Background:Almost 80% of people have low back pain at least once in their life. Clinical guidelines emphasize the use of conservative physiotherapy and the importance of staying active. While the psychological factors predicting poor recovery following surgical intervention are understood, the psychosocial factors associated with poor outcomes following physiotherapy have yet to be identified.Methods:Electronic searches of PubMed, Medline, CINAHL, PsycINFO and EBSCO were conducted using terms relating to psychosocial factors, chronic low back pain, disability and physiotherapy. Papers examining the relationship between psychosocial factors and pain and disability outcomes following physiotherapy were included. Two reviewers selected, appraised and extracted studies independently.Results:In total, 10 observational studies were identified that suggested an association between fear of movement, depression, self-efficacy and catastrophizing in modifying pain and disability outcomes following physiotherapy.Discussion:Although limited by methodological shortcomings of included studies, and heterogeneity of physiotherapy interventions and measures of disability and psychosocial outcomes, the findings are consistent with other research in the context of back pain and physiotherapy, which suggest an association between psychosocial factors, including fear of movement, catastrophizing and self-efficacy and pain and disability outcomes in chronic low back pain patients treated by physiotherapist. However, a direct relationship cannot be concluded from this study.Conclusion:Findings suggest an association between psychosocial factors, including fear of movement, catastrophizing and self-efficacy and pain and disability outcomes in chronic low back pain patients treated by physiotherapist, which warrants further study.

The conflict of interest amongst the professionals like client and contractor project managers, site engineers, quantity surveyors and designers/architects play crucial roles for the unethical practices and consequently these practices have adverse impact on the product quality, faith of clients and investors' confidence in the construction industry. Hence, this research is aimed at examining the common forms of unethical practices among professionals in the construction industry as well as uncovering the factors that have encouraged these practices. This study depends on the questionnaire survey amongst professionals of the construction industry. The survey is conducted to recognise the view of key stakeholders from different perspectives of the affected parties on the concept of business ethics in the building and construction industry, which has key contribution on the national economic growth of the developing countries. The survey concludes that untimely legal action including changing project manager'sresponsibility and delays in payment processes are key ethical practices from owner/client aspect, while contractor's unethical practices are under bidding, bid cutting and shopping, bid rigging and over billing. But from the consultant aspect; lack of supervision, poor monitoring and taking bribes under different pretend are found to be the encouraging factors for unethical conducts in the construction industry. It is also found thataccepting the bribes, gifts and conflicts of interest are the most common forms of unethical practices. The findings from the study are expected to help as an important eye opener to policy makers and regulatory agencies in detecting and preventing unethical practices. In conclusion, avoiding the conflict of interest and promoting the ethic codes to professionals will help to restore the investor and people confidence, faith of the clients and improve the quality of buildings and infrastructures. The study recommends that promoting awareness regarding the values of ethical behaviour at different forum and ensuring the effective punishment for unethical activities at different stages of project life cycle might reduce the unethical practices in the construction industry.

ObjectivesThe 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.DesignCross-sectional study.SettingSaudi Arabia (SA).ParticipantsAn 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).ResultsA 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).ConclusionsBiomedical 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 numberResearchregistry3944.

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Aim: To explore awareness of the diagnostic criteria and management of fibromyalgia (FM) among physical therapists practicing in Saudi Arabia. Methods: A cross-sectional survey was distributed electronically among musculoskeletal physical therapists. It was designed based on the research literature relevant to FM and reviewed by two rheumatologists for accuracy and comprehension. The survey included two sections: participants' demographic information and questions related to FM. The data were described using absolute and relative frequencies. Results: A total of 234 physical therapists accepted the invitation to participate in the study, and 52 were excluded for not satisfying the inclusion criteria or not completing the survey. Responses were received from March to May 2020; only 118 (65%) respondents completed the FM section. The average age of the participants was 31.2 (SD=6.9) years, and 36% were females. Eighty percent reported seeing fewer than five patients with FM in the past year; 51% acquired FM-related knowledge through self-learning; half reported having little to no confidence in their FM assessments and management; and less than 20% were familiar with common diagnostic criteria and management guidelines for FM. Conclusion: Participating physical therapists showed little awareness of or confidence in the assessment and management of patients with FM; moreover, their awareness was not supported by their adherence to recent FM guidelines. Despite the common practice of referring patients with FM for physical therapy, there are many misconceptions about FM. This study highlights the need for educational programs to provide up-to-date evidence in undergraduate and postgraduate education.

