Pain Attitudes And Beliefs Scale For Physiotherapists Research Articles

Identifying the low back pain-related attitudes, beliefs of Turkish physiotherapists’ and associated factors

Purpose The aim of the research is to determine the biomedical and biopsychosocial approaches of Turkish physiotherapists towards chronic non-specific low back pain (CNLBP) and related factors. Methods This research, planned as a cross-sectional study, was completed with the inclusion of 134 physiotherapists using the online survey method. Attitudes and beliefs of Turkish physiotherapists regarding CNLBP were evaluated using Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and Revised Neurophysiology of Pain Questionnaire (RNPQ). The characteristics of the participants were also evaluated. Spearman’s correlation and simple linear regression analysis were conducted between the characteristics and attitudes and beliefs of Turkish physiotherapists towards CNLBP. Results Simple linear regression analysis showed presence of training on low back pain (LBP) was associated with lower HC-PAIRS scores. Relationship between professional experience and the biomedical (r: −0.205, p: .018) and biopsychosocial orientation (r: −0.180, p: .038) was observed. Additionally, higher level of education was associated with higher RNPQ scores (r: 0.193, p: .025). Conclusions The results of the study show that factors such as education level, years of professional experience and receiving training on LBP affect Turkish physiotherapists’ attitudes and beliefs towards CN.

Translation, validity and reliability of the pain attitudes and beliefs scale for physiotherapists in French.

The Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) questionnaire evaluates manual therapists' biomedical and biopsychosocial beliefs regarding the management of chronic low back pain. Its usage in clinical settings is an important step in the implementation of national guidelines and policies to improve patient management. The objective of this study was to translate the PABS-PT questionnaire into French, to adapt it culturally, and to conduct a psychometric analysis. Qualitative and cross-sectional study. The translation process followed published guidelines with cross-cultural validation by an expert committee. We followed a forward and backward translation procedure and an expert committee, including the original author of the questionnaire and a linguistics expert ensuring good cultural adaptation, issued a finalised version. Psychometric analysis of the French version of the questionnaire was conducted among 390 French manual therapists in two phases. The first phase evaluated structural validity as well as external validity compared with the TSK and BBQ questionnaires. Then, reliability and scalability were analysed. The second phase evaluated test-retest reproducibility by sending the same questionnaire 3months later. The validity study revealed three subscales: the classic biomedical subscale and two subscales for biopsychosocial beliefs (aetiology of pain and physical activity). With 21 items in total for the PABS-PT-FR, the structural validity scores were good (BM: alpha=0.82, H=0.38; Physical Activity: alpha=0.62, H=0.32; Aetiology of Pain: alpha=0.55, H=0.29). This study provides a validated tool to assess French physiotherapists' and, more generally, healthcare providers' beliefs about chronic low back pain, with a new insight into the BPS subscale internal construct.

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.

Attitudes and beliefs towards low back pain (LBP) among physiotherapists in Spain

BackgroundThe aim of this study is to investigate the attitudes and beliefs of Spanish physiotherapists towards the diagnosis and management of low back pain (LBP). A descriptive, cross-sectional study was conducted according to STROBE guidelines from December 18, 2021, to May 2022. An online survey was developed based on Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), a reliable and validated self-administered instrument developed to assess the strength of two possible treatment orientations of physiotherapists towards the diagnosis and management of LBP. Respondents were selected through a non-probabilistic convenience sampling technique, and the selection criteria were (1) active physiotherapists with no restrictions on gender and length of service, (2) physical therapists who have worked in both public and private environments, and (3) physiotherapists who have been officially registered with no restriction on the place of practice in Spain. Survey data was obtained and analyzed using the SPSS Statistic 28 (IBM®) statistical software.ResultsThree hundred eighty-one questionnaires were finally included (F;n=151, M;n=230). In relation to the diagnosis, the respondents indicated that the tissue damage was sufficient to explain widespread and lasting pain, but rather that it was due to psychological factors. In addition, for those surveyed, the diagnosis should not focus exclusively on imaging tests but on clinical symptoms and signs. However, the weak relationship between objective damage and perceived pain intensity, as well as the weak relationship between posture and the development or worsening of LBP, did not seem to be clear to physiotherapists. From the point of view of treatment, we can indicate that professionals are committed to maintaining adequate and individualized physical activity as a first-line treatment in pain management.ConclusionsMost physiotherapists in Spain have up-to-date knowledge of the biopsychosocial model of pain care. However, regarding attitudes and beliefs towards LBP, there are still contents and behaviors based on spine protective paradigms that are not conducive to active pain management.

