Back Pain Beliefs Research Articles

Determinants of outcomes for patients with chronic low back pain and fear-avoidance beliefs following treatment with specific stabilisation exercises.

Specific stabilisation exercises (SSE) can combat the debilitating effects of chronic non-specific low back pain (CLBP), improve disability, pain and fear-avoidance beliefs (FAB). To elicit the determinants of outcome in patients with CLBP with associated FABs after treatment with SSE. Twenty-nine patients (20 females) with CLBP were classified using FAB questionnaire into high or low Work and Physical Activity (PA) subscales. After 4-week treatment, evaluations were done for pain, disability and lumbar spine active range of motion (AROM). Data was analysed exploratory-descriptively with a significance level set at p< 0.05. Participants were aged 55.24 ± 11.91 years. They scored 19 (65.5%) and 5 (17.2%) respectively on Work and PA subscales. The post-intervention evaluation showed significant differences in all outcomes, but no significant difference between patients with high or low FAB scores for both subscales. PA scores correlated significantly with pain while work scores correlated significantly with disability. Participants' gender predicted disability, pain and AROM with moderate to large effect sizes. SSE can potentially improve disability, pain and range of motion for patients with chronic low back pain regardless of FABQ status. Gender and baseline patient status are potential determinants of outcome of treatment using SSE.

‘Specialist before physiotherapist’: physicians’ and physiotherapists’ beliefs and management of chronic low back pain in Ghana – A qualitative study

Purpose This study provides an understanding of the chronic low back pain (CLBP) beliefs and management practices of physicians/doctors and physiotherapists in Ghana, and the mechanisms underlying their beliefs and practices. Materials/Methods Thirty-three individual semi-structured interviews, involving eighteen physio­therapists and fifteen physicians involved with CLBP management, were carried out. Interviews were audio recorded, transcribed, and analysed using Straussian grounded theory principles and critical realist philosophy. Results Five categories were derived: The predominance of bio-medical/mechanical beliefs, maladaptive beliefs, maladaptive practices, limited involvement of physiotherapists and other healthcare professionals (HCPs) and evidence-based beliefs and practices. The predominant mechanisms underlying the HCPs beliefs and practices were: the healthcare environment (professional roles/identity hinged around paternalistic and biomedical care, fragmented CLBP management, limited physiotherapy/HCPs’ knowledge) and sociocultural environment (sociocultural/patients’ expectations of passive therapy and paternalism). Conclusion The CLBP beliefs and practices of HCPs involved with CLBP in Ghana is modelled around a professional identity that is largely hinged on paternalism and bio-medical/mechanical understandings. Lack of collaboration and sociocultural expectations also play a significant role. There is the need for a reconstitution of Ghanaian HCPs’ CLBP beliefs and management approaches to align with evidenced-based approaches (e.g., imaging should not be universally prescribed, biopsychosocial and patient-centred care).

An exploration of low back pain beliefs held by health care professionals in Northern America.

Prior research demonstrated that people in the United States and Canada (Northern America) hold predominantly biomedical beliefs about Low back pain (LBP); such beliefs were attributed to healthcare professionals (HCP). Further investigation is needed to understand HCP' LBP beliefs, preferred management strategies, and sources of beliefs. Participants were recruited via social media to complete a qualitative cross-sectional online survey. The survey was distributed to assess LBP beliefs in a U.S. and Canadian-based clinician population. Participants answered questions about the cause of LBP, reasons for recurrence or persistence, use of imaging, management strategies, and sources of beliefs. Responses were analysed using an inductive thematic analysis. One hundred and sixty three participants were included, reporting multiple causes for LBP. However, many references were anchored to biological problems. When psychological variables were mentioned, it typically involved patient blaming. Like prior research studies, minimal attention was given to societal and environmental influences. Management strategies often aligned with guideline care except for the recommendation of inappropriate imaging and a reliance on passive interventions. These findings align with prior research studies on general population beliefs, demonstrating a preference for biological causes of LBP. Further updates are needed for clinical education, while future studies should seek to assess the translation of clinician beliefs into clinical practice and health system constraints.

