Do Physical Therapists in the United Kingdom Recognize Psychosocial Factors in Patients With Acute Low Back Pain?

Abstract

A cross-sectional, descriptive vignette survey of practicing, musculoskeletal physical therapists. The aim of this study was to determine if musculoskeletal physical therapists, in the United Kingdom, recognize when patients with low back pain (LBP) are at risk of chronicity due to psychosocial factors. A secondary aim was to explore the advice they give to patients about work and activities. Psychosocial factors have been shown to be important in the progression from acute LBP to chronic disability. Early identification of individuals at risk of developing chronic disability is important to enable targeted intervention. Three vignettes were written based on acute LBP patients attending for physical therapy and incorporated into a self-completed postal questionnaire sent to a simple random sample of musculoskeletal physical therapists in the United Kingdom (n = 900). After one reminder, 20% of nonresponders were sent a further questionnaire (n = 80). Data were analyzed using the Statistical Package for the Social Sciences (SPSS version 11). The response rate was 57.7% (n = 518) with 453 meeting all inclusion criteria. The sample consisted of physical therapists working in the musculoskeletal field across all practice settings. Most correctly rated the chronicity risk of the low- and high-risk patient vignettes. Advice to restrict work and activity was common. Most physical therapists recognize when patients are at high risk of developing chronicity, yet many recommend the patient limit their activity levels and not work. Advice to "not work" is associated with more severe perceived spinal pathology, suggesting persistence of the biomedical model for LBP.