The Modified Back Beliefs Questionnaire as a tool to screen for incorrect beliefs regarding back pain: Cross-cultural adaptation and measurement properties

BackgroundThe Modified Back Beliefs Questionnaire (MBBQ) evaluates and screens for incorrect beliefs about low back pain (LBP). Although the MBBQ has been used to assess, its measurement properties remain unknown therefore, a rigorous cross-cultural validation is necessary. ObjectiveTo translate and cross-culturally adapt the MBBQ into Brazilian Portuguese and investigate its measurement properties. MethodsThe MBBQ was translated and cross-culturally adapted into Brazilian Portuguese. In the final stage of the cross-cultural adaptation process, the translated version was tested with 30 physical therapists to check the understanding of each item. Then, we evaluated the measurement properties in a sample of 100 physical therapists. We calculated test-retest reliability, internal consistency, standard error of the measurement (SEM) and minimal detectable change (MDC). The Pain Attitudes and Beliefs Scale for Physiotherapists (PABS.PT) was used in the construct validity analysis. ResultsThe reliability analysis showed high internal consistency, good to excellent test-retest reproducibility. Cronbach alpha coefficient for the MBBQ inevitability score was 0.80 and for the composite score 0.89. Intraclass correlation coefficient (ICC) for the Inevitability score was 0.67 (95%CI: 0.55 to 0.77) and 0.79 (95%CI: 0.70 to 0.86) for the composite score. The MBBQ inevitability and composite scores showed SEM of 1.9 and 2.4 points and minimal detectable change (MDC) of 5.1 and 6.7 points, respectively. Construct validity analyses showed moderate to excellent correlation of the MBBQ scores and the biomedical subscale of the PABS.PT. ConclusionsMBBQ showed acceptable measurement properties and may be considered a reliable and valid tool to assess physical therapists' beliefs about low back pain.

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.
 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).
 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>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).
 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.

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.

Does pain neuroscience education improve pain knowledge, beliefs and attitudes in undergraduate physiotherapy students?

To evaluate the effect of a brief pain neuroscience education (PNE) session on physiotherapy students' knowledge of pain and their beliefs and attitudes about the treatment of patients with chronic low back pain. This study was a single-center, cross-sectional study including 205 physiotherapy undergraduate students. The participants completed the Neurophysiology of Pain Questionnaire (NPQ) and Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). They then received a 70-min neuroscience education session covering the mechanisms and biopsychosocial aspects of chronic low back pain. The questionnaires were readministered immediately after the educational session and at 6 months posteducation. Our analysis included data from 156 participants (mean age: 20.9±2.51, 69.8% women) who completed the questionnaires pre-, post-, and 6 months after the educational session. To assess the effect of the education on the scores of the questionnaires, a repeated-measures ANOVA was conducted. There was a significant interaction observed for NPQ over time (p=0.00; η 2 =0.654), for PABS-PT factor 1(p<0.001; η2=0.50) and for PABS-PT factor 2 over time (p=0.02; η 2 =0.04) CONCLUSION: This study showed that a 70-min session of PNE improves the level of pain knowledge in undergraduate physiotherapy students and influences their beliefs and attitudes concerning chronic low back pain. These findings suggest that adding PNE to the curricula of physiotherapy and rehabilitation programs may be beneficial.