Low back pain prevention behaviors and beliefs among the Polish population in a cross-sectional survey.

Low back pain (LBP) is one of the most common problems of public health and creates a burden globally. The aim was to assess the Polish population's back pain prevention behaviors and beliefs and to examine how these health behaviors and beliefs vary across sociodemographic factors and physical activity. A cross-sectional survey was carried out among 208 randomly selected patients of the public general practitioner clinic. The differences in LBP-related beliefs and attitudes were determined due to participants' status of requiring or non-requiring LBP treatment. More than half of the respondents did not engage in behaviors that protect against back pain. Individuals with higher education levels and those who exercised at least once a week were significantly more likely to adopt behaviors to protect their backs. Less than half of the participants reported having a workplace that was adequately prepared to protect against back pain, and only 35.1% of the participants reported receiving instruction while taking up work on how to avoid back pain while working. According to respondents' opinions, preventive actions are necessary to protect against back pain. Inappropriate exercises and stress can be contributors to back pain, with these opinions reported more often by women and participants with higher education levels. Participants who received treatment for LBP showed a significantly higher expression of behaviors to protect against back pain compared to participants who did not require treatment. However, there were no significant differences in participants' beliefs about back pain prevention between the group requiring LBP treatment and the group not requiring LBP treatment. The study provides valuable insights into the association between LBP treatment, back pain prevention behaviors, and beliefs, suggesting potential avenues for future research and intervention development. By addressing workplace ergonomics and promoting a culture of back health, it may be possible to reduce the burden of LBP in Poland.

Assessment of back pain behaviors, attitudes, and beliefs of chiropractic research conference attendees after a biopsychosocial educational workshop.

The purpose of this study was to assess the behaviors, attitudes, and beliefs of attendees of a chiropractic research conference (which included chiropractic students, clinicians, researchers, and educators) toward chronic low back pain (CLBP) before and after a biopsychosocial (BPS)-based CLBP educational workshop. This single-arm intervention study used the Health Care Providers' Pain and Relationship Scale (HC-PAIRS) and CLBP-related clinic vignettes to assess behaviors, attitudes, and beliefs toward CLBP before and after a single 90-minute educational workshop. The HC-PAIRS is a self-reporting questionnaire that consists of 15 items rated on a 7-point rating scale, with a higher score suggesting a belief that pain is linked to movement and that recommendations should be given to avoid physical activities. The pre-education intervention HC-PAIRS and vignettes were completed by 40 of 56 attendees. A total of 18 participants completed the posteducation intervention HC-PAIRS and CLBP-related clinical vignettes. Most of participants identified as full-time clinicians, employees of the United States Department of Veterans Affairs, and musculoskeletal/neuromusculoskeletal providers. The pre-education intervention HC-PAIRS mean score was 44.8 (SD 9.22), and the postscore was 39.5 (SD 6.49). Findings suggest an immediate change in HC-PAIRS scores following a BPS-focused CLBP education intervention for a chiropractic audience. However, due to limitations related to sample size and target population, findings should be interpreted cautiously.

Comparing multi-disciplinary low back pain care in the ED to the Australian clinical care standard: The possible influence of profession, experience and back pain beliefs

Comparing multi-disciplinary low back pain care in the ED to the Australian clinical care standard: The possible influence of profession, experience and back pain beliefs

A cross-sectional investigation of back pain beliefs and fear in physiotherapy and sport undergraduate students.

