Health Care Providers' Pain And Impairment Relationship Scale Research Articles

The influence of low back pain-related attitudes and beliefs on the clinical decision making of physical therapists

ABSTRACT Background The LBP-related attitudes and beliefs of clinicians may impact the experience of patients by influencing clinician decision-making and by shaping the attitudes, beliefs, and actions of patients. The purpose of this study was to identify the specific LBP-related attitudes and beliefs of US-based physical therapists and determine if those beliefs correlate with clinical decision-making. Methods An electronic survey was sent to US-based physical therapists. Attitudes and beliefs were measured using the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain and Impairment Relationship Scale for Physiotherapists (PABS-PT). The survey also included 2 patient vignettes that collected information about clinical decision-making. Results Complete survey responses were recorded from 420 physical therapists. Eleven of the 27 attitude and beliefs questions were answered in a more biomedically oriented way by at least 20% of respondents. Physical therapist low back pain-related attitudes and beliefs were associated with activity and management strategies for both vignettes in the expected direction. Higher scores on HC-PAIRS and PABS-BM were associated with more restrictive work and activity recommendations, lower-intensity exercise choices, biomechanical rationale for manual therapy and motor control exercises, pathoanatomical-focused education, and use of modalities. Conclusion Some physical therapists hold biomedically oriented beliefs about the connection between pain and physical activity. Clinician beliefs were associated with activity and work recommendations, and treatment choices. Physical therapists with more biomedically oriented beliefs were more likely to limit physical activity and work, and less likely to incorporate psychologically informed interventions.

Attitudes, beliefs, and recommendations for persistent low back pain patients: cross-sectional surveys of students and faculty at a chiropractic college

BackgroundWhile the use of chiropractic care for persistent low back pain (PLBP) is prevalent, chiropractors’ attitudes and beliefs related to PLBP patients are not fully understood. The purpose of this study was to assess the attitudes, beliefs and activity/work recommendations of students and faculty at a chiropractic college regarding PLBP patients.MethodsThe Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) and clinical vignettes were requested to be completed by chiropractic students and faculty at Parker University in April 2018. Higher HC-PAIRS scores indicate stronger beliefs that PLBP justifies disability and limitation of activities. Activity and work recommendations from clinical vignettes were rated as “adequate”, “neutral”, or “inadequate”, as defined in previous literature. Descriptive statistics, independent t-tests, and logistic regression were used to analyze results.ResultsStudent and faculty response rates were 63.6% and 25.9%, respectively. Faculty mean HC-PAIRS scores (3.66 [SD:0.88]) were significantly lower than students’ (4.41 [SD:0.71]). The percentage of faculty providing “adequate” activity (62.1%) and work (41.0%) recommendations was significantly greater than the percentage of students (activity: 33.9%, work: 21.2%) (p < 0.05). Higher HC-PAIRS scores in students were associated with decreased odds of providing “adequate” activity and work recommendations.ConclusionsStudent and faculty attitudes and beliefs, and students’ activity/work recommendations were found to be dissimilar to those from similar studies and less congruent with CPG recommendations. Lower HC-PAIRS scores increased the odds of students providing “adequate” activity and work recommendations to patients with PLBP. Results from this study may help guide future research and training opportunities.

Transcultural Adaptation and Psychometric Validation of the Spanish Version of the Pain Attitudes and Beliefs Scale for Physiotherapists.

