists with a stronger biomedical treatment orientation were more likely to use treatments (p<0.05) such as specific back exercises, electrotherapy, soft tissue release, hydrotherapy, massage, lumbar supports and acupuncture. However, physiotherapists with a stronger biopsychosocial treatment orientation were more likely to use cognitive functional therapy (p<0.01). CONCLUSIONS:Biomedical and biopsychosocial treatment orientations were relatively low among physiotherapists in SA. Although treatments such as home exercises and patient education were frequently used, some passive and traditional treatments not recommended by clinical practice guidelines continue to be commonly used by physiotherapists in SA. This study has confirmed that physiotherapists' pain attitudes and beliefs are significantly associated with treatment selection when managing individuals with NSCLBP. TRIAL REGISTRATION NUMBER:Researchregistry3944.

SUBMITTER: Alshehri MA

PROVIDER: S-EPMC7311013 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Physiotherapists' pain attitudes and beliefs towards chronic low back pain and their association with treatment selection: a cross-sectional study.

Alshehri Mansour Abdullah MA Alzahrani Hosam H Alotaibi Mazyad M Alhowimel Ahmed A Khoja Omar O

BMJ open 20200622 6

<h4>Objectives</h4>The main aim of this study was to investigate physiotherapists' pain attitudes and beliefs towardss non-specific chronic low back pain (NSCLBP) and identify whether they are associated with treatment selection.<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>Saudi Arabia (SA).<h4>Participants</h4>An online survey was distributed to physiotherapists from April 2018 to January 2019. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Biomedical and biopsychosocial treatment orientat ...[more]

PMID: 32571864

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Project description:ObjectivesTo explore the prevalence of attitudes and beliefs about back pain in New Zealand and compare certain beliefs based on back pain history or health professional exposure.DesignPopulation-based cross-sectional survey.SettingPostal survey.ParticipantsNew Zealand residents and citizens aged 18 years and above. 1000 participants were randomly selected from the New Zealand Electoral Roll. Participants listed on the Electoral Roll with an overseas postal address were excluded. 602 valid responses were received.MeasuresAttitudes and beliefs about back pain were measured with the Back Pain Attitudes Questionnaire (Back-PAQ). The interaction between attitudes and beliefs and (1) back pain experience and (2) health professional exposure was investigated.ResultsThe lifetime prevalence of back pain was reported as 87% (95% CI 84% to 90%), and the point prevalence as 27% (95% CI 24% to 31%). Negative views about the back and back pain were prevalent, in particular the need to protect the back to prevent injury. People with current back pain had more negative overall scores, particularly related to back pain prognosis. There was uncertainty about links between pain and injury and appropriate physical activity levels during an episode of back pain. Respondents had more positive views about activity if they had consulted a health professional about back pain. The beliefs of New Zealanders appeared to be broadly similar to those of other Western populations.ConclusionsA large proportion of respondents believed that they needed to protect their back to prevent injury; we theorise that this belief may result in reduced confidence to use the back and contribute to fear avoidance. Uncertainty regarding what is a safe level of activity during an episode of back pain may limit participation. People experiencing back pain may benefit from more targeted information about the positive prognosis. The provision of clear guidance about levels of activity may enable confident participation in an active recovery.

Project description:BackgroundImplementing clinical guidelines is challenging. To facilitate uptake, we developed a model of care (BetterBack Model of Care) and an implementation strategy to support management of low back pain in primary care. The aim of this study was to evaluate physiotherapists´ confidence, attitudes and beliefs in managing patients with low back pain before and after a multifaceted implementation of the BetterBack Model of Care. A further aim was to evaluate determinants of implementation behaviours among physiotherapists.MethodsThis clinical trial was an experimental before and after study within a hybrid type 2 effectiveness-implementation trial. The primary outcome was Practitioner Self-Confidence Scale (PCS), secondary outcomes were the Pain Attitude and Beliefs Scale for Physiotherapists (PABS-PT) and Determinants of Implementation Behaviour Questionnaire (DIBQ). Data was analysed using repeated measures ANOVA and pairwise comparisons.ResultsOne hundred sixteen physiotherapists answered a questionnaire before, directly after, as well as 3 and 12 months after implementation of the Model of Care. PCS improved over time with a large effect size post implementation (ηp2 = 0.197, p < 0.001). Changes in PABS-PT were only significant after 12 months with higher biopsychosocial orientation, (ηp2 = 0.071, p < 0.01) and lower biomedical orientation, (ηp2 = 0.136, p < 0.001). Directly after the workshop, after 3 and 12 months, physiotherapists had high ratings on all DIBQ domains, (scores > 50) implying that all were potential facilitators of the implementation. However, after 3 months, all domains had significantly decreased except for organisation, social influence and patient expectation domains. However, after 12 months, organisation and social influence domains had significantly decreased while domains such as knowledge, skills and beliefs about capabilities returned to initial levels.ConclusionsPhysiotherapists´ confidence and biopsychosocial orientation increased after implementation and may have the potential to improve management of low back pain in primary care. The implementation behaviour showed mostly facilitating patterns but changed over time, pinpointing a need to repeatedly monitor these changes. This can inform the need for changes of implementation efforts in different phases and support sustainability strategies.Trail registrationClinicalTrials.gov NCT03147300 3 May 2017, prospectivly registered.

