Argentine physical therapists’ beliefs and attitudes towards the rehabilitation of patients with low back pain
A survey descriptive study
Abstract
Objective: To describe Argentine physical therapists’ beliefs, attitudes, and approaches towards the rehabilitation of patients with low back pain.
Materials and method: A descriptive, cross-sectional survey was carried out between March and May 2018. Through a non-probabilistic sampling, Argentine physical therapists were invited to participate via the SurveyMonkey ® online platform. The survey contained 21 questions, including multiple choice and open-ended questions.
Results: A total of 159 physical therapists completed the survey; of them, 129 (81.5%) reported having experienced low back pain in their lifetime. Of 134 physical therapists, 11 (8.2%) recommend resting, and 80 (60.4%) suggest limiting some movement. Of the physical therapists surveyed, 154 (96.8%) educate their patients, 131 (82.3%) highlight the importance of postural assessment, and 105 (66.1%) consider that a change in posture is part of treatment success. Work activity and psychosocial factors are considered the most relevant variables in the chronicity of low back pain. Nuclear magnetic resonance imaging and x-rays are the most used complementary studies.
Conclusion: Assessing posture is considered important by 82.5% of the physical therapists surveyed. Most allocate time of their sessions to educate their patients, and only 8.2% suggest resting. Between 12% and 21% of the physical therapists administer disability, fear of movement or catastrophizing questionnaires.
References
Vos T, Abajobir AA, Abbafati C, Abbas KM, Abate KH, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211–59.
Tousignant-Laflamme Y, Martel MO, Joshi AB, Cook C. Rehabilitation management of low back pain – it’s time to pull it all together! J Pain Res. 2017;2373–85.
Donelson R, McIntosh G, Hall H. Is It Time to Rethink the Typical Course of Low Back Pain? PM&R. 2012;4(6):394–401.
da C Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LOP. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012/05/14. 2012 Aug 7;184(11):E613–24.
O’Sullivan P. Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism. Man Ther. 2005;10(4):242–55.
Costa L da CM, Maher CG, McAuley JH, Hancock MJ, Herbert RD, Refshauge KM, et al. Prognosis for patients with chronic low back pain: inception cohort study. BMJ. 2009 Oct 6;339:b3829.
Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976). 2002;27(5):E109-20.
Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015; Apr;36(4):811-6.
Bernstein IA, Malik Q. Low back pain and sciatica : summary of NICE guidance. Br Med J. 2017;6748:10–3.
Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa G, Shekelle P, et al. Low Back Pain. J Orthop Sport Phys Ther [Internet]. 2012 Apr 1;42(4):A1–57.
Asavasopon S. Chronification of low back pain: getting to the spine of the problem. Braz J Phys Ther. 2018 Jan - Feb;22(1):1-6.
Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018 Sep;27(Suppl 6):796-801.
Gardner T, Refshauge K, Smith L, McAuley J, Hübscher M, Goodall S. Physiotherapists’ beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. J Physiother. 2017;63(3):132–43.
Petit A, Begue C, Richard I, Roquelaure Y. Factors influencing physiotherapists’ attitudes and beliefs toward chronic low back pain: Impact of a care network belonging. Physiother Theory Pract. 2019 May 4;35(5):437–43.
Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010 Dec;19(12):2075–94.
Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–83.
Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin C-WC, Chenot J-F, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791–803.
Villumsen M, Samani A, Jørgensen MB, Gupta N, Madeleine P, Holtermann A. Are forward bending of the trunk and low back pain associated among Danish blue-collar workers? A cross-sectional field study based on objective measures. Ergonomics. 2015;58(2):246–58.
Buchbinder R, van Tulder M, Öberg B, Costa LM, Woolf A, Schoene M, et al. Low back pain: a call for action. Lancet. 2018;391(10137):2384–8.
Darlow B. Beliefs about back pain: The confluence of client, clinician and community. Int J Osteopath Med. 2017;20:53–61.
Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014 May 1;14(5):816–836.e4.
Louw A, Diener I, Butler DS, Puentedura EJ. The Effect of Neuroscience Education on Pain, Disability, Anxiety, and Stress in Chronic Musculoskeletal Pain. Arch Phys Med Rehabil. 2011 Dec 1;92(12):2041–56.
O’Keeffe M, O’Sullivan PB, O’Sullivan K. Education can ‘change the world’: Can clinical education change the trajectory of individuals with back pain? Br J Sports Med. 2019 Feb 8. pii: bjsports-2018-100190.
O’Keeffe M, Maher CG, Stanton TR, O’Connell NE, Deshpande S, Gross DP, O’Sullivan K. Mass media campaigns are needed to counter misconceptions about back pain and promote higher value care. Br J Sports Med. 2019 Oct;53(20):1261-1262.
Darlow B, Dowell A, Baxter GD, Perry M. The Enduring Impact of What Clinicians Say to People With Low Back Pain. Ann Fam Med. 2013;527–34.
Darlow B, O’Sullivan PB. Why are back pain guidelines left on the sidelines? Three myths appear to be guiding management of back pain in sport. Br J Sports Med. 2016 Nov;50(21):1294-1295.
Nolan D, O’Sullivan K, Stephenson J, O’Sullivan P, Lucock M. What do physiotherapists and manual handling advisors consider the safest lifting posture, and do back beliefs influence their choice? Musculoskelet Sci Pract. 2018 Feb 1;33:35–40.
Chou R, Shekelle P. Will This Patient Develop Persistent Disabling Low Back Pain? JAMA. 2010 Apr 7;303(13):1295–302.
Preece SJ, Willan P, Nester CJ, Graham-Smith P, Herrington L, Bowker P. Variation in pelvic morphology may prevent the identification of anterior pelvic tilt. J Man Manip Ther. 2008;16(2):113–7.
Schmidt H, Bashkuev M, Weerts J, Graichen F, Altenscheidt J, Maier C, et al. How do we stand? Variations during repeated standing phases of asymptomatic subjects and low back pain patients. J Biomech. 2018 Mar 21;70:67–76.
Murrie VL, Dixon AK, Hollingworth W, Wilson H, Doyle TAC. Lumbar lordosis: Study of patients with and without low back pain. Clin Anat. 2003;16(2):144–7.
Nourbakhsh MR, Arab AM. Relationship Between Mechanical Factors and Incidence of Low Back Pain. J Orthop Sport Phys Ther. 2002 Sep 1;32(9):447–60.
Herrington L. Assessment of the degree of pelvic tilt within a normal asymptomatic population. Man Ther. 2011 Dec 1;16(6):646–8.
Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356–67.
Webster BS, Cifuentes M. Relationship of Early Magnetic Resonance Imaging for Work-Related Acute Low Back Pain With Disability and Medical Utilization Outcomes. J Occup Environ Med. 2010;52(9).
Darlow B, Forster BB, O’Sullivan K, O’Sullivan P. It is time to stop causing harm with inappropriate imaging for low back pain. Br J Sports Med. 2017;51(5):414–5.
Sloan TJ, Walsh DA. Explanatory and Diagnostic Labels and Perceived Prognosis in Chronic Low Back Pain. Spine (Phila Pa 1976). 2010;35(21).
Hart DL, Werneke MW, George SZ, Matheson JW, Wang Y-C, Cook KF, et al. Screening for Elevated Levels of Fear-Avoidance Beliefs Regarding Work or Physical Activities in People Receiving Outpatient Therapy. Phys Ther. 2009 Aug 1;89(8):770–85.
Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen EIntern Med. 1997 Jul;12(7):439–45.
Policastro PO, Navarro E, Novoa GA. Primera encuesta online sobre el abordaje kinésico de las afecciones de hombro en Argentina. AJRPT. 2019;1(1):11-20.
