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Physiotherapists’ knowledge, attitude and practice behavior to prevent chronification in patients with non-specific, non-traumatic, acute- and subacute neck pain: A qualitative study

Background: The purpose of this study was to explore physiotherapists’ knowledge, attitude, and practice behavior in assessing and managing patients with non-specific, non-traumatic, acute- and subacute neck pain, with a focus on prognostic factors for chronification. Method: A qualitative study using in-depth semi-structured interviews was conducted with 13 physiotherapists working in primary care. A purposive sampling method served to seek the broadest perspectives. The knowledgeattitude and practice framework was used as an analytic lens throughout the process. Textual data were analyzed using qualitative content analysis with an inductive approach and constant comparison. Results: Seven main themes emerged from the data; physiotherapists self-estimated knowledge and attitude, role clarity, therapeutic relationship, internal- and external barriers to practice behavior, physiotherapists’ practice behaviors, and self-reflection. These findings are presented in an adjusted knowledge-attitude and practice behavior framework. Conclusion: A complex relationship was found between a physiotherapist’s knowledge about, attitude, and practice behavior concerning the diagnostic process and interventions for non-specific, non-traumatic, acute, and subacute neck pain. Overall, physiotherapists used a biopsychosocial view of patients with non-specific neck pain. Physiotherapists’ practice behaviors was influenced by individual attitudes towards their professional role and therapeutic relationship with the patient, and individual knowledge and skills, personal routines and habits, the feeling of powerlessness to modify patients’ external factors, and patients’ lack of willingness to a biopsychosocial approach influenced physiotherapists’ clinical decisions. In addition, we found self-reflection to have an essential role in developing self-estimated knowledge and change in attitude towards their therapeutic role and therapist-patient relationship.

Knowledge and attitudes toward musculoskeletal pain neuroscience of manual therapy postgraduate students in the Netherlands

Background: Health care practitioners' knowledge and attitudes influence patients’ beliefs and health outcomes in musculoskeletal (MSK) pain. It is unclear to what extent physiotherapists undertaking a postgraduate master in manual therapy (MT students) possess the knowledge and attitudes toward pain neuroscience to be able to apply the biopsychosocial model in patients with MSK pain. Objectives: The aim of this study was to assess the knowledge and attitudes toward pain neuroscience in MT students. Design: A cross-sectional study. Method: Self-reported knowledge and attitudes were measured among students (n = 662) at baseline and in all years of the MT postgraduate programs in the Netherlands. The Knowledge and Attitudes of Pain questionnaire (KNAP) was used as a primary measure. Difference in KNAP-scores between baseline (0), year 1, year 2 and year 3 was tested using a one-way ANOVA (hypothesis: 0 < 1

Healthy development of children: a spiral of (dis)engagement?

Background: Healthy development of children is under pressure. While governments, schools and organizations are trying to stimulate physical activity in children, reduce overweight and improve motor skills, they are facing challenges in finding effective strategies. The model proposed by Stodden et al. (2008) is an interesting framework for studying healthy development of children, as it encompasses the physical aspect (motor skill competence, physical fitness, weight status), the mental aspect (perceived competence) and a behavioral component (physical activity). Importantly, it acknowledges the developmental stages of children by including age. Therefore, this model serves as the basis for this study in which we are looking for insights to effectively influence healthy development of children. Methods and Results: We measured these five variables in a large sample (N > 1000) of children in the Netherlands (age: 4-12, 50% girls). Through structural equation modeling we searched for cross-sectional as well as 1-year longitudinal relationships. Our results showed concurrent relationships between all variables and a tipping point at which relationships emerged or strengthened. The results indicated that targeting motor competence at a young age might be a feasible way to ensure continued participation in physical activities. However, longitudinal analyses revealed no effect of motor skill competence (T1) on physical activity (T2). Physical fitness appeared to be more important as a potential mediator than perceived motor competence. As a follow-up study, the five variables will be analyzed via a person-centered approach (latent profile analyses). This will guide us towards tailoring future interventions to the specific needs of subgroups of children. Analyses of this study are ongoing and will be presented at the conference. Conclusions: Our multiple analyses have shed additional light on the complexity of healthy development of children. In the upcoming presentation we will unite our study findings and delineate implications for developing effective strategies.

Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators - A scoping review

The use of the biopsychosocial model in primary care physiotherapy for chronic pain is far from the recommendations given in research and current guidelines. To understand why physiotherapists have difficulty implementing a biopsychosocial approach, more insight is needed on the barriers and facilitators. This scoping review aimed to investigate and map these barriers and facilitators that physiotherapists working in primary care reportedly face when treating patients with chronic musculoskeletal pain from a biopsychosocial perspective. Four electronic databases (PubMed, Embase, CINAHL and ERIC) and the grey literature were searched. Studies were included if they investigated the experiences of physiotherapists in the treatment of chronic pain from a biopsychosocial perspective in primary care. Extracted data were discussed and sub grouped in themes following a qualitative content analysis approach. To align with current use of theories on behavior change, the resulting themes were compared to the Theoretical Domains Framework. After screening, twenty-four studies were included. Eight groups of barriers and facilitators were identified, thematically clustered in six themes: knowledge, skills, and attitudes; environmental context and resources; role clarity; confidence; therapeutic alliance; and patient expectations. The results of this review can be used to inform the development of implementation programs.

Construct validity of functional capacity tests in healthy workers

Background: Functional Capacity (FC) is a multidimensional construct within the activity domain of the International Classification of Functioning, Disability and Health framework (ICF). Functional capacity evaluations (FCEs) are assessments of work-related FC. The extent to which these work-related FC tests are associated to bio-, psycho-, or social factors is unknown. The aims of this study were to test relationships between FC tests and other ICF factors in a sample of healthy workers, and to determine the amount of statistical variance in FC tests that can be explained by these factors. Methods: A cross sectional study. The sample was comprised of 403 healthy workers who completed material handling FC tests (lifting low, overhead lifting, and carrying) and static work FC tests (overhead working and standing forward bend). The explainable variables were; six muscle strength tests; aerobic capacity test; and questionnaires regarding personal factors (age, gender, body height, body weight, and education), psychological factors (mental health, vitality, and general health perceptions), and social factors (perception of work, physical workloads, sport-, leisure time-, and work-index). A priori construct validity hypotheses were formulated and analyzed by means of correlation coefficients and regression analyses. Results: Moderate correlations were detected between material handling FC tests and muscle strength, gender, body weight, and body height. As for static work FC tests; overhead working correlated fair with aerobic capacity and handgrip strength, and low with the sport-index and perception of work. For standing forward bend FC test, all hypotheses were rejected. The regression model revealed that 61% to 62% of material handling FC tests were explained by physical factors. Five to 15% of static work FC tests were explained by physical and social factors. Conclusions: The current study revealed that, in a sample of healthy workers, material handling FC tests were related to physical factors but not to the psychosocial factors measured in this study. The construct of static work FC tests remained largely unexplained.

De bio-psychosociale paradox