Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences - Physical Therapy Department

First Advisor

Josh Cleland

Second Advisor

Morey Kolber

Third Advisor

Jason Rodeghero

Publication Date / Copyright Date

2020

Publisher

Nova Southeastern University

Abstract

Introduction: Physical therapist attitudes and beliefs about low back pain (LBP) have been shown to influence patientbeliefs and affect clinician behavior. The purpose of this project was to investigate physical therapist attitudes and beliefsabout LBP, identify factors that influence those beliefs, and determine if attitudes and beliefs have an impact on patientoutcomes. Methods: This study was a retrospective cohort design that included a survey of physical therapists and thecollection of patient outcomes from Focus on Therapeutic Outcomes, Inc. (FOTO). Attitudes and beliefs were measured using the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Outcomes were measured using Computerized Lumbar Functional Scale change scores (CLFS), CLFS residual scores, number of visits, and Fear Avoidance Beliefs Scale physical activity subscale (FABQpa).

Results: Complete attitudes and beliefs scales were collected from 140 physical therapists. PABS-BM and PABS-BPS scores were predicted by a model that included age between 18 and 34, board certification, and NPQ scores. A multiple variate model could not be developed for HC-PAIRS scores, as NPQ score was the only significant predictor. A linear model containing HC-PAIRS scores and change in FABQpa scores predicted 16.1% of the variability in CLFS scores and 12.8% of the variability in thenumber of visits. HC-PAIRS was a univariate logistic predictor for a greater than expected CLFS change for the 10 patient cut-off sample. Receiver operating characteristic (ROC) curve identified an HC-PAIRS cut-off score of 30.50. This score had a sensitivity of .564 and specificity of .641. Scores on the PABS-PT scale were not multivariate predictors of any outcome measure.

Conclusion: Several factors predicted LBP-related attitudes and beliefs, with the most consistent predictor being knowledge of current pain science. The LBP attitudes and beliefs of physical therapists were not consistent predictors of outcomes. HC-PAIRS scores were found to be related to outcomes in 8 of the 33 performed analyses; however, this relationship was not in the predicted direction. Physical therapists who believed there was a stronger relationship between pain and disability had better outcomes.

Disciplines

Physical Therapy

Keywords

Attitudes, Back pain, Beliefs, HC-PAIRS, PABS-PT, Physical therapy

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