Low back pain (LBP) is one of the main musculoskeletal pain conditions, and it affects 23-28% of the global population. Strong evidence supports the absence of a direct relationship between the intensity of pain and tissue damage, with psychosocial factors also playing a crucial role. In this context, the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) is a useful tool for evaluating physiotherapists' treatment orientations and beliefs regarding the management of low back pain (LBP). It helps identify practitioners who may benefit from additional education in modern pain neuroscience. However, there is not a Spanish validation of this scale for physiotherapists. Thus, the aims of this study were to translate and culturally adapt the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) into Spanish and to evaluate its psychometric properties. This validation study used three convenience samples of physiotherapists (PTs) (n = 22 for the pilot study, n = 529 for the validity study and n = 53 for assessing the instrument's responsiveness). The process of translating and adapting the PABS-PT into Spanish followed international guidelines and produced a satisfactory pre-final version of the questionnaire. Factor analysis confirmed the two-factor structure of the original version, with the biomedical (BM) factor explaining 39.4% of the variance and the biopsychosocial (BPS) factor explaining 13.8% of the variance. Cronbach's alpha values were excellent for the BM factor (0.86) and good for the BPS factor (0.77), indicating good internal consistency. Test-retest reliability was excellent for both factors, with intraclass correlation coefficients (ICCs) of 0.84 for BM and 0.82 for BPS. The standard error of measurement (SEM) was acceptable for both factors (3.9 points for BM and 2.4 points for BPS). Concurrent validity was moderate and in the expected direction and had significant correlations with the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and Revised Neurophysiology Pain Questionnaire (R-NPQ). Sensitivity to change was demonstrated by significant improvements in both factors after an educational intervention, with medium-to-large effect sizes. The PABS-PT also showed good discriminative ability, as it was able to distinguish between physiotherapists with and without pain education. Cut-off values for the BM and BPS factors were determined. In conclusion, the translated and adapted Spanish version of the PABS-PT demonstrated good psychometric properties and can be reliably used to assess the attitudes and beliefs of Spanish-speaking physiotherapists regarding LBP. The questionnaire is recommended for use in clinical and educational research in the Spanish language context.

Management of Low Back Pain: Do Physiotherapists Know the Evidence-Based Guidelines?

Clinical practice guidelines promote bio-psychosocial management of patients suffering from low back pain (LBP). The objective of this study was to examine the current knowledge, attitudes and beliefs of physiotherapists about a guideline-adherent approach to LBP and to assess the ability of physiotherapists to recognise signs of a specific LBP in a clinical vignette. Physiotherapists were recruited to participate in an online study. They were asked to indicate whether they were familiar with evidence-based guidelines and then to fill in the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), as well as questions related to two clinical vignettes. In total, 527 physiotherapists participated in this study. Only 38% reported being familiar with guidelines for the management of LBP. Sixty-three percent of the physiotherapists gave guideline-inconsistent recommendations regarding work. Only half of the physiotherapists recognised the signs of a specific LBP. The high proportion of physiotherapists unfamiliar with guidelines and demonstrating attitudes and beliefs not in line with evidence-based management of LBP is concerning. It is crucial to develop efficient strategies to enhance knowledge of guidelines among physiotherapists and increase their implementation in clinical practice.

What influences graduate medical students’ beliefs of lower back pain? A mixed methods cross sectional study

BackgroundLow back pain (LBP) is a common condition with substantial associated disability and costs, best understood using a biopsychosocial approach. Research demonstrates that beliefs about LBP are important, with biomedical beliefs influencing practitioner’s management and patient recovery. Beliefs about LBP can be inconsistent amongst healthcare and medical students. The aim of this study was to investigate graduate medical student’s beliefs of LBP and what influences them.MethodA cross sectional mixed methods study of Phase 1 (first year) and Phase 3 (third and fourth year) current graduate medical students at the University of Warwick (MBChB) was conducted. Participants were recruited via voluntary response sampling. A survey investigated LBP beliefs, utilising the Back Beliefs Questionnaire (BBQ) and Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS). Qualitative data was collected on what influences beliefs about the causes and management of LBP, which was analysed descriptively using thematic analysis.ResultsFifty-seven students completed the questionnaire (61% female), with a mean age of 27.2 years. Eighty two percent of participants reported a history of LBP. Median BBQ scores were 31.5 for phase 1 and 31 for phase 3, with median HC-PAIRS scores of 57 and 60 for phase 1 and phase 3 students respectively. Three main themes emerged from the qualitative data: Sources of influence, influence of personal experience and influence of medical education. Participants discussed single or multiple sources influencing their beliefs about the causes and management of LBP. Another main theme was the influence of experiencing LBP personally or through discussions with family, friends and patients. The final main theme described the influence of medical education, including lectures, seminars and clinical placements.ConclusionsThe HC-PAIRS and BBQ scores suggest graduate medical students in this sample tended to have positive beliefs about the outcome of LBP and functional expectations of chronic LBP patients, consistent with other healthcare students. The findings from qualitative data suggest how medical students form beliefs about the causes and management of LBP is complex.

