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Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz

  • November 2018
  • Conference: 3. Forschungssymposium Physiotherapie der Deutschen Gesellschaft für Physiotherapiewissenschaft (DGPTW)
  • At: Universität Lübeck
Authors:
Daniel Riese at Kliniken Valens
Daniel Riese
Anna-Lena Englert at Landeskrankenhaus
Anna-Lena Englert
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Überzeugungen und Einstellungen
von Physiotherapeuten/-innen zu
chronischen Rückenschmerzen in
Deutschland, Österreich und der
deutschsprachigen Schweiz
Daniel Riese, PT MSc
Kliniken Valens, Valens (CH); Akademischer Physioverband CH
Anna-Lena Englert, PT MSc
Rheinhessen-Fachklinik Alzey, Bad Kreuznach
Marcel Kluge, PT MSc
Klinik Lengg AG, Zürich
Gerhard Mayer, PT MSc
Traunstein D
Forschungssymposium
Physiotherapie
Lübeck, 17. November 2018
Agenda
1. Hintergrund
2. Forschungsfragen
3. Methoden
4. Ergebnisse
5. Interpretation/Diskussion
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
Hintergrund
»Grossteil von Kreuzschmerzen
haben keine spezifische
mechanische Ursache (Maher et al.
2017)
»Angst und kinesiophobes
Verhalten von Patienten mit
Kreuzschmerzen haben
möglicherweise einen großen
negativen Einfluss (Wertli et al. 2014a;
Wertli et al. 2014b; Morton et al. 2018)
»Kinesiophobe Einstellungen von
PTs können großen Einfluss auf
die Behandlung und auch auf die
Überzeugungen des Patienten
selber (Gardner et al. 2017; Darlow et al. 2012)
»Weiterhin zeigt sich, dass PTs mit
kinesiophoben Einstellungen
dazu neigen, Patienten mit
Kreuzschmerzen mehr
Restriktionen aufzuerlegen (Gardner
et al. 2017; Darlow et al. 2012; Lakke et al. 2015)
»Die langfristigsten, effektivsten, konservativen
Therapien und Empfehlungen bei Patienten
mit chronischen Kreuzschmerzen sind
Übungen, Kräftigung und aktiv bleiben (Traeger
et al. 2017; Shiri et al. 2018; Geneen et al. 2017; Maher et al. 2017)
Hintergrund
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
»Es ist allgemein belegt, dass das
biomedizinische Modell bei der Erklärung
chronischer Schmerzen im Bewegungsapparat
nicht ausreichend ist. Obwohl viele PTs in
ihrem Verständnis weiterentwickelt sind und
eine breite biopsychosoziale Sichtweise in
Bezug auf chronische Schmerzkrankheiten
anwenden, hat die Mehrheit der PTs ein
biomedizinisch ausgerichtete Ausbildung
erhalten (Nijs et al. 2013)
PSYCHO
BIO
SOCIAL
Forschungsfragen & Methode
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
»Studiendesign
•Querschnittsstudie mittels Online-Fragebogen
»Einschluss
•PTs
•Arbeitsland D, AT oder deutschsprachige CH
•Auszubildende/Studenten ab dem 2. Jahr/3. Semester
»Sind kinesiophobe Einstellung bei PTs in D, AT, und der CH in
Bezug auf die Behandlung von Patienten mit Kreuzschmerzen
vorhanden?
•Welchen Einfluss haben soziodemografische Faktoren auf mögliche kinesiophobe
Einstellungen bei PTs?
•Welchen Einfluss hat die Behandlungspräferenz von PTs auf mögliche
kinesiophobe Einstellungen bei PTs?
