Are They Complying? Physicians’ Knowledge, Attitudes, and Readiness to Change Regarding Low Back Pain Treatment Guideline Adherence

Epstein-Sher, Sheera; Jaffe, Dena H.; Lahad, Amnon

doi:10.1097/brs.0000000000001714

Cited by 21 publications

(20 citation statements)

References 32 publications

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“…Expertise in physiotherapy is achieved through formal education, as well as through years of clinical experience and on‐the‐job learning . Previous studies were inconclusive about whether seniority affects the attitudes of health care providers toward LBP: older and more experienced general practitioners exhibited more orthodox attitudes, but at the same time, experienced health care providers were shown to be less fearful of pain, which attests to more advanced psychosocial approaches. The latter finding in the current study appears to be the result of physiotherapists' abundant experience with LBP patients, and echoes the repeated evidence from nursing, according to which exposure to patients' pain results in desensitization to pain …”

Section: Discussionmentioning

confidence: 97%

“…Psychometric evaluations have shown that the internal consistency of the instrument is satisfactory (Cronbach's α = 0.78/0.84, respectively) and the validity of the HC‐Pairs has been proven adequate, as a measure showing the statistical association between beliefs about pain and impairment. This instrument was translated into Hebrew as part of a recent study …”

Section: Methodsmentioning

confidence: 99%

“…The attitudes, beliefs, and decision making of practitioners are influenced not only by work settings but by many additional factors, including their professional training, traditions, and clinical experience . A few studies have asked how participatory experience affects health professionals' attitudes toward LBP, but to the best of our knowledge, they did not explore the aspect of the day‐to‐day clinical experience specifically with patients suffering from LBP.…”

Section: Introductionmentioning

confidence: 99%

“…Studies assessed attitudes using PABS, found that general practitioners and physiotherapists who have been working longer than their colleagues were more likely to score high on the biomedical subscale of the PABS questionnaire . Physicians over the age of 50 had greater likelihood of leaning toward biomedical approaches (scored higher on HC‐Pairs) than their younger colleagues . By contrast, Simmonds et al found that physiotherapists who had more clinical experience were less fearful of pain, which attests to an inclination toward the psychosocial approach rather than the biomedical approach.…”

Section: Introductionmentioning

confidence: 99%

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Physiotherapists' attitudes toward low back pain treatment: Do work setting and clinical experience with low back patients matter?

Roitenberg

2018

Evaluation Clinical Practice

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Rationale, aims, and objectives: Physiotherapists' attitudes toward low back pain (LBP) are linked to patients' attitudes toward pain, chronicity, and disability. Nevertheless, there is a scarcity of studies exploring the variables associated with physiotherapists' attitudes. The present study seeks to explore whether there is an association between the physiotherapists' work setting and their attitudes toward LBP, whether there is an association between the physiotherapists' clinical experience with LBP patients and their attitudes toward LBP, and which variable best predicts physiotherapists' attitudes toward LBP.Method: A self-administered questionnaire was used to collect the data which included a socio-demographic section, self-reports about the work setting, and a clinical experience section. Participants also completed the 15-item Health Care Providers' Pain and Impairment Relationship Scale (HC-Pairs) questionnaire. The HC-Pairs is scored on a 7-point Likert scale, a high score indicating a stronger belief that pain limits daily function.Results: A total of 213 physiotherapists completed the questionnaire. The mean HC-Pairs score of community-orthopaedics physiotherapists was significantly lower than that of non community-orthopaedics physiotherapists (mean 44.02-+ 9.44 vs 48.69-+ 10.89, t = −3.29, P < 0.001) indicating that community-orthopaedics physiotherapists hold a weaker belief that pain limits daily function. Analysis suggests that there is a statistically significant difference in the mean HC-Pairs scores between the high-frequency and the low-frequency group (F = 4.688, P < 0.05) implicating that as physiotherapists experience more frequent encounters with LBP patients, their belief that pain limits daily function of these patients weakens. Work setting is the only variable that predicts the HC-Pairs scores.Conclusions: There is an association between physiotherapists' work setting and clinical experience with LBP patients and their attitudes toward LBP. These findings have implications for future educational programs for physiotherapists and suggest the need to adapt programs to the work setting of physiotherapists and to their level of clinical experience.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Physiotherapists' attitudes toward low back pain treatment: Do work setting and clinical experience with low back patients matter?

