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Christe G1, Pichonnaz C1
1School of Health Science (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Department of Physiotherapy, Lausanne, Switzerland
Background: Since management strategies and advices rely strongly on health professionals' attitudes and beliefs about back pain, changing common misconceptions among health care providers should be a priority to promote evidenced-based management of this condition. Moreover, health professionals can have an important impact on patients' beliefs, which in turn can modulate their pain, disability, coping strategies and behaviours. Understanding better the influence of training on physiotherapists' conceptions about back pain is thus a prerequisite to improve patient care. However, there is a paucity of data on entry-level physiotherapy students' attitudes and beliefs about back pain, and on the impact of training on them.
Purpose: To investigate physiotherapy students' attitudes and beliefs about back pain and their evolution through physiotherapy training.
Methods: A survey was conducted in one physiotherapy school in Switzerland during the 2017-2018 academic year. The Back-Pain Attitudes Questionnaire, which rates unhelpful attitudes and beliefs on a scale from 34 to 170 (the higher the score, the more unhelpful beliefs), was completed by 1st year students at the beginning of the second semester, by 2nd year students before and after a back pain management module and by 3rd year students at the end of training. Mean, standard deviations (SD) and 95% confidence intervals (95% CI) were calculated.
Results: The survey was completed by 121 students [mean (SD) age 23.2 (2.6), 66% female, participation rate 87.7%]. First and 2nd year before back pain module mean scores were 94.8 (95% CI 91.2 to 98.3) and 95.6 (90.9 to 100.3). After the module, the score decreased by 29% to 68.2 (64.9 to 71.5), which was maintained at the end of the 3rd year [mean score 62.2 (56.9 to 67.5)]. Pre-module unhelpful beliefs, suggesting the vulnerability of the back, the need to protect the back and the special nature of back pain, positively changed. Additionally, pre-module positive beliefs, such as the lack of relation between pain and injury, the positive impact of activity participation and the good prognosis of back pain, were strengthened.
Conclusion(s): Physiotherapy students' attitudes and beliefs changed positively during the Bachelor curriculum. At the end of the 3rd year, the back was no more considered as a vulnerable structure that needs protection (such as good back posture) and movements were considered positive and safe (such as lifting without bending the knees or vigorous physical activity). The beliefs that patients with back pain need a specific diagnostic and should always see a health professional largely decreased. Further research should investigate how these beliefs influence patients' management and outcomes.
Implications: A targeted training that stresses helpful messages about back pain, such as its capacity to tolerate loads and adapt through movement and exercises, seems required to improve student attitudes and beliefs toward evidence-based knowledge. This strategy appears to be effective in ensuring that the attitudes and beliefs of entry-level physiotherapists are consistent with current recommendations at the end of training. These results are encouraging as this is a prerequisite to address adequately patients' common misconceptions about back pain, and improve management strategies.
Keywords: physiotherapy education, back pain, beliefs
Funding acknowledgements: This study was not funded.
Purpose: To investigate physiotherapy students' attitudes and beliefs about back pain and their evolution through physiotherapy training.
Methods: A survey was conducted in one physiotherapy school in Switzerland during the 2017-2018 academic year. The Back-Pain Attitudes Questionnaire, which rates unhelpful attitudes and beliefs on a scale from 34 to 170 (the higher the score, the more unhelpful beliefs), was completed by 1st year students at the beginning of the second semester, by 2nd year students before and after a back pain management module and by 3rd year students at the end of training. Mean, standard deviations (SD) and 95% confidence intervals (95% CI) were calculated.
Results: The survey was completed by 121 students [mean (SD) age 23.2 (2.6), 66% female, participation rate 87.7%]. First and 2nd year before back pain module mean scores were 94.8 (95% CI 91.2 to 98.3) and 95.6 (90.9 to 100.3). After the module, the score decreased by 29% to 68.2 (64.9 to 71.5), which was maintained at the end of the 3rd year [mean score 62.2 (56.9 to 67.5)]. Pre-module unhelpful beliefs, suggesting the vulnerability of the back, the need to protect the back and the special nature of back pain, positively changed. Additionally, pre-module positive beliefs, such as the lack of relation between pain and injury, the positive impact of activity participation and the good prognosis of back pain, were strengthened.
Conclusion(s): Physiotherapy students' attitudes and beliefs changed positively during the Bachelor curriculum. At the end of the 3rd year, the back was no more considered as a vulnerable structure that needs protection (such as good back posture) and movements were considered positive and safe (such as lifting without bending the knees or vigorous physical activity). The beliefs that patients with back pain need a specific diagnostic and should always see a health professional largely decreased. Further research should investigate how these beliefs influence patients' management and outcomes.
Implications: A targeted training that stresses helpful messages about back pain, such as its capacity to tolerate loads and adapt through movement and exercises, seems required to improve student attitudes and beliefs toward evidence-based knowledge. This strategy appears to be effective in ensuring that the attitudes and beliefs of entry-level physiotherapists are consistent with current recommendations at the end of training. These results are encouraging as this is a prerequisite to address adequately patients' common misconceptions about back pain, and improve management strategies.
Keywords: physiotherapy education, back pain, beliefs
Funding acknowledgements: This study was not funded.
Topic: Education; Musculoskeletal: spine
Ethics approval required: No
Institution: Swiss Ethics
Ethics committee: Commission cantonale d''éthique de la recherche sur l''être humain Vaud
Reason not required: No health related data was acquired during this project (Req-2018-00146).
All authors, affiliations and abstracts have been published as submitted.
