Changes in physiotherapy students' beliefs and attitudes about low back pain through pre-registration training

Abstract

Background: Implementation of best-practice care for patients with low back pain (LBP) is an important issue. Physiotherapists' who hold unhelpful beliefs are less likely to adhere to guidelines and may negatively influence their patients' beliefs. Pre-registration education is critical in moving towards a biopsychosocial model of care. This study aimed to investigate the changes in 2nd year physiotherapy students' beliefs about LBP after a module on spinal pain management and determine whether these changes were maintained at the end of academic training.

Methods: During three consecutive calendar years, this longitudinal cohort study assessed physiotherapy students' beliefs with the Back Pain Attitudes Questionnaires (Back-PAQ) in their 1st year, before and after their 2nd year spinal management learning module, and at the end of academic training (3rd year). Unpaired t-tests were conducted to explore changes in Back-PAQ score.

Results: The mean response rate after the spinal management module was 90% (128/143 students). The mean (± SD) Back-PAQ score was 87.73 (± 14.21) before and 60.79 (± 11.44) after the module, representing a mean difference of - 26.95 (95%CI - 30.09 to - 23.80, p < 0.001). Beliefs were further improved at the end of 3rd year (- 7.16, 95%CI - 10.50 to - 3.81, p < 0.001).

Conclusions: A spinal management learning module considerably improved physiotherapy students' beliefs about back pain. Specifically, unhelpful beliefs about the back being vulnerable and in need of protection were substantially decreased after the module. Improvements were maintained at the end of academic training one-year later. Future research should investigate whether modifying students' beliefs leads to improved clinical practice in their first years of practice.

Keywords: Biopsychosocial; Education; Low back pain; Psychological factors.

Fig. 1

Assessment of attitudes and beliefs during the physiotherapy program. Only information relevant to this study are included in the figure. BSc-1: first year students; BSc-2: second year students; BSc-3: third year students

Fig. 2

Back-PAQ scores at each study time point for the three cohorts with longitudinal data. Cohorts are named based on their start and end year of study (e.g 2019–2021 cohort is equivalent to 2019 BSc-1 and 2020 Bsc-2). *: p < 0.001; †:p < 0.005 (colours are related to the corresponding cohort)