Roitenberg

2018

Evaluation Clinical Practice

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“…Practitioners' beliefs affect how they explain pain to the patient and what kind of care they choose [28,29]. Non-pharmacological treatment considering psychosocial factors is not given, as LBP guidelines and evidence suggest, if the attitudes and beliefs of the treating physician are biomedical [30]. It also matters which type of health care professional first sees the patient.…”

Section: Introductionmentioning

confidence: 99%

A classification-based approach to low back pain in primary care – protocol for a benchmarking controlled trial

et al. 2020

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Background: Guidelines recommend a biopsychosocial framework for low back pain (LBP) management and the avoidance of inappropriate imaging. In clinical practice, care strategies are often inconsistent with evidence and guidelines, even though LBP is the most common disabling health condition worldwide. Unhelpful beliefs, attitudes and inappropriate imaging are common. LBP is understood to be a complex biopsychosocial phenomenon with many known multidimensional risk factors (symptom-and lifestyle-related, psychological and social) for persistent or prolonged disability, which should be identified and addressed by treatment. The STarT Back Tool (SBT) was developed for early identification of individual risk factors of LBP to enable targeted care. Stratified care according SBT has been shown to improve the effectiveness of care in a primary care setting. A biopsychosocially-oriented patient education booklet, which includes imaging guidelines and information, is one possible way to increase patients' understanding of LBP and to reduce inappropriate imaging. Premeditated pathways, education of professionals, written material, and electronic patient registry support in health care organizations could help implement evidence-based care. Methods: We will use a Benchmarking Controlled Trial (BCT) design in our study. We will prospectively collect data from three health care regions before and after the implementation of a classification-based approach to LBP in primary care. The primary outcome will be change in PROMIS (Patient-Reported Outcomes Measurement Information System) (short form 20a) over 12-month follow-up. Discussion: The implementation of a classification-based biopsychosocial approach can potentially improve the care of LBP patients, reduce inappropriate imaging without increasing health-care costs, and decrease indirect costs by reducing work disability. Using the BCT we will be able to evaluate the effectiveness of the improvement strategy for the entire care pathway.

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Making exercise count: Considerations for the role of exercise in back pain treatment

Cashin

Booth

McAuley

et al. 2021

Musculoskeletal Care

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Introduction Chronic low back pain (CLBP) is pain that has persisted for greater than three months. It is common and burdensome and represents a significant proportion of primary health presentations. For the majority of people with CLBP, a specific nociceptive contributor cannot be reliably identified, and the pain is categorised as ‘non‐specific’. Exercise therapy is recommended by international clinical guidelines as a first‐line treatment for non‐specific CLBP. Aim This comprehensive review aims to synthesise and appraise the current research to provide practical, evidence‐based guidance concerning exercise prescription for non‐specific CLBP. We discuss detailed initial assessment and being informed by patient preferences, values, expectations, competencies and goals. Methods We searched the Cochrane Database of Systematic Reviews, PubMed and the Physiotherapy Evidence Database (PEDro) using broad search terms from January 2000 to March 2021, to identify the most recent clinical practice guidelines, systematic reviews and randomised controlled trials on exercise for CLBP. Results/Discussion Systematic reviews show exercise is effective for small, short‐term reductions in pain and disability, when compared with placebo, usual care, or waiting list control, and serious adverse events are rare. A range of individualised or group‐based exercise modalities have been demonstrated as effective in reducing pain and disability. Despite this consensus, controversies and significant challenges remain. Conclusion To promote recovery, sustainable outcomes and self‐management, exercise can be coupled with education strategies, as well as interventions that enhance adherence, motivation and patient self‐efficacy. Clinicians might benefit from intentionally considering their own knowledge and competencies, potential harms of exercise and costs to the patient. This comprehensive review provides evidence‐based practical guidance to health professionals who prescribe exercise for people with non‐specific CLBP.

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Are They Complying? Physicians’ Knowledge, Attitudes, and Readiness to Change Regarding Low Back Pain Treatment Guideline Adherence

Abstract: 3.

Cited by 21 publications

References 32 publications

Physiotherapists' attitudes toward low back pain treatment: Do work setting and clinical experience with low back patients matter?

Physiotherapists' attitudes toward low back pain treatment: Do work setting and clinical experience with low back patients matter?

A classification-based approach to low back pain in primary care – protocol for a benchmarking controlled trial

Making exercise count: Considerations for the role of exercise in back pain treatment

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