International, multi-disciplinary, cross-section study of pain knowledge and attitudes in nursing, midwifery and allied health professions students

BackgroundPersistent pain is a highly prevalent, global cause of disability. Research suggests that many healthcare professionals are not well equipped to manage pain, and this may be attributable at least in part to undergraduate education. The primary aim of this study was to quantify and compare first and final year nursing, midwifery and allied health professional (NMAHP) students’ pain related knowledge and attitudes. The secondary aim was to explore what factors influence students’ pain related knowledge and attitudes.MethodsIn this cross-sectional study, 1154 first and final year healthcare students, from 12 universities in five different countries completed the Revised Neurophysiology of Pain Quiz (RNPQ) [knowledge] and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) [attitudes].ResultsPhysiotherapy was the only student group with statistically and clinically improved pain related knowledge [mean difference, 95% CI] (3.4, 3.0 to 3.9, p = 0.01) and attitudes (-17.2, -19.2 to 15.2, p = 0.01) between first and final year. Pain education teaching varied considerably from course to course (0 to 40 h), with greater levels of pain related knowledge and attitudes associated with higher volumes of pain specific teaching.ConclusionsThere was little difference in pain knowledge and attitudes between all first and final year NMAHP students other than physiotherapy. This suggests that for most NMAHP disciplines, undergraduate teaching has little or no impact on students’ understanding of pain. There is an urgent need to enhance pain education provision at the undergraduate level in NMAHPs.Trial RegistrationThe study protocol was prospectively registered at ClinicalTrials.Gov NCT03522857.

The Portuguese osteopaths' attitudes towards a biomechanical or biopsychosocial model in the approach of chronic low back pain – A cross-sectional questionnaire-based survey

ObjectiveThis study investigated the Portuguese Osteopaths attitudes towards a biomechanical or biopsychosocial approach of care in patients with chronic low back pain (cLBP). MethodsA cross-sectional questionnaire-based survey of Portuguese registered osteopaths was composed using sociodemographic determinants, the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and Pain Attitudes and Beliefs for Physiotherapists (PABS-PT). The HC-PAIRS assesses the attitudes and beliefs about the functional expectations of patients with cLBP, and the PABS-PT assesses the dominant model of care. ResultsPortuguese registered osteopaths (n = 103) had mean PABS-PT subscale scores of 29.6 ± 7.7 [CI95% 28.12–31.14] (biomechanical) and 22.9 ± 5.3 [CI95% 21.88–23.94] (biopsychosocial). The mean HC-PAIRS total score was 52.4 ± 9.0 [CI95% 50.66–54.16]. There was a strong and positive correlation between the HC-PAIRS and the PABS-PT biomechanical subscale (n (103) = 0.55, p < 0.001, and in PABS-PT a negative correlation between the biomechanical and biopsychosocial subscale scores (n(103) = -0.21, p = 0.028). ConclusionsPortuguese osteopaths tend to adopt a biomechanical model of care instead of a biopsychosocial model in the management of patients with chronic low back pain. They seem to agree that chronic low back pain was due entirely to tissue damage, indicating strong biomechanical beliefs about the pain that may ultimately influence their clinical decisions.

The attitudes and beliefs of physiotherapists, family physicians and physiatrists concerning chronic low back pain

Objective: To examine the chronic low back pain (CLBP)-related attitudes and beliefs of primary and secondary healthcare professionals responsible for the treatment of this condition.&#x0D; Material and Method: The study was conducted with 40 family physicians, 30 physiatrists, and 40 physiotherapists. The beliefs and attitudes of the participants concerning CLBP were evaluated using the Back Belief Questionnaire (BBQ), Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), and Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT).&#x0D; Results: Among all the participants, the rate of those with predominantly biomedical beliefs was 80.9%, while the rate of those with predominantly biopsychosocial beliefs was 15.5%. In addition, it was observed that the BBQ, HC-PAIRS and PABS-PT scores were not affected by educational status, number of patients with CLBP treated or examined in a week, and years of experience (p&gt;0.05). The BBQ and HC-PAIRS scores of the family physicians were statistically significantly lower compared to the physiotherapists and those of the physiotherapists were statistically significantly lower compared to the physiatrists (p0.05).&#x0D; Conclusion: This study revealed that family physicians, physiotherapists, and physiatrists in Turkey might have negative attitudes and beliefs concerning CLBP and the biopsychosocial approach should be further adopted among healthcare professionals.

