Doctor of Philosophy (PhD) in Physical Therapy
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College of Health Care Sciences - Physical Therapy Department
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Nova Southeastern University
Adam P. Rufa. 2020. Impact of Physical Therapist Attitudes and Beliefs on the Outcomes of Patients with Low Back Pain. Doctoral dissertation. Nova Southeastern University. Retrieved from NSUWorks, College of Health Care Sciences - Physical Therapy Department. (185)
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.
Attitudes, Back pain, Beliefs, HC-PAIRS, PABS-PT, Physical therapy