Pain Neurophysiology Knowledge Enhances Attitudes toward Biopsychosocial Management of Low Back Pain among Japanese Physical Therapists.

ABSTRACTObjectives:The aim of the current study was to investigate whether a postgraduate academic degree, longer clinical experience, and pain neurophysiology knowledge influence attitudes toward the balance between biomedical and biopsychosocial management of low back pain (LBP).Methods:Ninety Japanese physical therapists completed the revised Neurophysiology of Pain Questionnaire (revised NPQ), the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) questionnaire, and a survey on their degree qualifications and clinical experience. Their attitudes toward the balance between biomedical and biopsychosocial management of LBP were assessed using the mean biomedical scale scores divided by the mean biopsychosocial scale scores of the PABS-PT. Multiple regression modeling of the attitudes toward the balance between biomedical and biopsychosocial management of LBP was carried out using three independent variables: possession of an undergraduate or postgraduate academic degree, length of clinical experience, and the score on the revised NPQ.Results:Of the 90 therapists, 72 had an undergraduate degree and 18 also had a postgraduate degree. Only the revised NPQ score (β=−0.364, P <0.001) was a statistically significant contributing factor to attitudes toward the balance between biomedical and biopsychosocial management of LBP (R2=0.14). Neither having a postgraduate degree (β=0.017, P=0.871) nor the length of clinical experience (β=−0.107, P=0.303) had a significant effect.Conclusions:This study demonstrated that pain neurophysiology knowledge, but not the possession of a postgraduate academic degree or the length of clinical experience, promotes attitudes toward biopsychosocial management of LBP among Japanese physical therapists.

Pain Knowledge, Attitudes and Beliefs of Allied Health Learners Across Three Curricular Models

PurposeThe global burden of pain is considerable; therefore, all health professionals require comprehensive pain education. Pain education is essential and should be embedded in health professional curricula. This paper reports on pain knowledge, attitudes and beliefs changes of osteopathy learners undertaking pain education via three curricula models. MethodsOsteopathy learners undertook pain education via three different curricula models and at different time points in the course: Standard (Year 4 & 5), Integrated (Year 2 & 3) or Block (Year 1). Learners completed questionnaires at the start (T1) and end (T2) of the 2018 academic year. Evaluation included demographic information, Neurophysiology of Pain Questionnaire (NPQ) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). ResultsMatched data was received for 211 learners (40.5% response rate). Pain knowledge increased from T1 to T2 within all curricula models (p < 0.007) and between Block and Standard curricula models (p < 0.01). Differences in biomedical orientation scores for Block and Integrated (p < 0.01) and Block and Standard (p < 0.01) were found between groups, with Block model respondents recording the highest biomedical orientation scores. Differences in behavioural orientation score were found for Block and Standard (p < 0.01) with highest behavioural scores in the Integrated and Standard models. Cronbach's alpha was acceptable for PABS-PT Biomedical orientation score only (α = 0.71). T2 NPQ score was found to have a medium negative correlation with the T2 PABS-PT biomedical orientation score for all models, and with the behavioural orientation score for the integrated curriculum group (r = −0.31, p < 0.03). DiscussionThere were reductions in biomedical beliefs and increases in behavioural orientation scores as pain knowledge increased in each cohort over the 2018 academic year. However, osteopathy learners were also measured at different progress points and some measures have low reliability. Following these learner groups over time will enable further comparisons between these different curricula models.