Factors associated with the low back pain-related attitudes and beliefs of physical therapists

BackgroundClinicians who believe in a strong connection between pain and disability, and who have biomedically oriented beliefs recommend less physical activity, more time off work, and promote unhelpful beliefs in patients. Understanding how these beliefs develop may assist in identifying ways to reduce unhelpful beliefs in clinicians. ObjectiveTo identify factors that are associated with the LBP-related attitudes and beliefs of US-based physical therapists. DesignCross-sectional design MethodAn electronic survey was sent to US-based physical therapists. Attitudes and beliefs were measured using the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), pain science knowledge was measured using the Neurophysiology of Pain Questionnaire (NPQ), and professional and demographic information were collected. ResultsCompleted surveys were obtained from 420 physical therapists. More helpful attitudes and beliefs were associated with board certification in orthopedics or sports, higher NPQ scores, and working in a hospital-based clinic. Less helpful attitudes and beliefs were associated with working in private practice and a personal history of LBP that had a minimum or significant impact on life. The factors included in this study explained 16.8% of the variability in HC-PAIRS scores (p < .001), 13% of the variability in PABS-BM scores (p < .001), and 8.3% of the variability in PABS-BPS scores (p < .001). ConclusionSeveral modifiable and non-modifiable factors are associated with the LBP-related attitudes and beliefs of US physical therapists.

Cross-cultural adaptation, validation and psychometric evaluation of the attitudes to back pain scale in musculoskeletal practitioners - Hebrew version

BackgroundResearch suggests that clinician's attitudes and beliefs towards low back pain (LBP) management may affect their patients' treatment course and outcomes. Attitudes to Back pain Scale in musculoskeletal practitioners (ABS-mp) is a questionnaire developed to assess musculoskeletal clinicians' attitudes and beliefs regarding LBP. ObjectiveThis study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Hebrew version of the ABS-mp questionnaire. DesignCross-sectional study with nested prospective sub-sample. MethodsThe translation was performed in several steps following the cross-cultural adaptation process. Test-retest and internal consistency reliability of the scales were evaluated along with convergent validity exploration between the ABS-mp and the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS). A convenience sample of 177 physical therapists were requested to participate in the study, out of which 132 have completed the survey, providing a 74% participation rate. ResultsThe forward-backward translation process revealed minor discrepancies that were addressed by the expert panel. The test-retest reliability of the Hebrew ABS-mp was excellent (ICC = 0.906). Five items were found to be irrelevant for the Israeli physiotherapy health settings and were omitted. For internal consistency, the average inter-item correlation reached appropriate values for the Psychological, Biomedical, Re-activation, and Limitation on Sessions subscales (0.437, 0.265, 0.341, 0.197, respectively). For convergent validity, the ABS-mp's Biomedical subscale and the HC-PAIRS's total score were moderately correlated (0.535). ConclusionsThe Hebrew version of the ABS-mp has been validated and has demonstrated excellent test-retest reliability, good convergent validity and acceptable internal consistency.

The impact of physical therapist attitudes and beliefs on the outcomes of patients with low back pain

BackgroundLow back pain (LBP) is a common problem that places a major burden on individuals and society. It has been proposed that patients treated by biomedically oriented clinicians will have worse outcomes than those treated by biopsychosocially oriented clinicians. ObjectiveTo investigate the impact of physical therapist LBP related attitudes and beliefs on the outcomes of patients with LBP. DesignRetrospective cohort design. MethodUnited States based physical therapists utilizing the Focus on Therapeutic Outcomes, Inc. (FOTO) database were surveyed using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Outcomes were measured using average Computerized Lumbar Functional Scale change scores (CLFS) and CLFS residual scores. ResultsAnalysis was performed on outcome data from 78 physical therapist and included 2345 patients. HC-PAIRS was a univariate predictor of average CLFS change scores and average CLFS residual scores. PABS-PT Biomedical subscale was a univariate predictor of average CLFS change scores. After adjusting for confounding variables, higher HC-PAIRS scores and PABS-BM scores were associated with a greater change in average CLFS score, and higher PABS-BM scores were associated with higher CLFS residual scores. ConclusionPhysical therapists who believed in a stronger relationship between pain and disability had improved patient outcomes.

