Caneiro J.P.1,2, O'Sullivan P.1,2, Smith A.1, Ovrebekk I.R.1, Tozer L.1, Williams M.1,2, Teng M.L.1, Lipp O.V.3
1Curtin University, School of Physiotherapy and Exercise Science, Perth, Australia, 2Body Logic Physiotherapy Clinic, Perth, Australia, 3Curtin University, School of Psychology and Speech Pathology, Perth, Australia

Background: Persistent low back pain (PLBP) remains a major public health issue worldwide. Beliefs and attitudes about pain are significant predictors of PLBP disability. Beliefs that the back is easily harmed, hard to rehabilitate, and requires protection from bending and lifting are common in people with PLBP. A common example is that the back is vulnerable to injury when flexed, in spite of a lack of clear evidence to support these beliefs. Furthermore, fear-related beliefs around LBP are also prevalent amongst health care practitioners (HCPs). Previous research has shown that HCPs' beliefs strongly influence their patient's, which can lead to or reinforce avoidance behaviour.
Beliefs and attitudes can be assessed via explicit and implicit measures. Explicit measures require conscious awareness and reflection, being susceptible to self-report bias. Implicit measures however, are displayed more automatically due to reduced time for introspection. While several studies have investigated HCP's beliefs towards LBP, to our knowledge no studies have investigated implicit attitudes of physiotherapists specifically related to forward bending and lifting.

Purpose: The aims were to investigate implicit attitudes of physiotherapists in relation to perceived danger of bending and lifting with a round-back (vs. straight-back), and to assess whether these attitudes correlate with explicit beliefs.

Methods: Forty-seven (25 male) musculoskeletal physiotherapists participated in this study. Explicit beliefs were assessed with self-report measures of fear-avoidance (TSK-HC), back pain beliefs, (BPAQ) and explicit belief about bending with a round-back (EBB). An Implicit Association Test (IAT) was used to assess implicit attitudes toward bending and lifting with a round-back (vs. straight back) as either safe or dangerous. Correlations between outcome measures were examined using Pearson’s or Spearman Rho’s correlation analysis.

Results: The IAT results indicated an overall implicit bias towards bending and lifting with a round-back being dangerous (μ = 0.213, p=.003, CI: .075-.350). In contrast, only 29,8% of participants self-reported bending with a round-back as dangerous (EBB), 21,3% displayed fear-avoidant beliefs (TSK-HC), and on average the group presented positive back beliefs indicated by the BPAQ score (μ = 29.7, SD= 15.7). There was no significant correlation between the IAT and the TSK-HC (p=.658, r=.066) or the BPAQ (p=.058, r=-.279). The EBB correlated significantly with IAT (p=.006, r=.392), TSK-HC (p≤.001, r=.481), and BPAQ (p≤.001, r= -.619). There were also significant correlations between TSK-HC and BPAQ (p≤.001, r= -.597).

Conclusion(s): This group of physiotherapists displayed a negative implicit bias towards bending and lifting with a round-back (vs. straight-back) as dangerous, and explicit beliefs that bending with a round-back is safe. Implicit attitudes of bending and lifting correlated moderately with explicit belief about bending, but did not correlate with fear-avoidance or back pain beliefs.

Implications: Considering implicit attitudes influence behaviour, our findings that physiotherapists displayed stronger implicit attitudes toward bending and lifting with a round-back as dangerous may be indicative of their clinical behaviour in relation to these tasks. Future studies investigating whether implicit attitude is associated with physiotherapist’s clinical behaviours on bending and lifting advice may be warranted.

Funding acknowledgements: JP Caneiro is supported by Australian Postgraduate Awards (APA) and Curtin University Postgraduate (CUPS) Scholarships.

Topic: Professional practice: other

Ethics approval: The study protocol was approved by Curtin University’s Health Science Human Research Ethics Committee (approval number: HRE2016-0192).

All authors, affiliations and abstracts have been published as submitted.

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