»Rekrutierung
•18.02. –15.04.2018 (8 Wochen)
• E-Mail Anschreiben zufällige Auswahl
•Veröffentlichen der Umfrage auf „social media“-
Facebook (diverse PT-Foren), Twitter
• Physio Deutschland informierte Mitglieder
Forschungsfragen & Methode
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
»Erhebung Deskriptive Daten
•Alter, Geschlecht, Berufserfahrung, Arbeitsland
•Höchster Abschluss als PT oder in einem PT-
assoziierten Studium
•MT-Abschluss (über min. 260 UE)
•Anteil an Hands-ON/OFF-Arbeit bei Patienten mit
chronischen Kreuzschmerzen
DAT CH
Praxen 663 494 380
Klinken 110 56 22
Schulen 176 16 2
Forschungsfragen & Methode
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
»Messimnstrument
•Tampa Scale of Kniesiophobia for Healthcareprofessionals
Forschungsfragen & Methode
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
»Messimnstrument
•Tampa Scale of Kniesiophobia for Healthcareprofessionals
Valider und zuverlässiger Selbsteinschätzungs-Fragebogen zur
Messung eigener Überzeugungen und Einstellungen in Bezug auf die
Behandlung von Patienten mit chronischen Kreuzschmerzen
(Moran et al. 2017; Laekeman et al. 2009)
Die interne Konsistenz des TSK-HC ist gut (Cronbach alpha=.81)
(Houben et al. 2005b; Houben et al. 2005a)
Höhere Werte stellen eine stärkere Bedenken hinsichtlich der Gefahr
von Rückenverletzungen durch körperliche Aktivität dar
(Lakke et al. 2015)
Verschiedene bisherige Arbeiten und Literatur geben einen Cut-Off-
Wert für Kinesiophobische Einstellungen von 37 –40 Punkten an
Tampa Scale of Kinesiophobia Deutsche Version © Abt für Medizinische Psychologie Ruhr Universität Bochum
Deskription der TN
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
1220
71%
235
14%
265
15%
Arbeitsland
629
37%
1091
63%
Geschlecht
Ja
899
52%
Nein
821
48%
Abschluss MT
BFS/HF
1027
60%
BFS
(Ausb)
168
10%
Akadem
438
25%
Im
Studium
87
5%
Art des Abschlusses
0-25
378
22%
26-50
456
27%
51-75
589
34%
76-100
297
%iger Anteil Arbeit Hands-On
Deskription der TN
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
1220
71%
235
14%
265
15%
Arbeitsland
629
37%
1091
63%
Geschlecht
Ja
899
52%
Nein
821
48%
Abschluss MT
BFS/HF
1027
60%
BFS
(Ausb)
168
10%
Akadem
438
25%
Im
Studium
87
5%
Art des Abschlusses
0-25
378
22%
26-50
456
27%
51-75
589
34%
76-100
297
%iger Anteil Arbeit Hands-On
TSK-HC
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
Mittelwerte (SD): Gesamt = 42.69 (12.6)
D= 45.18 (12.6)
AT = 40.62 (10.6)
CH = 33.02 (11.8)
TSK-HC –Art des Abschlusses
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
TSK-PT –Anteil Arbeit „Hands-On“
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in
Deutschland, Österreich und der deutschsprachigen Schweiz
TSK-PT –Anteil Arbeit „Hands-On“
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in
Deutschland, Österreich und der deutschsprachigen Schweiz
TSK-PT –Anteil Arbeit „Hands-On“
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in
Deutschland, Österreich und der deutschsprachigen Schweiz
TSK-HC -Berufserfahrung
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
TSK-HC -Regression
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
Quelle F p
Arbeit Hands-On 23.41 <.0001
Art Abschluss 6.50 <.0001
Land 5.47 <.0001
Abschluss MT 2.53 .028
Abschluss
MT*Arbeit
Hands-ON
2.83 .037
TSK-PT
R- Quadrat = .535
Alle anderen soziodemografischen Quellen
zeigen keinen signifikanten Einfluss.
Interpretation/Diskussion
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
Limitationen
»Rekrutierung nicht systematisch
•Keine genauen Angaben über
Herkunft
»Online-Survey
•Doppelte TN (trotz IP/Cookie-
Saver
» Definition Hands-On/Off
• Nicht genau definiert
Interpretation/Schlussfolgerung
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
Curricula von
Ausbildungen
Akademisierung
Selbstreflexion
Literatur/Referenzen
Überzeugungen und Einstellungen von Physiotherapeuten/-innen zu chronischen Rückenschmerzen in Deutschland, Österreich und der deutschsprachigen Schweiz
Darlow, B.; Fullen, B. M.; Dean, S.; Hurley, D. A.; Baxter, G. D.; Dowell, A. (2012): The
association between health care professional attitudes and beliefs and the attitudes and beliefs,
clinical management, and outcomes of patients with low back pain. A systematic review. In:
European journal of pain (London, England) 16 (1), S. 3–17. DOI:
10.1016/j.ejpain.2011.06.006.