Although low back pain (LBP) beliefs have been well investigated in mainstream healthcare discipline students, the beliefs within sports-related study students, such as Sport and Exercise Science (SES), Sports Therapy (ST), and Sport Performance and Coaching (SPC) programmes have yet to be explored. This study aims to understand any differences in the beliefs and fear associated with movement in students enrolled in four undergraduate study programmes-physiotherapy (PT), ST, SES, and SPC. 136 undergraduate students completed an online survey. All participants completed the Tampa Scale of Kinesiophobia (TSK) and Back Beliefs Questionnaire (BBQ). Two sets of two-way between-subjects Analysis of Variance (ANOVA) were conducted for each outcome of TSK and BBQ, with the independent variables of the study programme, study year (1st, 2nd, 3rd), and their interaction. There was a significant interaction between study programme and year for TSK (F(6, 124) = 4.90, P < 0.001) and BBQ (F(6, 124) = 8.18, P < 0.001). Post-hoc analysis revealed that both PT and ST students had lower TSK and higher BBQ scores than SES and SPC students particularly in the 3rd year. The beliefs of clinicians and trainers managing LBP are known to transfer to patients, and more negative beliefs have been associated with greater disability. This is the first study to understand the beliefs about back pain in various sports study programmes, which is timely, given that the management of injured athletes typically involves a multidisciplinary team.

Negative influence of a mediatised video on low back pain-related misbeliefs and attitudes in the general population

Background: Low back pain (LBP)-related misbeliefs are a risk factor for chronicity and thereby requires further attention.&#x0D; Objective: To assess the influence of a video clip on low back pain (LBP)-related misbeliefs in the general population and examine whether participants intended to change their behavior to protect their back after viewing it.&#x0D; Method: French-speaking adults within the general population were recruited through advertisements and asked to complete a self‐administered questionnaire online from the January to April 2021. The questionnaire asked about socio-demographic information and back pain beliefs (the 10-item Back-PAQ), then invited participants to watch a video clip conveying negative messages. Immediately after viewing, participants indicated their degree of agreement with the messages conveyed, completed the Back-PAQ a second time and indicated whether they planned to change their behavior after watching the video.&#x0D; Changes in mean Back-PAQ score after viewing the video and the percentage of participants planning to protect their backs more were investigated. Influence of LBP history was also collected.&#x0D; Results: 1338 participants were included. The initial mean Back-PAQ score was high and increased significantly after viewing the video (Cohen d: 0.42), indicating an increase in negative beliefs. This change was greater than the minimum detectable change for more than 10% of participants. In total, 55% of respondents reported that they would protect their backs more after watching the video. Change in Back-PAQ score post viewing was not influenced by pain history.&#x0D; Conclusions: This study shows that a video clip shown on social media that conveyed negative messages about LBP reinforced LBP-related misbeliefs and may promote maladaptive behavior in a significant number of individuals. This study also confirms the prevalence of such misbeliefs in the general population and thereby, the necessity for clinicians to explore patients’ misbeliefs and their origin.

More Load, Less Harm? Perceived Harmfulness of Daily Activities and Low Back Pain Beliefs in Weightlifters and Powerlifters

The purpose of this study was to understand how weightlifting/powerlifting (WL/PL) influences low back pain (LBP) beliefs and pain-related fear, and the potential influence of training, individual, and injury characteristics on these psychological features. Responses to the Photographic Series of Daily Activities-Short Electronic Version (PHODA-SeV) and the Back Pain and Attitudes Questionnaire (Back-PAQ) were collected from 67 participants who train on WL/PL. Relevant statistics were conducted to (1) compare questionnaire scores to previously published values from the general population, (2) compare male versus female WL/PL participants, (3) estimate the correlation between PHODA-SeV and Back-PAQ, and (4) identify the most important associative factors of both scores. Only the Back-PAQ was significantly lower than the published score of 113 (p &lt; 0.001). Male participants had a significantly lower PHODA-SeV score compared to female participants (p = 0.008), but no difference was observed for the Back-PAQ. Back-PAQ and PHODA-SeV scores were moderately correlated with each other (r = 0.54). One of the most important association factors was back squat weight for both PHODA-SeV (p &lt; 0.001) and Back-PAQ (p = 0.006). Future studies are required to investigate whether frequent WL/PL training improves pain-related fear and beliefs and reduces the risk of LBP occurrence.

