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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