Pain knowledge, attitudes and beliefs of Australian osteopaths drawn from a nationally representative sample of the profession

BackgroundPain has been identified as a global health issue with substantial effects on individuals and society. Health professionals managing pain complaints must have appropriate knowledge of pain neurophysiology, and attitudes and beliefs towards pain management that align with current practice guidelines. ObjectivesEvaluate Australian osteopaths' current level of knowledge of pain neurophysiology and their beliefs and attitudes towards pain, and explore associations with demographic variables. MethodAustralian osteopaths drawn from a nationally representative practice-based research network received the questionnaire. The questionnaire included demographic information, Neurophysiology of Pain Questionnaire (NPQ), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Attitudes to Back Pain Scale in Musculoskeletal Practitioners (ABS-mp). ResultsComplete responses were received from 211 osteopaths (21.3% response rate). The mean total NPQ score was equivalent to 72.2% correct responses. The PABS-PT Biomedical scale mean score was 38.8 ( ±9.1, α = 0.81) and the Biopsychosocial scale was 22.3 ( ±3.3, α = 0.38). ABS-mp mean factor scores suggest osteopaths support psychological approaches (22.1, ±3.3, α = 0.71) but endorsed more treatment sessions for those with back pain (15.9, ±4.7, α = 0.71). Trivial correlations between measures and most demographic variables were observed. Osteopaths who undertook further studies in pain had higher mean NPQ scores, with moderate negative correlations with a lower PABS-PT Biomedical subscale score (ρ = −0.45, p < 0.01). ConclusionsAustralian osteopaths demonstrate a range of pain neurophysiology knowledge, and beliefs and attitudes towards pain. The findings support the positive impact of professional development for improving pain knowledge in this population.

Can the Pain Attitudes and Beliefs Scales be adapted for use in the context of osteoarthritis with general practitioners and physiotherapists?

BackgroundConservative, first-line treatments (exercise, education and weight-loss if appropriate) for hip and knee joint osteoarthritis are underused despite the known benefits. Clinicians’ beliefs can affect the advice and education given to patients, in turn, this can influence the uptake of treatment. In New Zealand, most conservative OA management is prescribed by general practitioners (GPs; primary care physicians) and physiotherapists. Few questionnaires have been designed to measure GPs’ and physiotherapists’ osteoarthritis-related health, illness and treatment beliefs. This study aimed to identify if a questionnaire about low back pain beliefs, the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), can be adapted to assess GP and physiotherapists’ beliefs about osteoarthritis.MethodsThis study used a cross-sectional observational design. Data were collected anonymously from GPs and physiotherapists using an online survey. The survey included a study-specific demographic and occupational characteristics questionnaire and the PABS-PT questionnaire adapted for osteoarthritis. All data were analysed using descriptive statistics, and the PABS-PT data underwent principal factor analysis.ResultsIn total, 295 clinicians (87 GPs, 208 physiotherapists) participated in this study. The principal factor analysis identified two factors or subscales (categorised as biomedical and behavioural), with a Cronbach’s alpha of 0.84 and 0.44, respectively.ConclusionsThe biomedical subscale of the PABS-PT appears appropriate for adaptation for use in the context of osteoarthritis, but the low internal consistency of the behavioural subscale suggests this subscale is not currently suitable. Future research should consider the inclusion of additional items to the behavioural subscale to improve internal consistency or look to develop a new, osteoarthritis-specific questionnaire.Trial registrationThis trial was part of the primary author’s PhD, which began in 2012 and therefore this study was not registered.

Ontario Musculoskeletal Physiotherapists' Attitudes toward and Beliefs about Managing Chronic Low Back Pain.