An exploration of low back pain beliefs in a Northern America based general population

BackgroundPrior research has demonstrated that people across different populations hold beliefs about low back pain (LBP) that are inconsistent with current evidence. Qualitative research is needed to explore current LBP beliefs in Northern America (NA). ObjectivesWe conducted a primarily qualitative cross-sectional online survey to assess LBP beliefs in a NA population (USA and Canada). MethodsParticipants were recruited online using social media advertisements targeting individuals in NA over the age of 18 with English speaking and reading comprehension. Participants answered questions regarding the cause of LBP, reasons for reoccurrence or persistence of LBP, and sources of these beliefs. Responses were analyzed using conventional (inductive) content analysis. Results/findings62 participants were included with a mean age of 47.6 years. Most participants reported multiple causes for LBP as well as its persistence and reoccurrence, however, these were biomedically focused with minimal to no regard for psychological or environmental influences. The primary cited source of participants’ beliefs was healthcare professionals. ConclusionsOur findings align with prior research from other regions, demonstrating a need for updating clinical education and public messaging about the biopsychosocial nature of LBP.

An Exploration of Low Back Pain Beliefs from a North American Based General Population

Globally, low back pain (LBP) is the leading cause of years lived with disability. LBP is usually benign yet is often interpreted as an ominous sign of disease. Prior research has demonstrated many populations have misinformed beliefs about the nature, etiology, and prognosis of LBP, with the primary source being healthcare professionals (HCP). There is a gap in knowledge about LBP beliefs in the North American (NA) population. Current beliefs must be identified to inform future educational interventions. We conducted a cross-sectional online qualitative survey to assess NA population beliefs about LBP. Participants were recruited via social media advertisements targeting individuals over age 18 with English speaking and reading comprehension. We used an inductive content analysis approach to develop categories based on participants' responses to 3 open-ended questions about the presumed cause of their low back pain, its persistence, and the source of these beliefs. 62 participants (51 women, 7 men) were included, mean age of 47.6 years, 33 located in U.S.A. and 29 in Canada. Participants presumed causes of LBP fell into three categories: physical (biology, biomechanics, prior injury), psychological, unknown. Similar themes were generated regarding reported reasons for the recurrence or persistence of LBP, with the addition of a single category, environmental. Participants' primary source of beliefs was HCP (n = 34, 55%) with secondary sources of family (n = 12, 19%) and internet (n = 12, 19%). Many participants reported multiple causes for LBP, however, these were mostly focused on the physical body, with minimal consideration of psychological and sociological influences.[PASD1] Our study findings align with prior research from other regions in the world, further demonstrating a need for updating clinical education and public messaging about LBP. Funding provided by Faculty Research Fund at Bridgewater College.

‘Keep moving, but carefully’: back pain beliefs among NHS staff

Background Back pain (BP) is a major cause of absenteeism in National Health Service (NHS) staff in the UK. However, the back beliefs of NHS staff with BP are unknown. Objectives To explore the BP beliefs of UK NHS staff presenting with BP, and how these beliefs are constructed. Method Purposive sampling of NHS staff with BP who had self-referred to University Hospitals of Leicester NHS Trusts occupational health physiotherapy service. 30 participants completed the Back-Pain Attitudes Questionnaire. Ten participants with a range of BP beliefs also completed semi-structured interviews. Mean responses, and frequency of different responses were reported, for the questionnaire data. Interviews were analysed using thematic analysis. Results Total Back-PAQ scores (mean −9.6, SD 9.16) indicated unhelpful BP beliefs overall, though some BP beliefs such as the potential benefit of exercise were more positive. Key themes identified from the interviews were; (i) the uniquely vulnerable nature of BP, (ii) the need to protect the back through avoidance behaviours, and (iii) the importance of being active for BP. Conclusion NHS staff presenting with BP generally held negative BP beliefs, based on both questionnaire responses and the qualitative interviews. Awareness of the potential benefits of activity contrasted with the notion that ongoing protection of the back was required, and was evident in questionnaire data and interviews. Back pain beliefs were influenced by health care professional advice (both formal and informal settings), moving and handling training, family opinion and childhood experiences, offering insights into the settings where BP beliefs could be targeted.