Objective Previous evidence has recommended conservative interventions as the best treatment in individuals with chronic low back pain (CLBP). However, the influence of psychosocial factors on the treatment outcomes is unclear. Therefore, this systematic review aimed to address the psychosocial factors that influence changes in pain and disability in patients with CLBP after a guideline-based conservative intervention. Methods Four electronic databases were systematically searched from inception until September 2020 for prospective studies examining the relationship between psychosocial factors and the outcomes of pain and disability after conservative intervention. All included studies were selected, extracted, and critically evaluated by two independent reviewers. Results In total, 15 studies were included in this systematic review. The results support the link between the baseline fear of movement, depression, self-efficacy, and catastrophizing with future functional disability outcomes after conservative interventions. However, these factors were less likely to predict changes in pain intensity outcomes after conservative interventions. Self-efficacy seems to mediate between some of the baseline psychosocial factors (eg, fear) and future pain and disability. Conclusion Fear of movement, self-efficacy, catastrophizing and depression were consistently reported to predict disability outcomes irrespective of the type of conservative intervention. This highlights the importance of addressing these factors in conservative management of CLBP.

Worldwide, low back pain is common and linked with many risk factors. There is a lack of studies in the Saudi Arabian community on low back pain prevalence and risk factors. Therefore, the present research will investigate the prevalence of low back pain in the middle-aged and elderly community population and examine the risk factors contributing to low back pain in Saudi Arabia. The present paper is a cross-sectional study of the community living in Riyadh and the surrounding areas in Saudi Arabia. Data were collected between October 2019 and April 2020 via trained research assistants. A total of 276 participants were included in the analysis. The prevalence of low back pain was 27.9% (n = 77) among the participants included in this study. All participants reported low back pain severity with a mean of 4.35 ± 2.19 on the pain rating scale. Older age, arthritis, hypertension, anemia, osteoporosis, and a history of fractures were all associated with having LBP. Low back pain is highly prevalent in the Saudi community adult population living in Riyadh and its surrounding areas. More than a fourth of the sample reported experiencing back pain. The study outlines several modifiable risk factors (BMI, education, employment status, marital status, and smoking status) and unmodifiable risk factors (arthritis, hypertension, anemia, osteoporosis, and a history of fractures) associated with low back pain in the study sample.

Background and objectives: The use of appropriate outcome measures can help guide multidimensional low back pain (LBP) management, elucidate the efficacy/effectiveness of interventions, and inform clinicians when selected targets have been achieved and this can be used for educational or research purposes. Aim: This study aimed to explore and describe the use, attitudes, knowledge, and beliefs regarding patient-reported outcome measures used by healthcare practitioners practising in Saudi Arabia who are frequently involved in the healthcare of individuals with LBP. Materials and Methods: A cross-sectional design was undertaken using a web-based survey. An electronic invitation to participate was sent to primary care physicians and physical therapists practising in Saudi Arabia. The survey included three sections: demographic data, a list of the most commonly used patient-reported outcome measures with LBP patients, and statements regarding attitudes, knowledge, and beliefs about outcome measures. Results: A total of 156 practitioners participated: 45 primary care physicians and 111 physical therapists. The numeric pain rating and visual analogue scales were the outcome measures most frequently reported as being often used by both primary care physicians and physical therapists. The majority of participants reported often using 1–2 patient reported outcome measures (PROMs). While most participants indicated that they were confident at selecting the most appropriate PROM, fewer were familiar with the concept of the minimally important clinical difference. A lack of Arabic versions of PROMs was reported as a barrier to using them to assess pain. Conclusions: This study shows that, although primary care physicians and physical therapists in Saudi Arabia frequently use patient-reported outcome measures in their clinical management of patients with LBP, there is a noticeable gap in the knowledge and use of the multidimensional outcome measures for LBP management among the participants. This highlights a need for professional training on the use of standardised outcome measures related to LBP.