Impact of an Enhanced Transtheoretical Model Intervention (ETMI) Workshop on the Attitudes and Beliefs Regarding Low Back Pain of Primary Care Physicians in the Israeli Navy

Abstract

Low back pain (LBP) is a major cause of discomfort and disability. Physicians' attitudes and beliefs influence the way patients with LBP are diagnosed and treated. The objective of the study is the assessment of military primary care physicians' attitudes towards LBP and the effect of an enhanced transtheoretical model intervention (ETMI) workshop on them. We evaluated the impact of a 90-min ETMI workshop on the attitudes and beliefs of primary care physicians in the Israeli Navy on LBP. Outcomes were assessed using the Attitudes to Back Pain Scale in Musculoskeletal Practitioners questionnaire (ABS-mp). Participants responded before and after the workshop, and responses were compared to a control group of primary care physicians in the Air and Space Force. The intervention group included 22 participants and the control group included 18 participants. Both groups were heterogenic (gender, age, seniority). In both groups, primary care physicians reported the common use of non-steroidal anti-inflammatory drugs (NSAIDs) and over-the-counter (OTC) pain medications and often included physical activity and physiotherapy in the treatment plan. Physicians mentioned reassurance and suggestions of early return to physical activity as part of their appointment. There was a positive correlation between questionnaire items suggesting the physician tended to a biomedical approach and reporting the use of imaging modalities (r = 0.451, p = 0.005). After attending the workshop, physicians were significantly more likely to recommend an early return to physical activity (18 ± 0.48 vs. 16.4 ± 0.52, p = 0.04). An ETMI workshop had a minor impact on the attitudes and beliefs of primary care physicians regarding LBP, but a statistically significant impact was noted on return to physical activity recommendations. These findings may be important in the military setting.