Back pain beliefs among Indian migrants in Australia: a cross-sectional study

Purpose One of the largest migrant communities in Australia is the Indian migrant community. Current back pain guidelines recommend assessment of patients’ beliefs; however, little is known about these beliefs in Indian communities. We aimed to investigate beliefs about back pain among Indian migrants living in Sydney. Material and methods An online questionnaire with demographic information, participant characteristics, the Back Beliefs Questionnaire (BBQ) and open-ended questions relating to beliefs about causes of back pain and treatment preferences was completed by 386 Indian migrants in Sydney. Results The overall BBQ score was 25.1 ± 6.7. We found significant but slightly more positive beliefs among Indian females than Indian males (standardized regression coefficient, β = 0.134, p = 0.014). Presence and severity of pain did not affect back pain beliefs. There seemed to be a belief in physical and structural/anatomical causes of back pain, and a belief in the effectiveness of exercise, medications, and Indian traditional approaches for pain management. Conclusions Beliefs of Indian migrants aligned with a “western traditional” biomedical model for the cause of pain, but with a belief in the effectiveness of both Indian traditional and western treatment approaches. Awareness of these beliefs could enable an effective therapeutic alliance between clinicians and Indian patients. IMPLICATIONS FOR REHABILITATION Back pain beliefs of Australian Indian migrants are similar to their western counterparts, so the current guidelines for back pain can potentially be implemented without too much adjustment for this migrant community. Awareness of these beliefs is likely to improve the therapeutic alliance between clinician and an Indian migrant patient.

Low back pain prevalence, beliefs and treatment-seeking behaviour in multi-ethnic Suriname.

ObjectivesThe aims were to determine, for the first time, the prevalence of low back pain (LBP) in urban and rural communities and to assess back beliefs and treatment-seeking behaviour in Suriname, a multi-ethnic country in the Caribbean community.MethodsA cross-sectional community-based survey using the Community Oriented Program for the Control of Rheumatic Diseases methodology was performed between April 2016 and July 2017. Information was collected on LBP prevalence and LBP-related treatment seeking, beliefs about LBP [Back Beliefs Questionnaire (BBQ)], level of disability (Oswestry Disability Index) and the risk of developing persistent disabling pain (Start Back Screening Tool).ResultsA total of 541 out of 2902 individuals reported current acute or chronic LBP. It was more prevalent in urban (20.2%) than in rural (13.7%) communities, especially in females and older adults (>55 years of age). Individuals from rural areas [median BBQ = 18.00 (14.00–22.00)] had significantly more negative beliefs than the urban population [median BBQ = 25.00 (19.00–31.00); P < 0.001]. Maroons displayed more negative beliefs than Creole (P = 0.040), Hindustani (P < 0.001), Javanese (P < 0.001) and mixed ethnicity (P < 0.001) groups. At least 75% of the LBP population sought care, especially from a western health-care practitioner. Seeking treatment and having a higher risk of developing persistent disabling pain was significantly associated with more disability (P < 0.001). Age ≥45 years (P < 0.001), Indigenous ethnicity (P < 0.05) and functional disability (P < 0.001) were factors influencing treatment seeking.ConclusionLow back pain is a prevalent health problem in the Surinamese urban community, especially in older adults and among females. Most individuals experiencing LBP visited a western health-care practitioner and had more negative beliefs compared with other communities.

Nurses back pain beliefs, coping strategies and factors associated with participant activation for self-management of back pain.

To determine the back pain beliefs, coping strategies and factors associated with participant activation for self-management of back pain amongst nurses working in peri-urban district healthcare centres. A descriptive cross-sectional study design. Data were collected between February and March 2020 using a self-administered questionnaire. Descriptive data analysis was done in Stata version 20.0. Back pain beliefs, participant activation and coping strategies were presented using relative frequencies and percentages. Odds ratios at 5% significance level were used to test association of factors for participant activation for self-management of back pain. Majority of the participants had experienced back pain which lasted 3days for half of the participants. Further, pain medication was commonly used to cope with back pain. In addition, age, gender and work-setting were significantly associated with participant activation for self-management of back pain. Participants' coping strategies for back pain were linked to the conveyed back pain beliefs which demonstrate that participants believed in rest and lengthy periods of time off work for back pain. However, participants acknowledged that taking an active role in determining one's health and function is vital. This highlights the importance of self-management support for health behaviour change amongst nurses. The study addressed back pain beliefs, coping strategies and participant activation for self-management of back pain amongst nurses in peri-urban healthcare centres. Majority of the participants experienced back pain which lasted 3days. Pain medication was commonly used to cope with back pain. Age, gender and work-setting were significantly associated with participant activation for self-management of back pain. Although this study was conducted in Zambia, outcomes from this study may be of benefit to nurses in similar settings. Further, the research provides insight to the international body of knowledge on the process and appropriateness of international research in resource-constrained settings.

