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

Abstract

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.

A mixed-methods survey of physiotherapists who practice acupuncture and dry needling in Ontario, Canada: practice characteristics, motivations, and professional outcomes

“…Study respondents' almost-universal endorsement of needling as an effective treatment for musculoskeletal disorders contrasts with lower rates of needling endorsement previously reported within the larger PT profession [30,32,35]. This disproportionately high enthusiasm for the practice is likely a reflection of the occupational subset of PTs surveyed, all of whom had elected to complete training in needling themselves.…”

“…A second Swedish study found that 56% of oncology-focused PTs treat patients using acupuncture (42% for cancer-related pain specifically) [31]. Fourteen percent of PTs studied in Saudi Arabia use acupuncture in clinical practice; and, usage was found to be more frequent among PTs with a stronger "biomedical" rather than "biopsychosocial treatment orientation" [32]. In the United Kingdom, 61% of surveyed PTs use acupuncture to treat contracted (frozen) shoulder [33]; and, at least a quarter use the technique to treat osteoarthritis of the hip [34].…”

Comparison of attitudes and beliefs of physical therapists and primary care physicians regarding low back pain management: A cross-sectional study

“…Moreover, various studies from different countries have demonstrated successful implementation of physical therapy at the first point of contact for patients with musculoskeletal conditions [21][22][23]. The biopsychosocial and biomedical orientations toward LBP appeared to be low among physiotherapists according to a recent study [24]. A stronger orientation toward biopsy-chosocial beliefs and attitudes regarding LBP management was associated with a better selection of guidelinebased physiotherapy interventions [24].…”

The attitudes and beliefs of physiotherapists, family physicians and physiatrists concerning chronic low back pain

“…Many researchers suggested that factors such as the educational level of healthcare professionals, clinical experience, and number of patients treated may affect their treatment approach and choices (12)(13)(14)(15). In contrast, Alshehri et al (22), examining the relationship between the educational level of healthcare professionals and their CLBP-related attitudes and beliefs, concluded that educational level did not have an effect on the PABS-PT scores. Innes et al (23) determined that the number of patients treated had no effect on the chiropractors' biomedical or biopsychosocial beliefs and attitudes concerning CLBP.…”