Purpose: The purpose of this study was to explore Ontario musculoskeletal physiotherapists' attitudes toward and beliefs about managing chronic low back pain (CLBP), and their biomedical (BM) and bio-psychosocial (BPS) treatment orientation. Method: Through a link in the Ontario Physiotherapy Association newsletter, we administered an electronic survey to registered physiotherapists via SurveyMonkey. We used a modified three-step Dillman approach to encourage participation. The questionnaire included the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) measure, and demographic-practice items. Results: A total of 99 physiotherapists met the eligibility criteria and completed the PABS-PT (72.7% women; mean 17 years of experience). Respondents scored a mean of 26.98 (SD 7.69) on the BM sub-scale and 34.43 (SD 4.84) on the BPS sub-scale. Physiotherapists in public practice had a stronger BPS orientation (mean 36.52) than those in private practice (33.80; p=0.01). Less experienced physiotherapists (<10 y) had a higher BM sub-scale score (mean 29.33) than more experienced physiotherapists (25.24, p=0.013), and 78.8% of physiotherapists reported an awareness of clinical practice guidelines. Conclusions: Our preliminary findings suggest that Ontario physiotherapists' attitudes and beliefs align with a BPS orientation. Future studies should explore the impact of education that promotes a BPS approach to the management of CLBP.

Evaluation of pain knowledge and attitudes and beliefs from a pre-licensure physical therapy curriculum and a stand-alone pain elective

BackgroundAdequate pain education of health professionals is fundamental in the management of pain. Although an interprofessional consensus of core competencies for health professional pre-licensure education in pain have been established, the degree of their incorporation into physical therapy curriculum varies greatly. The purpose of this study was to 1. Assess students’ pain knowledge and their attitudes and beliefs in a pre-licensure physical therapy curriculum using a cross sectional comparison, and 2. Using a sub-sample of this population, we evaluated if an elective course on pain based on International Association for the Study of Pain (IASP) guidelines had an effect on students’ knowledge and beliefs.MethodsThe Neurophysiology of Pain Questionnaire (NPQ) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) was completed by first semester (n = 72) and final (n = 56) semester doctor of physical therapy (DPT) students. Final semester students completed surveys before and after participation in an elective course of their choosing (pain elective (PE) or other electives (OE)).ResultsParticipation rate was > 90% (n = 128/140). We found mean differences in NPQ scores between final semester (3rd year) students (76.9%) compared to first semester students (64%), p < 0.001. Third year students showed a mean difference on PABS-PT subscales, showing decreased biomedical (p < 0.001) and increased biopsychosocial (p = 0.005) scores compared to first semester students. Only final semester students that participated in the PE improved their NPQ scores (from 79 to 86%, p < 0.001) and demonstrated a significant change in the expected direction on PABS-PT subscales with increased biopsychosocial (p = 0.003) and decreased biological scores (p < 0.001).ConclusionsWe suggest that although core pre-licensure DPT education improves students’ pain knowledge and changes their attitudes towards pain, taking a IASP based pain elective continues to improve their pain neurobiology knowledge and also further changes their attitudes and beliefs towards pain. Therefore, a stand-alone course on pain in addition to pain concepts threaded throughout the curriculum may help ensure that entry-level DPT students are better prepared to effectively work with patients with pain.

(321) Physiotherapists’ Attitudes and Beliefs Towards Chronic Non-Specific Low Back Pain in Saudi Arabia

Chronic non-specific low back pain (CNSLBP) is one of the most widespread conditions affecting the population indiscriminately across the world. It is a considerable health problem and the main causes of disability and pain. It is a complex, multifactorial disorder and one of the most controversial conditions for clinicians, patients, and policy makers. Physiotherapists’ (PTs) attitudes and beliefs towards CNSLBP still unknown in Saudi Arabia (SA). The aim of this study was to identify PTs attitudes and beliefs towards NSLBP in SA. A cross sectional study was conducted using a convenience sample. An online survey was distributed from April to September 2018. Only participants working as physiotherapists in SA whether in clinical or academic settings were included. Data were collected regarding demographics, beliefs and attitudes towards NSLBP using the short form of Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). The short form of PABS-PT consisted of 19 items on a 6-point scale evaluating ‘biomedical’ and ‘biopsychosocial treatment orientation’ factors. Higher scores indicate a higher level of orientation. The data analysis was performed using IBM SPSS (v.24). A total of 299 PTs participated in this study. The majority of the participants were males (61.5%) and most of them had completed their bachelor's degree (54.5%). Most participants worked as a full time (79.9%) and more than half of them had experience less than 5 years (53.8%). The overall mean score for biomedical factor was 34.4 (SD 7.7) and overall mean score for biopsychosocial factor was 31.7 (SD 5.5). Overall mean score of both factors was mean 66.2 (SD 9.6). Among the 19 items of PABS-PT, the lowest three mean scores items were related to biopsychosocial orientation. Physiotherapists were found to have similar biomedical and biopsychosocial orientations in their attitudes and beliefs but both orientation scores were not high.