Graded activity with and without daily-monitored-walking in patients with type 2 diabetes with low back pain: secondary analysis of a randomized-clinical trial

BackgroundGraded activity is gradually emerging as a preferred choice in improving psychosocial outcomes including pain self-efficacy, fear-avoidance beliefs, and back-pain beliefs in the general population with low back pain (LBP). Such evidence is, however, lacking among patients with concomitant LBP and type-2 diabetes mellitus (T2DM). This secondary analysis of a randomized control trial aimed to compare the efficacy between graded activity augmented with additional daily-monitored-walking and graded activity alone on disability, pain self-efficacy (PSE), fear-avoidance beliefs (FAB), back-pain beliefs (BPB) and glycaemic control (HbA1c) in patients with concomitant LBP and T2DM.MethodsFifty-eight patients with concomitant LBP and T2DM were randomised into two groups, graded activity with daily-monitored-walking group (GAMWG = 29) or (graded activity group (GAG = 29) in this 12-week single-blind trial. Both groups received graded activity (home/work-place visits, back school and sub-maximal exercises) while the GAMWG received additional daily-monitored-walking. Disability and selected psychosocial outcomes were assessed at weeks 0, 4, 8 and 12 using Roland-Morris disability, fear-avoidance behaviour, pain self-efficacy and back belief questionnaires. Glycaemic control was assessed at weeks 0 and 12 using a point-of-care system (In2it, Biorad Latvia). Data were analysed using mean, median, Friedman’s ANOVA, Mann-Whitney test and t-tests.ResultsParticipants’ mean age was 48.3 ± 9.4 years (95%CI: 45.6, 50.9) while 35.3% were males. The GAMWG participants (n = 25) had better outcomes (P < 0.05) than GAG participants (n = 26) on PSE (1.0, 3.0; r = − 0.1) and FAB (0.01, − 2.0; r = − 0.1) at week 4, LBP-related disability (0.01, − 2.0; r = − 0.2) at week 8 and glycaemic control at week 12 (− 0.59 ± 0.51%,-0.46 ± 0.22%). No other between-group comparisons were statistically significant.ConclusionGraded activity with daily-monitored-walking provided earlier improvements on disability, pain self-efficacy, fear-avoidance beliefs, and glycaemic control, but not back pain beliefs, in patients with concomitant LBP and T2DM.Trial registrationPACTR201702001728564; 26 July, 2016 (retrospectively registered).

The patient enablement instrument for back pain: reliability, content validity, construct validity and responsiveness

BackgroundCurrently, there are no outcome measures assessing the ability of people with non-specific low back pain to self-manage their illness. Inspired by the ‘Patient Enablement Instrument’, we developed the Patient Enablement Instrument for Back Pain (PEI-BP). The aim of this study was to describe the development of the Patient Enablement Instrument for Back Pain (PEI-BP) and investigate content validity, construct validity, internal consistency, test–retest reliability, measurement error, responsiveness and floor and ceiling effects.MethodsThe PEI-BP consists of 6 items that are rated on a 0–10 Numeric Rating Scale. Measurement properties were evaluated using the COSMIN taxonomy and were based on three cohorts from primary care with low back pain: The content validity cohort (N = 14) which participated in semi-structured interviews, the GLA:D® Back cohort (N = 272) and the test–retest cohort (N = 37) which both completed self-reported questionnaires. For construct validity and responsiveness, enablement was compared to disability (Oswestry Disability Index), back pain beliefs (Brief Illness Perception Questionnaire), fear avoidance (Fear-Avoidance Beliefs Questionnaire—physical activity), mental health (SF-36), educational level and number of previous episodes of low back pain.ResultsThe PEI-BP was found to have acceptable content validity, construct validity, reliability (internal consistency, test–retest reliability and measurement error) and responsiveness. The Smallest Detectable Change was 10.1 points illustrating that a patient would have to change more than 1/6 of the scale range for it to be a true change. A skewed distribution towards the high scores were found at baseline indicating a potentially problematic ceiling effect in the current population.ConclusionsThe PEI-BP can be considered a valid and reliable tool to measure enablement on people seeking care for non-specific LBP. Further testing of the PEI-BP in populations with more severe LBP is recommended.Trial registration: Not applicable.