Gardner, Tania; Refshauge, Kathryn; Smith, Lorraine; McAuley, James; Hübscher, Markus;
Goodall, Stephen (2017): Physiotherapists' beliefs and attitudes influence clinical practice in
chronic low back pain. A systematic review of quantitative and qualitative studies. In: Journal of
physiotherapy 63 (3), S. 132–143. DOI: 10.1016/j.jphys.2017.05.017.
Geneen, Louise J.; Moore, R. Andrew; Clarke, Clare; Martin, Denis; Colvin, Lesley A.; Smith,
Blair H. (2017): Physical activity and exercise for chronic pain in adults. An overview of
Cochrane Reviews. In: The Cochrane database of systematic reviews 1, CD011279. DOI:
10.1002/14651858.CD011279.pub2.
Houben, R. M. A.; Gijsen, A.; Peterson, J.; Jong, P. J. de; Vlaeyen, J. W. S. (2005a): Do health
care providers' attitudes towards back pain predict their treatment recommendations?
Differential predictive validity of implicit and explicit attitude measures. In: Pain 114 (3), S. 491–
498. DOI: 10.1016/j.pain.2005.01.017.
Houben, Ruud M. A.; Ostelo, Raymond W. J. G.; Vlaeyen, Johan W. S.; Wolters, Pieter M. J.
C.; Peters, Madelon; Stomp-van den Berg, Suzanne G. M. (2005b): Health care providers'
orientations towards common low back pain predict perceived harmfulness of physical activities
and recommendations regarding return to normal activity. In: European journal of pain (London,
England) 9 (2), S. 173–183. DOI: 10.1016/j.ejpain.2004.05.002.
Laekeman, M. A.; Sitter, H.; Oostendorp, R.A.B. (2009): 932 PHYSIOTHERAPY STUDENTS'
BELIEFS ABOUT HARMFULNESS OF PHYSICAL ACTIVITIES IN BACK PAIN PATIENTS. In:
European Journal of Pain 13, S264. DOI: 10.1016/S1090-3801(09)60935-6.
Lakke, Sandra E.; Soer, Remko; Krijnen, Wim P.; van der Schans, Cees P.; Reneman, Michiel
F.; Geertzen, Jan H. B. (2015): Influence of Physical Therapists' Kinesiophobic Beliefs on
Lifting Capacity in Healthy Adults. In: Physical therapy 95 (9), S. 1224–1233. DOI:
10.2522/ptj.20130194.
Maher, Chris; Underwood, Martin; Buchbinder, Rachelle (2017): Non-specific low back pain. In:
The Lancet 389 (10070), S. 736–747. DOI: 10.1016/S0140-6736(16)30970-9.
Moran, Robert W.; Rushworth, Wendy M.; Mason, Jesse (2017): Investigation of four self-report
instruments (FABT, TSK-HC, Back-PAQ, HC-PAIRS) to measure healthcare practitioners'
attitudes and beliefs toward low back pain. Reliability, convergent validity and survey of New
Zealand osteopaths and manipulative physiotherapists. In: Musculoskeletal science & practice
32, S. 44–50. DOI: 10.1016/j.msksp.2017.08.008.
Morton, L.; Bruin, M. de; Krajewska, M.; Whibley, D.; Macfarlane, G. J. (2018): Beliefs about
back pain and pain management behaviours, and their associations in the general population.
A systematic review. In: European journal of pain (London, England). DOI: 10.1002/ejp.1285.
Nijs, Jo; Roussel, Nathalie; van Paul Wilgen, C.; Köke, Albère; Smeets, Rob (2013): Thinking
beyond muscles and joints. Therapists' and patients' attitudes and beliefs regarding chronic
musculoskeletal pain are key to applying effective treatment. In: Manual therapy 18 (2), S. 96–
102. DOI: 10.1016/j.math.2012.11.001.
Shiri, Rahman; Coggon, David; Falah-Hassani, Kobra (2018): Exercise for the Prevention of
Low Back Pain. Systematic Review and Meta-Analysis of Controlled Trials. In: American journal
of epidemiology 187 (5), S. 1093–1101. DOI: 10.1093/aje/kwx337.