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.

Translation and psychometric evaluation of the Hebrew version of the Health Care Providers' Pain and Impairment Relationship Scale.

Physiotherapists' different attitudes towards low back pain (LBP) are associated with patients' attitudes towards pain and with patients' disability. The Health Care Providers' Pain and Impairment Relationship Scale (HC-Pairs) is a self-administered instrument that assesses the attitudes and beliefs of health care professionals regarding LBP and the patient's daily function. The aims of this study are to translate, culturally adapt, and asses the psychometric properties of the Hebrew version of the HC-Pairs. The English version of the HC-Pairs was forward-backward translated, pretested, and reviewed by a panel of experts. Reliability was determined by computing Cronbach's α, and validity by exploring the correlations between the HC-Pairs' scores and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) scores. Confirmatory factor analysis was performed. A convenience sample of 277 physiotherapists was invited to fill the HC-Pairs and PABS-PT questionnaires and a sociodemographic questionnaire. The forward-backward translation process revealed minor discrepancies between the texts. After the pretest, the expert panel agreed on a final version. A sample of 241 physiotherapists completed the questionnaires (response rate of 87%; 241/277); 213 met the inclusion criteria. Factor analysis suggests that the Hebrew version of the scale fits the one-factor model. Cronbach's α was 0.81 after deletion of two items and indicated good internal consistency. The scores produced by the instrument showed a substantial correlation with those of the biomedical dimension of the PABS-PT, and poor correlation with the behavioural dimension, in the expected directions. The findings of the present study on the psychometric properties of the HC-Pairs are positive. Nevertheless, the Hebrew version of the HC-Pairs is still in a developmental stage. Further psychometric research is needed to assess the attitudes and beliefs of Hebrew-speaking physiotherapists, which have been shown to be associated with treatment orientations and work recommendations.

The attitudes and beliefs of UK osteopaths towards the management of low back pain: A cross-sectional study

ObjectivesTo assess the biomedical (BM) and biopsychosocial (BM) attitudes and beliefs of osteopaths towards the management of low back pain (LBP) and whether this is associated with certain demographic variables. MethodsA cross-sectional survey of UK osteopaths was undertaken utilising the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS.PT), which assesses practitioners' treatment orientation (BPS or BM) in LBP management. A demographic questionnaire was used to assess the relationship with certain demographic variables. ResultsResponses were analysed from 107 osteopaths. The mean PABS.PT score for the BM scale was 32.41 (SD 6.32) and 31.99 (SD 4.09) for the BPS scale. There was a statistically significant, negative correlation between the scales. Most osteopaths recognised stress as a contributing factor to LBP and believed in the benefits of exercise for LBP but had diverse views regarding the relationships between pain and tissue damage. None of the demographic variables were associated with the PABS.PT scales. ConclusionOsteopaths' beliefs may indicate an acceptance of the BPS approach, but some still hold strong BM beliefs about pain, which may influence their clinical decision making. Future studies should investigate the impact of osteopaths’ beliefs on their clinical management of LBP.

Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'.

Background and aim: ‘Reasoning 4 Change’ (R4C) is a newly developed instrument, including four domains (D1–D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1–D4); inter-rater reliability (D2–D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (α range: 0.67–0.91), satisfactory test-retest reliability (ICC range: 0.46–0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94–1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06–0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.