Low Back Pain–Related Disability Is Associated with Pain-Related Beliefs Across Divergent Non–English-Speaking Populations: Systematic Review and Meta-Analysis

This systematic review and meta-analysis examined relationships between low back pain (LBP)-related disability and pain beliefs, including pain catastrophizing, pain-related fear, self-efficacy, and back pain beliefs, in non-English-speaking populations. Additionally, the effects of selected cultural factors (i.e., language/geographic area) on the strength of relationships were examined. Systematic review and meta-analysis. Nine databases were searched. Studies included observational or randomized control clinical trials. Eligible studies had to report estimates of the association between pain beliefs and disability. Pooled estimates of correlation coefficients were obtained through random-effects meta-analysis methods. Fifty-nine studies, (n = 15,383) were included. Moderate correlations were identified between disability and pain self-efficacy (chronic LBP r = -0.51, P ≤ 0.001), between disability and pain catastrophizing (acute LBP r = 0.47, P ≤ 0.001; chronic LBP r = 0.44, P ≤ 0.001), and also between disability and pain-related fear (chronic LBP r = 0.41, P ≤ 0.001). Otherwise, weak correlations were identified between disability and most pain beliefs (range r = -0.23 to 0.35, P ≤ 0.001). Pooled correlation coefficients between disability and all pain beliefs (except the Fear Avoidance Belief Questionnaire-Work subscale) represent medium effects and suggest that lower disability was associated with greater pain self-efficacy, less pain-related fear, less catastrophic thinking, and less negative back pain beliefs about the nature and cause of back pain. Results were consistent across most language groups and geographic regions; few studies reported ethnicity or religion. LBP-related disability was associated with pain-related beliefs, with consistency demonstrated for each pain belief construct across divergent non-English-speaking populations. Further research examining cultural factors, such as ethnicity or religion, and with a more diverse population is warranted.

What are the back beliefs of NHS employees, and does manual handling training influence them

Background Work absence due to back pain is best predicted by beliefs and attitudes. Lots of money is spent on training in the NHS trying to prevent back pain; this study explores the effect of that training on back pain beliefs. Methods 151 NHS employees were surveyed using the Back Pain Attitudes Questionnaire before and after manual handling training. Results NHS employees had mixed beliefs. Before training, staff had positive beliefs about activity participation (8.25, SD 1.78), neutral beliefs about psychological influences (6.11, SD 2.51) and prognosis (6.34, SD 2.18), negative beliefs about relationship with injury (5.26, SD 2.09) and strongly negative beliefs about vulnerability of the back (2.81, SD 1.45). Training had a small negative effect (–1.57, SD 4.06 p < 0.001) primarily through exacerbating beliefs regarding the vulnerability of the back (–0.45, SD 1.24, p < 0.001) and the relationship between pain and injury (–0.80, SD 1.83 p < 0.001). Conclusion NHS employees hold many outdated views on back pain. The immediate effects of manual handling training based on the traditional paradigm of ‘protect your back’ appeared to make respondents slightly more cautious about using the spine; viewing it as easy to injure, that pain and damage may be linked, and slightly less optimistic about recovery.

Association Between Low Back Pain and Biomedical Beliefs in Academics of Physiotherapy: Erratum.

Association Between Low Back Pain and Biomedical Beliefs in Academics of Physiotherapy: Erratum.