Beliefs of Australian Physical Therapists Related to Lumbopelvic Pain Following a Biopsychosocial Workshop

Abstract

INTRODUCTIONHealth care practitioner (HCP) beliefs are a catalyst of clinical behaviors and outcomes,1 with evidence emerging in the literature. The purpose of this study was to determine if participation in a 1-day workshop focusing on the biopsychosocial nature of pelvic girdle pain (under the broad contemporary understanding of lumbopelvic pain disorders) would influence the beliefs of physical therapists in Australia. Insufficient data investigating the effect of education on lumbopelvic pain beliefs of qualified physical therapists in Australia are available in the literature.REVIEW OF THE LITERATUREThere is growing recognition of the need to consider pain disorders from a biopsychosocial perspective.2'5 Within this model there is growing interest in the role of beliefs of both the patient and the HCP.6For patients, the future course and inevitability of back pain has been identified as an important aspect of back pain beliefs. Research has identified that greater levels of disability in adults with non-specific chronic low back pain (LBP) are associated with negative back pain beliefs.710 These beliefs center on the notions that back pain requires rest and extended absences from work, that painful activity should be avoided, that back trouble is indicative of a weak back, and that back pain will relegate the afflicted to a wheelchair. These negative thoughts do not align to current understanding regarding the course of back pain, and are inconsistent with the presently broad guidelines for back pain management. In adults, negative back pain beliefs have been associated with increased absenteeism from work, reduced work productivity,11'13 and poorer long-term outcomes.13,14 Furthermore, recent research has shown that negative back pain beliefs are related to activity avoidance in subjects with adolescent LBP.15 Taken together, these findings suggest that beliefs in the future course and inevitability of back pain can be a significant factor in LBP-related disability levels.Back pain beliefs are influenced by culture,8 familial environment,16 professional training,8 pain experience,6 depression,17 education level, perceived general health, work absenteeism, and LBP activity limitation.18 Backpain beliefs can be positively influenced with education.19'21 Improvements in back pain beliefs are associated with reduced absenteeism and fewer claims for LBP.21,22 However, to date, this has not been investigated in relation to pelvic girdle pain. Pelvic girdle pain describes musculoskeletal disorders of the anatomical pelvis, which includes the sacroiliac joints, symphysis pubis and associated ligamentous structures.23 Pelvic girdle pain disorders have been recognized as a distinctly separate set of disorders from LBP disorders. Pelvic girdle pain commonly occurs during pregnancy, but is not limited to that circumstance.23It's important to note that the beliefs of HCPs may influence the beliefs of patients,1,24 and influence patient management.1,25 Recommending time off work to cope with LBP, for example, can be the result of HCP avoidance beliefs,26 adherence of a biomedical model of pain, or lower behavioral understanding of I.BP.27'29 Similarly, HCP beliefs may influence advice given to patients regarding general activity.26,28 This highlights the importance of understanding the back pain beliefs of HCPs.While HCP beliefs related to LBP have been a growing focus of research, the same cannot be said for pelvic girdle pain. Though anatomical differences are acknowledged, there are clear similarities between persistent LBP and pelvic girdle pain disorders when viewed from a biopsychosocial perspective.3,4,23,30 Beliefs related to pelvic girdle pain, like those of LBP, may act as a barrier to effective management of these disorders.4,30 liiere is evidence of a mismatch between HCP advice regarding pelvic girdle pain and the beliefs of the subjects.31 The beliefs of the patients regarding the future consequences of pelvic girdle pain are highly predictive of outcome. …