Abstract
Design: Cross-sectional. Objective: Aim 1 was to preliminarily explore the contributions of the following factors to adherence to LBP practice guidelines using regression modeling: 1) the credential qualification of Mechanical Diagnosis and Therapy (MDT); 2) balance of biomedical and behavioral (i.e. biopsychosocial) oriented approach for low back pain (LBP); 3) demographics; 4) academic degree and 5) the attitude towards updating information for evidence-based clinical practice. Aim 2 was to investigate whether therapists credentialed in MDT (Cred.MDT) were more behavioral oriented and less biomedical oriented than general physical therapists. Summary of Background Data: LBP practice guidelines are not adhered to by every physical therapist. MDT is a behavioral modification approach. Thus, it was hypothesized that the Cred.MDT therapist was more behavioral oriented and more adherent to LBP practice guidelines compared with general physical therapists. Methods: One-hundred-twenty Cred.MDT therapists and 2000 general physical therapists in Japan were contacted. For regression modeling, the dependent variable was adherent to guidelines using a questionnaire with a vignette. Independent variables included balance of biomedical and behavioral perspectives for LBP using the Pain Attitudes and Beliefs Scale for Physiotherapist (PABS-PT), demographics, academic degree and the attitude towards updatinginformation for evidence-based clinical practice. The ratio of the two mean scores of the biomedical and behavioral subscales in the PABS-PT was compared between the Cred.MDT therapist group and the general physical therapists group. Results: Data of 46 general physical therapists and 44 Cred.MDT therapists were available. The Cred.MDT therapist group was significantly (P < 0.05) more behavioral oriented and more adherent to LBP practice guidelines compared with the general physical therapist group. The regression indicated significance of the two predictors of adherence to guidelines, Cred.MDT (β = 0.58, P < 0.001) and academic degree (β = 0.19, P = 0.03). Conclusions: Cred.MDT therapists are more guideline-consistent and have a more biopsychosocial treatment orientation than general physical therapists in Japan.
Highlights
Low back pain (LBP) practice guidelines have been developed and disseminated to facilitate evidence-based clinical practice in primary care for LBP
The presence of Cred.Mechanical Diagnosis and Therapy (MDT) was the primary contributor and the highest educational level was the secondary contributor to adherence to LBP practice guidelines
This study revealed that the clinical practice of Cred.MDT therapists was more in line with LBP guidelines and that their practice was more biopsychosocial-orientated, as opposed to the general physical therapist group
Summary
Low back pain (LBP) practice guidelines have been developed and disseminated to facilitate evidence-based clinical practice in primary care for LBP. LBP practice guidelines are not adhered to by every physical therapist [2]. It is important to identify factors which predict adherence to guidelines by therapists in order to consider better educational strategies for physical therapists managing patients with LBP. Hendrick et al [5] found that less biomedical oriented approach was associated with adherence to LBP practice guidelines. We contend that the management of LBP from both biomedical and behavioral perspectives and other potential factors may be associated with adherence to guidelines [5] [6], for example, demographic factors, the highest education level attained, the attitude of therapists towards self-directed learning to facilitate evidence-based clinical practice (e.g. participation in workshops and conferences, and engaging in literature review)
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