The effect of pain neurophysiology education on healthcare students’ knowledge, attitudes and behaviours towards pain: A mixed-methods randomised controlled trial

Objective1) To investigate the effects of a brief pain neuroscience education (PNE) lecture on multi-disciplinary healthcare students' knowledge, attitudes and behaviours towards people with pain post intervention and at 6-months follow-up, 2) To explore students’ perceptions of PNE. DesignMixed-methods randomized controlled trial. SettingUK university. ParticipantsThirty-seven students (30♀, mean age 30 years) from six healthcare disciplines. Intervention70-min PNE lecture (intervention group) or a 70-min control education. Main outcome measures1) Knowledge: The Revised Pain Neurophysiology Quiz (RPNQ); 2) Attitudes: Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS); 3) Behaviours: A case vignette to assess clinical recommendations; and 4) Thematic analysis of semi-structured interviews (n = 12). ResultsThe intervention group increased knowledge compared to the control, post-intervention [mean difference 3.7 (95% CI, 2.4, 5.0), P < 0.001] but not at 6-months (0.1 (−1.1, 1.3), P = 0.860). Greater improvements in attitudes for the intervention group were seen post-intervention [-10.4 (−16.3, −4.6), P < 0.001] and at 6-months [-5.8 (−11.5, −0.2), P < 0.044]. There was no difference in behaviours between groups. Thematic analysis identified increased patient empathy, partial and patchy reconceptualisation of pain and increased confidence in recommending an active management programme following PNE. ConclusionThis study adds to existing knowledge by demonstrating that a 70-min PNE lecture can have a short-term effect on knowledge and positively shift attitudes towards people with pain in the short and medium-term. It also resulted in some students’ reconceptualisation of pain, increased empathy, and confidence to recommend activity. The effect of PNE on clinical behaviours was unclear.

How do the attitudes, confidence, knowledge and understanding differ in pre-registration healthcare students towards treating people with chronic pain: an observational, cross-sectional study

Background Attitudes, knowledge and understanding (K&U) may predispose practitioner adherence to clinical guidelines for chronic pain. To date, there are no data exploring this in adult, mental health and paediatric nursing, or occupational therapy, podiatry and physiotherapy student healthcare professionals at the same institution. Methods We approached 1383 students enrolled on pre-registration healthcare programmes at a Scottish University, using the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) and Pain Understanding and Confidence Questionnaire (PUnCQ). Results Three hundred and forty-six students completed the survey (response rate 25%). There was a significant effect of degree discipline on HC-PAIRS and PUnCQ with a moderate effect size of η p 2 = .212 and η p 2 = .204, respectively. Postgraduate pre-registration physiotherapy students had more positive attitudes towards function with pain, M(SD) HC-PAIRS score = 49.6(8.9), 95%CI = 46.5–52.8, and greater confidence towards management of chronic pain M(SD) = 6.3, 95%CI = 5.9–6.8 compared to the other disciplines surveyed. Undergraduate physiotherapy and mental health nursing also displayed significantly more positive attitudes M(SD) = 55.2 (10.2), 95%CI 53.3–57.2 and 62.6 (7.6), 60.1–65.2, respectively. Conclusions Physiotherapy students have more biopsychosocial-orientated attitudes, and higher confidence towards the management of people in pain than the other disciplines surveyed despite similar levels of K&U of pain.

Beliefs about chronic low back pain amongst osteopaths registered in Spain: A cross-sectional survey

