Attitudes and beliefs on low back pain in physical therapy education: A cross-sectional study

[en] Background: Prescription behavior in low back pain (LBP) differs between physical therapists with a biomedical versus a biopsychosocial belief, despite the presence of clinical guidelines. Objective: To examine (1) the beliefs of physical therapy students and their adherence to clinical LBP guidelines in Belgium and the Netherlands; (2) whether the beliefs and attitudes of physical therapy students change during education; (3) whether beliefs are related to guideline adherence; (4) whether beliefs and attitudes differ with or without a personal history of LBP. Methods: A cross-sectional design included students in the 2nd and 4th year of physical therapy education in 6 Belgian and 2 Dutch institutions. To quantify beliefs, the Pain Attitudes and Beliefs Scale, the Health Care Providers’ Pain and Impairment Relationship Scale, and a clinical case vignette were used. Results: In total, 1624 students participated. (1) Only 47% of physical therapy students provide clinical guidelines’ consistent recommendations for activity and 16% for work. (2) 2nd year students score higher on the biomedical subscales and lower on the psychosocial subscale. 4th year students make more guideline consistent recommendations about work and activity. (3) Students with a more biopsychosocial belief give more guideline adherent recommendations. (4) Personal experience with LBP is not associated with different beliefs or attitudes. Conclusions: A positive shift occurs from a merely biomedical model towards a more biopsychosocial model from the 2nd to the 4th year of physical therapy education. However, guideline adherence concerning activity and work recommendations remains low. © 2020 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia

Disciplines :

Orthopedics, rehabilitation & sports medicine

Author, co-author :

Leysen, Marijke; Department of Physical Therapy and Rehabilitation Sciences (REVAKI), Universiteit Antwerpen, Antwerp, Belgium, Pain in Motion International Research Group, www.paininmotion.be, Department of Physical Therapy, Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium

Nijs, Jo; Pain in Motion International Research Group, www.paininmotion.be, Department of Physical Therapy, Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium

Van Wilgen, Paul; Pain in Motion International Research Group, www.paininmotion.be, Department of Physical Therapy, Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium

Demoulin, Christophe ; Université de Liège - ULiège > Département des sciences de la motricité > Kinésithérapie spécifique et réadaptation motrice

Dankaerts, Wim; Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium

Danneels, Lieven; Department of Rehabilitation Sciences and Physical Therapy, Universiteit Gent, Ghent, Belgium

Voogt, Lennard; Pain in Motion International Research Group, www.paininmotion.be, Department of Physical Therapy, University of Applied Sciences Rotterdam, Rotterdam, Netherlands

Köke, Albère; Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands

Pitance, Laurent; Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium, Stomatology and Maxillofacial Surgery Department, Brussels, Belgium

Roussel, Nathalie; Department of Physical Therapy and Rehabilitation Sciences (REVAKI), Universiteit Antwerpen, Antwerp, Belgium

Language :

English

Title :

Attitudes and beliefs on low back pain in physical therapy education: A cross-sectional study

Publication date :

2020

Journal title :

Brazilian Journal of Physical Therapy

ISSN :

1413-3555

eISSN :

1809-9246

Publisher :

Revista Brasileira de Fisioterapia, Sao Carlos, Brazil

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 10 September 2020

Statistics

Number of views

70 (10 by ULiège)

