Physiotherapists' knowledge, attitudes, and intolerance of uncertainty influence decision making in low back pain.
BACKGROUND
Low back pain (LBP) remains a common health problem that is characterized by ambiguity and can progress to chronic disability. In recent years researchers have started to focus on understanding whether and how the attitudes and beliefs of the health care providers influence the management and the outcome of LBP.


OBJECTIVE
The purpose of this study was to characterize Quebec physiotherapists' (PTs') knowledge, attitudes, and beliefs about LBP and their intolerance of uncertainty (IU) to determine whether and how these characteristics predict judgments of assessment and treatment recommendations.


METHODS
A total of 108 PTs from Quebec, Canada completed the Pain Attitudes and Beliefs Scale for Physiotherapists, the Fear of Pain Questionnaire, and the Intolerance of Uncertainty Scale. Participants also read 2 vignettes that described patients with LBP and reported their assessment and treatment recommendations.


RESULTS
Only 13 PTs (12%) were able to identify clinical practice guidelines for LBP. In addition, PTs did not generally agree with recommendations to return to work or activity. A biomedical orientation was a significant predictor of clinical judgments of spinal pathology and was associated with an increased sense of IU. In contrast, a behavioral approach better predicted treatment recommendations for return-to-work or activity. Finally, the association between IU and treatment decisions was mediated by treatment orientation.


CONCLUSIONS
Health care practitioners play a significant role in the management of LBP. Research on the process of knowledge translation, clinical decision making, and dealing with uncertainty to avoid aggravating LBP disability is clearly warranted.
Department of Physical Therapy, School of Allied Health Professionals, University of Texas Health Sciences Centre at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. simmondsm@uthscsa.edu
Maureen J
MJ
Simmonds
Tamar
T
Derghazarian
Johan W S
JW
Vlaeyen
D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D059825:Physical Therapists / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011287:Prejudice; D011361:Professional Competence / Q000706:statistics & numerical data*; D011792:Quebec; D055815:Young Adult