BackgroundHealthcare providers' (HCPs) attitudes and beliefs might influence patients’ attitudes and beliefs as well as their management approach. It was hypothesised that osteopaths have a more biopsychosocial mindset towards chronic low back pain (CLBP) because of their holistic reasoning. ObjectiveThe primary aim of the study was to assess the beliefs of osteopaths registered in Spain about CLBP and the presence of kinesiophobic and fear-avoidance beliefs. The secondary aim was to compare these results with previous research and cut-off values. MethodMembers of the Spanish Federation of Osteopaths (FOE) were invited to participate in an online cross-sectional survey based on three questionnaires: the Health Care providers Pain and Impairment Relationship Scale (HC-PAIRS), the Tampa Scale of Kinesiophobia 11-item version for healthcare providers (TSK(11)-HC) and the Fear Avoidance Beliefs Questionnaire for healthcare providers (FABQ-HC). The mean scores were calculated for each questionnaire and correlations were established to assess the strength of the associations between the different instruments. The results were compared to previous research with other HCPs and to cut-off scores where available. ResultsThe response rate was 14.58% (n = 70). The mean score on the HC-PAIRS was 59.44 ± 12.19 [CI 95% 56.54–62.35] and there was a large variation in scores. On the TSK(11)-HC and FABQ-HC 28.6% and 25.7% of the sample respectively reached the cut-off scores. ConclusionThe study suggests that the Spanish osteopaths do not have a more biopsychosocial orientation towards the management of CLBP than other HCPs. Approximately a quarter of them hold kinesiophobic and fear-avoidance beliefs that might negatively influence their treatment approach.

Interdisciplinary Pain Neuroscience Continuing Education in the Veterans Affairs: Live Training and Live-Stream With 1-Year Follow-up.

Because of the pain and opioid epidemic in the United States, there is a need to update clinician's knowledge, attitudes, and beliefs regarding persistent pain across health care disciplines. The aim of this study was to determine if health care professionals can positively change their knowledge, attitudes, and beliefs regarding chronic pain, following a pain neuroscience education (PNE) lecture and 1 year follow-up. A total of 270 health care providers at the Minneapolis Veterans Affairs Health Care System received a 3.5-hour PNE lecture in person or via live-stream. Primary outcomes were the Neurophysiology of Pain Questionnaire (NPQ) and Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) measured before, immediately after, and 1 year after the PNE lecture. At 1 year participants were also asked how the PNE lecture affected their practice. Pain knowledge (NPQ) (P<0.01) and attitudes and beliefs regarding persistent pain (HC-PAIRS) (P<0.01) improved for all providers, with specific improvements across several disciplines. Positive gains in outcomes were equal for in-person attendance, and live-streaming of the lecture. One year later, NPQ and HC-PAIRS gains diminished, yet clinicians reported a large positive impact on daily clinical practice. PNE resulted in a positive clinical impact for health care providers treating patients with persistent pain. The mechanism of this effect may be about healthier attitudes and beliefs regarding persistent pain rather than increased knowledge about pain.

Level of knowledge, attitudes and beliefs towards patients with chronic low back pain among final year School of Therapeutic Sciences students at the University of the Witwatersrand – A cross-sectional study

BackgroundKnowledge of neurophysiology of pain influences healthcare providers’ attitudes and beliefs about patients with chronic low back pain which affect management choices.ObjectivesThe aim of this study was to determine the level of knowledge of pain and attitudes and beliefs towards patients with chronic low back pain among final year undergraduate students from the School of Therapeutic Sciences at the University of the Witwatersrand.MethodsThis cross-sectional study included two questionnaires – Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) for measuring attitudes and beliefs about pain and the Neurophysiology of Pain Questionnaire (NPQ) for knowledge of pain. These were distributed to 224 students. An analysis of variance and a two-sided t tests compared data with p ≤ 0.05.ResultsThe study had a 65% response rate (n = 145), of which the majority were female students (n = 115, 79%). Overall, the mean correct NPQ score was 6.01 (± 1.98), with a significant difference among the programmes (p = 0.005). Mean NPQ scores for each programme were as follows: physiotherapy 6.97 (1.77), biokinetics 6.31 (2.43), exercise science 6.25 (2.5), pharmacy and pharmacology 5.69 (1.39), nursing 5.32 (1.39) and occupation therapy 5.21 (2.09). The mean correct scores for HC-PAIRS were 63.1 (8.9), with significantly higher scores in females than males (p = 0.04). Knowledge scores had a low inverse relationship with scores for attitudes and beliefs towards patients with chronic low back pain (r = -0.304; p = 0.0002).ConclusionThere is a deficit in knowledge of pain among final year students in the School of Therapeutic Sciences, with a low correlation with attitudes and beliefs towards patients with chronic low back pain. Therefore, improving the knowledge of pain might result in a change in these attitudes and beliefs.Clinical implicationsThe results have shown an association between knowledge of pain and attitudes and beliefs towards patients with chronic low back pain. Therefore, knowledge is one of the factors that could contribute in changing the attitudes.