Project description:?-thalassemia is an autosomal recessive blood disorder caused by gene mutations that affect all aspects of ?-globin production. In majority of Asian countries including India, the frequency of ?-thalassemia is closely intertwined with social, cultural, and religious issues of the respective country. Several national level screening programs imparted education regarding ?-thalassemia, but follow-up evaluation revealed that education was not effective. It has been hypothesized that the beliefs and attitudes, carrier screening, and education among "high risk communities" will have far-reaching implications towards ?-thalassemia prevention in the country. The present study is aimed to investigate attitudes, intention, and behavior of ?-thalassemia high- and low-risk ethnic groups towards carrier screening and education. A structured questionnaire on knowledge, attitude, and practice regarding ?-thalassemia was administered on 926 individuals belong to Arora, a high-risk ethnic group for ?-thalassemia (347 rural (AR) and 202 urban (AU)) and 377 cosmopolitan commoners (CC) aged above 18 years of both sexes. To understand the relationship between various questions, Pearson's correlation test and factor analysis was performed. The responses were further categorized into the theory of planned behavior (TPB) constructs with the measures of the main constructs reported as a mean. Various dimensions of knowledge, attitude, and practice reveal that the urban groups (AU and CC) are better aware of the disease "?-thalassemia" than the rural group (AR) who witness suffering at close quarters. The AR group is more positive for preventive measures than the urban groups. Significant correlations and factor analysis show "intentions" for premarital and prenatal screening highly loaded as outcome behaviors. The Ajzen's "Theory of planned behavior" support that the "intention" and "perceived behavior control" are better predictors of "outcome behavior" compared to "attitude" and "subjective norm." As this study is cross-sectional and descriptive in nature, the constructs of the theory should be considered as perceptions. However, we believe the patterns observed are indicative of "predicting behavior" that has far-reaching implications on health planners and administrators in designing ?-thalassemia screening and prevention program.

Project description:ObjectivesTo explore the elements and composition of care provided by general practitioners (GPs), physiotherapists (PTs) and chiropractors (DCs) to patients with low back pain (LBP).DesignObservational study.SettingPrimary care setting, Denmark.ParticipantsPrimary care clinicians (GPs, PTs and DCs) in the Region of Southern Denmark were invited to register consecutive adult patient visits with LBP as the primary complaint.Primary outcome measuresClinicians reported care elements provided to patients with LBP. Elements varied due to professional differences (eg, prescriptive rights). Data were descriptively analysed, on group and individual levels, for frequency and combination of care elements, and practice patterns were explored with latent class analysis.ResultsThe clinicians (33 GPs, 67 PTs and 43 DCs with a median experience of 15 years and 59% were females) registered 3500 patient visits. On average, the visits involved patients aged 51 years, and 51% were with females. The frequencies of common care elements across professions were information (42%-56% of visits between professions) and advice (56%-81%), while other common elements for GPs were pain medication (40%) and referrals to PTs (36%), for PTs, use of exercises (81%) and for DCs, use of manual therapy (96%). Substantial variation was observed within professions and distinct practice patterns, with different focuses of attention to information and advice versus exercise and manual therapy, were identified for PTs and DCs.ConclusionsThese data indicate substantial variation in the care elements provided by GPs, PTs and DCs to LBP patients. The compositions of care and practice patterns identified challenge the understanding of usual care as a uniform concept and professions as homogeneous groups. Strategic use of particular care elements in different parts of treatment courses is indicated. Longitudinal data and qualitative enquiry are needed to assess if or how care is tailored to individual patients.

Project description:Background Low back pain (LBP) is a common condition with substantial associated disability and costs, best understood using a biopsychosocial approach. Research demonstrates that beliefs about LBP are important, with biomedical beliefs influencing practitioner’s management and patient recovery. Beliefs about LBP can be inconsistent amongst healthcare and medical students. The aim of this study was to investigate graduate medical student’s beliefs of LBP and what influences them. Method A cross sectional mixed methods study of Phase 1 (first year) and Phase 3 (third and fourth year) current graduate medical students at the University of Warwick (MBChB) was conducted. Participants were recruited via voluntary response sampling. A survey investigated LBP beliefs, utilising the Back Beliefs Questionnaire (BBQ) and Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS). Qualitative data was collected on what influences beliefs about the causes and management of LBP, which was analysed descriptively using thematic analysis. Results Fifty-seven students completed the questionnaire (61% female), with a mean age of 27.2 years. Eighty two percent of participants reported a history of LBP. Median BBQ scores were 31.5 for phase 1 and 31 for phase 3, with median HC-PAIRS scores of 57 and 60 for phase 1 and phase 3 students respectively. Three main themes emerged from the qualitative data: Sources of influence, influence of personal experience and influence of medical education. Participants discussed single or multiple sources influencing their beliefs about the causes and management of LBP. Another main theme was the influence of experiencing LBP personally or through discussions with family, friends and patients. The final main theme described the influence of medical education, including lectures, seminars and clinical placements. Conclusions The HC-PAIRS and BBQ scores suggest graduate medical students in this sample tended to have positive beliefs about the outcome of LBP and functional expectations of chronic LBP patients, consistent with other healthcare students. The findings from qualitative data suggest how medical students form beliefs about the causes and management of LBP is complex. Supplementary Information The online version contains supplementary material available at 10.1186/s12909-022-03692-1.

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Physiotherapists' pain attitudes and beliefs towards chronic low back pain and their association with treatment selection: a cross-sectional study.

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Physiotherapists' pain attitudes and beliefs towards chronic low back pain and their association with treatment selection: a cross-sectional study.

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