Number of downloads

15 (13 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

OpenAlex citations

Bibliography

Airaksinen, O., Brox, J., Cedraschi, C., et al. Chapter 4: European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2:Suppl (15) (2006), S192–S300.
Mv, Tulder, Becker, A., Bekkering, T., et al. Chapter 3: European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2:Suppl (15) (2006), S169–S191.
Delitto, A., George, S.Z., Van Dillen, L., et al. Low back pain: Clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the american physical therapy association. J Orthop Sports Phys Ther 42:4 (2012), A1–A57.
Bernstein, I.A., Malik, Q., Carville, S., Ward, S., Low back pain and sciatica: Summary of NICE guidance. BMJ, 356, 2017, i6748.
Caneiro, J.P., Bunzli, S., O'Sullivan, P., Beliefs about the body and pain: The critical role in musculoskeletal pain management. Braz J Phys Ther, 2020.
Leventhal, H., Brissette, I., Leventhal, E., The common-sense model of self-regulation of health and illness. Cameron, L.D., Leventhal, H., (eds.) The self-regulation of health and illness behavior, 2003, Routledge, New York.
Houben, R.M., Ostelo, R.W., Vlaeyen, J.W., Wolters, P.M., Peters, M., Stomp-van den Berg, S.G., Health care providers’ orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity. Eur J Pain 9:2 (2005), 173–183.
Houben, R.M., Gijsen, A., Peterson, J., de Jong, P.J., Vlaeyen, J.W., Do health care providers’ attitudes towards back pain predict their treatment recommendations? Differential predictive validity of implicit and explicit attitude measures. Pain 114:3 (2005), 491–498.
Ostelo, R.W., Stomp-van den Berg, S.G., Vlaeyen, J.W., Wolters, P.M., de Vet, H.C., Health care provider's attitudes and beliefs towards chronic low back pain: The development of a questionnaire. Man Ther 8:4 (2003), 214–222.
Rainville, J., Carlson, N., Polatin, P., Gatchel, R.J., Indahl, A., Exploration of physicians’ recommendations for activities in chronic low back pain. Spine 25:17 (2000), 2210–2220.
Foster, N.E., Bishop, A., Thomas, E., et al. Illness perceptions of low back pain patients in primary care: what are they, do they change and are they associated with outcome?. Pain 136:1–2 (2008), 177–187.
Roussel, N.A., Neels, H., Kuppens, K., et al. History taking by physiotherapists with low back pain patients: Are illness perceptions addressed properly?. Disabil Rehabil 38:13 (2016), 1268–1279.
Ferreira, P.H., Ferreira, M.L., Latimer, J., et al. Attitudes and beliefs of Brazilian and Australian physiotherapy students towards chronic back pain: A cross-cultural comparison. Physiother Res Int 9:1 (2004), 13–23.
Latimer, J., Maher, C., Refshauge, K., The attitudes and beliefs of physiotherapy students to chronic back pain. Clin J Pain 20:1 (2004), 45–50.
Morris, H., Ryan, C., Lauchlan, D., Field, M., Do medical student attitudes towards patients with chronic low back pain improve during training? A cross-sectional study. BMC Med Educ, 12, 2012, 10.
Chibnall, J.T., Tait, R.C., Andresen, E.M., Hadler, N.M., Race differences in diagnosis and surgery for occupational low back injuries. Spine 31:11 (2006), 1272–1275.
Tait, R.C., Chibnall, J.T., Work injury management of refractory low back pain: Relations with ethnicity, legal representation and diagnosis. Pain 91:1–2 (2001), 47–56.
Domenech, J., Sanchez-Zuriaga, D., Segura-Orti, E., Espejo-Tort, B., Lison, J.F., Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: A randomised clinical trial. Pain 152:11 (2011), 2557–2563.
Demmelmaier, I., Denison, E., Lindberg, P., Asenlof, P., Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain: Four quasi-experimental single-subject studies. Physiother Theory Pract 28:5 (2012), 359–372.
von Elm, E., Altman, D.G., Egger, M., et al. The strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet 370:9596 (2007), 1453–1457.
Beaton, D.E., Bombardier, C., Guillemin, F., Ferraz, M.B., Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25:24 (2000), 3186–3191.
Rainville, J., Bagnall, D., Phalen, L., Health care providers’ attitudes and beliefs about functional impairments and chronic back pain. Clin J Pain 11:4 (1995), 287–295.
Houben, R.M., Vlaeyen, J.W., Peters, M., Ostelo, R.W., Wolters, P.M., Stomp-van den Berg, S.G., Health care providers’ attitudes and beliefs towards common low back pain: Factor structure and psychometric properties of the HC-PAIRS. Clin J Pain 20:1 (2004), 37–44.
IBM SPSS Statistics for Windows, version 24 (IBM Corp., Armonk, N.Y., USA), https://www.ibm.com/be-en/products/spss-statistics.
Ryan, C., Murphy, D., Clark, M., Lee, A., The effect of a physiotherapy education compared with a non-healthcare education on the attitudes and beliefs of students towards functioning in individuals with back pain: An observational, cross-sectional study. Physiotherapy 96:2 (2010), 144–150.
van Wilgen, C.P., van Ittersum, M.W., Kaptein, A.A., Do illness perceptions of people with chronic low back pain differ from people without chronic low back pain?. Physiotherapy 99:1 (2012), 27–32.
Hussey, S., Hoddinott, P., Wilson, P., Dowell, J., Barbour, R., Sickness certification system in the United Kingdom: Qualitative study of views of general practitioners in Scotland. BMJ, 328(7431), 2004, 88.
Bishop, A., Foster, N.E., Thomas, E., Hay, E.M., How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists. Pain 135:1–2 (2008), 187–195.
Alshami, A.M., Albahrani, Y.A., A comparison of the attitudes toward chronic low back pain in Saudi, Australian and Brazilian physical therapy students. J Taibah Univ Med Sci 10:2 (2015), 181–187.
Brunner, E., Probst, M., Meichtry, A., Luomajoki, H., Dankaerts, W., Comparison of clinical vignettes and standardized patients as measures of physiotherapists’ activity and work recommendations in patients with non-specific low back pain. Clin Rehabil 30:1 (2016), 85–94.