Wasif P1, Alsammak E2, Sorinola I1, Trinidad P3, Critchley DJ1
1King's College London, Department of Physiotherapy, London, United Kingdom, 2Ministry of Health, Department of Physiotherapy, Manama, Bahrain, 3Metropolitan College of Arts, Science & Technology, College of Physical Therapy, Manila, Philippines
Background: Low back pain (LBP) is a common condition resulting in significant suffering, disability and healthcare costs. Pain and disability in LBP are influenced by patients' and healthcare providers attitudes and beliefs. Healthcare providers beliefs influence their management choices and also beliefs of their patients. No study to date has reported attitudes and beliefs of healthcare providers towards LBP in Bahrain or if management recommendations accord with best practice guidelines.
Purpose: To explore attitudes, beliefs, knowledge, and reported clinical management recommendations of healthcare providers in Bahrain towards LBP.
Methods: This study was an analytic cross-sectional survey collecting quantitative data. Data from 100 registered healthcare providers in Bahrain managing LBP (51 general practitioners and 49 physiotherapists) working in private (n=64) and public (n=36) healthcare sectors were randomly sampled. Data collected were demographic and practice information, Back Beliefs Questionnaire (BBQ), Modified Health Care Pain and Impairment Relationship Scale (HC-PAIRS) to measure attitudes and beliefs and knowledge towards LBP and clinical management recommendations in response to a vignette of a patient with acute LBP. Two-way ANOVA and Chi-Square was used to analyse the data obtained SPSS version 24.
Results: BBQ scores for all healthcare providers were (Mean 32.48 ± SD 5.99). No significant difference between mean attitudes and beliefs of healthcare providers at α=.01 with respect to tenure (public 10.36±7.39 and private sector 11.64±10.53) (p=0.042), workplace (public 33.17±6.92 and private sector 32.09±5.45) (p=0.324), professional status (general practitioners 32.08±6.19 and physiotherapists 32.90±5.82) (p=0.344), gender (female 31.82±5.93 and male 34±6) (p=0.171) and postgraduate training (without training 31.84±6.35 and with training 33.53±5.39) (p=0.324). Mean HC-PAIRS scores were (49.99±8.31).There was a significant difference between healthcare providers knowledge of the relationship between LBP and physical function with respect to workplace where public sector clinicians have better HC-PAIRS scores (47.33±8.66) than private sector (51.48±7.78) (p=0.009).Healthcare providers in public sector were significantly more likely to report recommendations on working with LBP in line with guidelines than private sector (Median=2.25 and Median=1.61 respectively)(p 0.001).
Conclusion(s): Bahraini healthcare professionals' attitudes, beliefs and knowledge about LBP are associated with clinical recommendations independent of professional status, workplace, tenure or postgraduate training, similar to a study on cross-discipline healthcare students in western Australia. Public healthcare providers in Bahrain better understand the relationship between LBP and disability and are more in line with guidelines on work than private sector professionals. Majority of healthcare providers in Bahrain are broadly in line with LBP guidelines, similar to a UK survey results. These attitudes, beliefs and unhelpful reported behaviour recommendations are likely to result in non-ideal clinical practices; however, this would need to be investigated directly. This evidence will influence future studies to investigate whether approaches targeted at modifying attitudes and beliefs of healthcare providers in Bahrain can lead to change in beliefs and behaviours and better outcomes for patients with LBP.
Implications: Implications: This study suggests Bahrain healthcare providers, especially those in private practice, require further training on modern understanding of the relationship between LBP and disability. It also suggests development of evidence-based guidelines to LBP management might be beneficial for healthcare in Bahrain.
Keywords: Low back Pain, Attitudes and Beliefs, Guideline Recommendations
Funding acknowledgements: No funding was received for the work described in this article.
Purpose: To explore attitudes, beliefs, knowledge, and reported clinical management recommendations of healthcare providers in Bahrain towards LBP.
Methods: This study was an analytic cross-sectional survey collecting quantitative data. Data from 100 registered healthcare providers in Bahrain managing LBP (51 general practitioners and 49 physiotherapists) working in private (n=64) and public (n=36) healthcare sectors were randomly sampled. Data collected were demographic and practice information, Back Beliefs Questionnaire (BBQ), Modified Health Care Pain and Impairment Relationship Scale (HC-PAIRS) to measure attitudes and beliefs and knowledge towards LBP and clinical management recommendations in response to a vignette of a patient with acute LBP. Two-way ANOVA and Chi-Square was used to analyse the data obtained SPSS version 24.
Results: BBQ scores for all healthcare providers were (Mean 32.48 ± SD 5.99). No significant difference between mean attitudes and beliefs of healthcare providers at α=.01 with respect to tenure (public 10.36±7.39 and private sector 11.64±10.53) (p=0.042), workplace (public 33.17±6.92 and private sector 32.09±5.45) (p=0.324), professional status (general practitioners 32.08±6.19 and physiotherapists 32.90±5.82) (p=0.344), gender (female 31.82±5.93 and male 34±6) (p=0.171) and postgraduate training (without training 31.84±6.35 and with training 33.53±5.39) (p=0.324). Mean HC-PAIRS scores were (49.99±8.31).There was a significant difference between healthcare providers knowledge of the relationship between LBP and physical function with respect to workplace where public sector clinicians have better HC-PAIRS scores (47.33±8.66) than private sector (51.48±7.78) (p=0.009).Healthcare providers in public sector were significantly more likely to report recommendations on working with LBP in line with guidelines than private sector (Median=2.25 and Median=1.61 respectively)(p 0.001).
Conclusion(s): Bahraini healthcare professionals' attitudes, beliefs and knowledge about LBP are associated with clinical recommendations independent of professional status, workplace, tenure or postgraduate training, similar to a study on cross-discipline healthcare students in western Australia. Public healthcare providers in Bahrain better understand the relationship between LBP and disability and are more in line with guidelines on work than private sector professionals. Majority of healthcare providers in Bahrain are broadly in line with LBP guidelines, similar to a UK survey results. These attitudes, beliefs and unhelpful reported behaviour recommendations are likely to result in non-ideal clinical practices; however, this would need to be investigated directly. This evidence will influence future studies to investigate whether approaches targeted at modifying attitudes and beliefs of healthcare providers in Bahrain can lead to change in beliefs and behaviours and better outcomes for patients with LBP.
Implications: Implications: This study suggests Bahrain healthcare providers, especially those in private practice, require further training on modern understanding of the relationship between LBP and disability. It also suggests development of evidence-based guidelines to LBP management might be beneficial for healthcare in Bahrain.
Keywords: Low back Pain, Attitudes and Beliefs, Guideline Recommendations
Funding acknowledgements: No funding was received for the work described in this article.
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: King''s College London,Ministry of Health in Bahrain and Private sectors
Ethics committee: King’s Research Ethics Office & Ministry of Health Ethics
Ethics number: MR/17/18-218 & AURS/390/2018
All authors, affiliations and abstracts have been published as submitted.