Can a training programme in motivationalinterviewing change musculoskeletalphysiotherapists’ practice?The example of low back pain

Background Low back pain (LBP) is a leading cause of disability nationally and globally, and forms between 40% and 65% of musculoskeletal physiotherapists’ caseloads in the UK. Despite professional expectations to deliver person-centred practice, a biomedical and practitioner-centred perspective continues to dominate within physiotherapy. Many physiotherapists lack the knowledge and skills to deliver psychologically informed practice, which for persistent LBP requires consideration of the needs, preferences and values of the patient. Motivational interviewing (MI) has been recommended as a psychologically informed approach for physiotherapists working with persistent LBP patients, although little research has been carried out into its use. Aim This study aims to investigate the effects of MI training on physiotherapists’ beliefs, attitudes and practice in relation to persistent LBP. Methods A convergent parallel mixed methods study was undertaken. Volunteer musculoskeletal physiotherapists (n=16) were recruited from two musculoskeletal physiotherapy departments within a Community NHS Trust in greater London and allocated to either a MI training Group A (n=10) or a comparison Group B (n=6). The MI training group received an initial two-day MI course followed up by monthly supervision sessions delivered in the workplace. Outcomes were measured pretraining (baseline) then at three and six months later for both groups. Beliefs and attitudes and to persistent low back pain were measured using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS). Self-reported proficiency, confidence and intention to use MI were measured using visual analogues scales (VAS). The Motivational Interviewing Training Integrity scale (MITI) generated global ratings and behaviour counts from audio-recordings of initial consultations with persistent LBP patients. The implementation and impact of MI in practice was explored through semi-structured interviews with Group A physiotherapists only at six months. Results A significant post-training decrease in biomedical orientation was demonstrated between the MI training group and the comparison group at three months (HCPAIRS) and six months (PABS-PT and HC-PAIRS) using independent t-tests. The MI training group had significantly increased proficiency, confidence and intention to use MI at three and six months (VAS); and increased MITI global ratings of Spirit (at three months), Collaboration (at three months) and Evocation (at six months). Qualitative content analysis of the semi-structured interviews revealed that the physiotherapists embraced MI as an approach. They were able to overcome initial challenges of putting MI training into practice such as time pressure and level of difficulty in changing ingrained practice and language, and found positive individual and collective ways to introduce and sustain their use of MI. Discussion The results of this study contribute new insights into the understanding of the role and impact of training musculoskeletal physiotherapists in MI, although the small sample size means that the results should be interpreted with caution. MI is acceptable to physiotherapists. Physiotherapists were able to embrace the spirit of MI and to embed MI within their practice. This allows them to development their skills as person-centred practitioners and to cope more effectively with patients perceived as difficult and those with complex presentations. However, ongoing supervision is required to develop MI proficiency, which can be expensive. Mi is acceptable to physiotherapists who seem keen to adopt this psychologically informed approach However, for MI practice to become adopted more widely across the profession, sustainable training approaches and appropriate professional support structures are required.

Changes in pain knowledge, attitudes and beliefs of osteopathy students after completing a clinically focused pain education module

BackgroundChronic pain is a substantial burden on the Australian healthcare system with an estimated 19.2% of Australians experiencing chronic pain. Knowledge of the neurophysiology and multidimensional aspects of pain is imperative to ensure health professionals apply a biopsychosocial approach to pain. Questionnaires may be used to assess learner changes in neurophysiology knowledge and beliefs and attitudes towards pain after education interventions.The aim of this study was to evaluate changes in pain neurophysiology knowledge, beliefs and attitudes following a 12 week clinically-focused pain module in year 3 osteopathy students as measured by the Neurophysiology of Pain (NPQ) Questionnaire and Health Care Providers Pain and Impairment Relationship scale (HC-PAIRS).MethodsA pre-post design was utilised. Learners completed a demographic information survey pre-module, and completed the NPQ & HC-PAIRS prior to undertaking, and after completing, a twelve week clinically-focused pain module.ResultsLearners (n = 55) completed the NPQ & HC-PAIRS at both time points. The median NPQ score was significantly increased with a large effect size (p < 0.001, z = − 5.71, r = 0.78) following the completion of the module. In contrast, the HC-PAIRS total score was significantly increased after the completion of the module (p < 0.01, z = − 6.95, r = 0.91) suggesting an increase in negative pain attitudes and beliefs. Results indicate that a clinically-focused pain module can increase pain neurophysiology knowledge. However the HC-PAIRS results suggest an increase in negative pain attitudes and beliefs. The HC-PAIRS questionnaire was developed for use with chronic low back pain attitudes & beliefs in practitioners, rather than pre-clinical students. Students were provided with general principles of pain management, rather than condition specific pain management. This study is the first comparing pain neurophysiology knowledge and changes in attitudes and beliefs towards pain pre-post a clinically-focused pain module using the NPQ & HC-PAIRS.ConclusionsThere was a significant improvement in NPQ score after the 12 week clinically-focused pain module. The HC-PAIRS result was paradoxical and may reflect issues with the module design or the measurement tool. The module duration is longer than that reported in the literature and demonstrates effectiveness in increasing pain neurophysiology knowledge.

Pragmatic Implementation of a Stratified Primary Care Model for Low Back Pain Management in Outpatient Physical Therapy Settings: Two-Phase, Sequential Preliminary Study.

The effectiveness of risk stratification for low back pain (LBP) management has not been demonstrated in outpatient physical therapy settings. The purposes of this study were: (1) to assess implementation of a stratified care approach for LBP management by evaluating short-term treatment effects and (2) to determine feasibility of conducting a larger-scale study. This was a 2-phase, preliminary study. In phase 1, clinicians were randomly assigned to receive standard (n=6) or stratified care (n=6) training. Stratified care training included 8 hours of content focusing on psychologically informed practice. Changes in LBP attitudes and beliefs were assessed using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS). In phase 2, clinicians receiving the stratified care training were instructed to incorporate those strategies in their practice and 4-week patient outcomes were collected using a numerical pain rating scale (NPRS), and the Oswestry Disability Index (ODI). Study feasibility was assessed to identify potential barriers for completion of a larger-scale study. In phase 1, minimal changes were observed for PABS-PT and HC-PAIRS scores for standard care clinicians (Cohen d=0.00-0.28). Decreased biomedical (-4.5±2.5 points, d=1.08) and increased biopsychosocial (+5.5±2.0 points, d=2.86) treatment orientations were observed for stratified care clinicians, with these changes sustained 6 months later on the PABS-PT. In phase 2, patients receiving stratified care (n=67) had greater between-group improvements in NPRS (0.8 points; 95% confidence interval=0.1, 1.5; d=0.40) and ODI (8.9% points; 95% confidence interval=4.1, 13.6; d=0.76) scores compared with patients receiving standard physical therapy care (n=33). In phase 2, treatment was not randomly assigned, and therapist adherence to treatment recommendations was not monitored. This study was not adequately powered to conduct subgroup analyses. In physical therapy settings, biomedical orientation can be modified, and risk-stratified care for LBP can be effectively implemented. Findings from this study can be used for planning of larger studies.

A comparison of the attitudes toward chronic low back pain in Saudi, Australian and Brazilian physical therapy students

Abstract Objectives The study aimed to: 1) translate the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) questionnaire into Arabic version; 2) investigate the attitudes and beliefs of Saudi physical therapy students toward chronic Low Back Pain (LBP); and 3) compare the HC-PAIRS scores of our students with those of Brazilian and Australian students from published data. Methods A back-translated Arabic version of the HC-PAIRS questionnaire was distributed to 150 students from the 2nd, 3rd, and 4th years and was collected immediately upon completion. Published data for Brazilian and Australian students were compared with data from our students. Analyses of variance were used for all comparisons of the HC-PAIRS scores. Results Response rate was 90%. No significant differences were found in the HC-PAIRS scores between students with chronic LBP and those without ( P ≥ .10) or between students at different year levels ( P ≥ .10). There were significant differences between our Saudi students and Brazilian and Australian students in the total score and all dimensions of HC-PAIRS ( P Conclusion This is the first study to translate HC-PAIRS into Arabic language. Compared with Brazilian and Australian students, Saudi physical therapy students agreed more strongly with the notion that chronic LBP leads to impairment and disability.