Traeger, Adrian; Buchbinder, Rachelle; Harris, Ian; Maher, Chris (2017): Diagnosis and
management of low-back pain in primary care. In: CMAJ : Canadian Medical Association
journal = journal de l'Association medicale canadienne 189 (45), E1386-E1395. DOI:
10.1503/cmaj.170527.
Wertli, Maria M.; Eugster, Rebekka; Held, Ulrike; Steurer, Johann; Kofmehl, Reto; Weiser,
Sherri (2014a): Catastrophizing-a prognostic factor for outcome in patients with low back pain.
A systematic review. In: The spine journal : official journal of the North American Spine Society
14 (11), S. 2639–2657. DOI: 10.1016/j.spinee.2014.03.003.
Wertli, Maria M.; Rasmussen-Barr, Eva; Weiser, Sherri; Bachmann, Lucas M.; Brunner, Florian
(2014b): The role of fear avoidance beliefs as a prognostic factor for outcome in patients with
nonspecific low back pain. A systematic review. In: The spine journal : official journal of the
North American Spine Society 14 (5), 816-36.e4. DOI: 10.1016/j.spinee.2013.09.036.
Taminaplatz 1
CH-7317 Valens
Daniel Riese
Physiotherapeut, MSc
daniel.riese@kliniken-valens.ch
+41 (0) 81 303 13 93
+41 (0) 78 648 98 42
ResearchGate has not been able to resolve any citations for this publication.
Beliefs about back pain and pain management behaviours, and their associations in the general population: A systematic review
Article
Full-text available
  • Jul 2018
Background and Objective Previous mass media campaigns have aimed to influence how people manage back pain, with mixed success. Campaigns should target beliefs which are related to the behaviours they aim to change. This systematic review brings together research that has measured the prevalence of beliefs about back pain in the general population and factors associated with these beliefs, including future pain‐related outcomes. Databases and Data Treatment Five databases were searched up until April 2017. Quantitative studies which reported a measure of agreement with a belief about back pain, cross‐sectional associations, or associations between beliefs and future outcomes were eligible. Eligibility was assessed and data extracted independently by two authors. Results were tabulated and narratively synthesised. Results Nineteen studies from 10 countries were eligible (median study n [IQR] = 990.5 [524.75‐2387.5]). Beliefs were measured using eight questionnaires and 57 stand‐alone items. Beliefs about back pain's negative consequences were common across countries and populations, whereas most samples did not hold fear‐avoidance beliefs. Beliefs about back pain's consequences were associated with pain and disability, but only one study investigated this specific relationship prospectively. No studies investigated whether beliefs are associated with future pain management behaviours. Agreement with certain beliefs (e.g. about negative consequences) was associated with sociodemographic characteristics (e.g. older age) and poorer self‐rated health. Conclusions Interventions may benefit from targeting beliefs about the perceived negative consequences of back pain in these populations. However, future research should explore how beliefs prospectively influence the management of back pain. This article is protected by copyright. All rights reserved.
Physiotherapists' beliefs and attitudes influence clinical practice in chronic low back pain: A systematic review of quantitative and qualitative studies
Article
Full-text available
  • Jun 2017
Question: What influence do physiotherapists' beliefs and attitudes about chronic low back pain have on their clinical management of people with chronic low back pain? Design: Systematic review with data from quantitative and qualitative studies. Quantitative and qualitative studies were included if they investigated an association between physiotherapists' attitudes and beliefs about chronic low back pain and their clinical management of people with chronic low back pain. Results: Five quantitative and five qualitative studies were included. Quantitative studies used measures of treatment orientation and fear avoidance to indicate physiotherapists' beliefs and attitudes about chronic low back pain. Quantitative studies showed that a higher biomedical orientation score (indicating a belief that pain and disability result from a specific structural impairment, and treatment is selected to address that impairment) was associated with: advice to delay return to work, advice to delay return to activity, and a belief that return to work or activity is a threat to the patient. Physiotherapists' fear avoidance scores were positively correlated with: increased certification of sick leave, advice to avoid return to work, and advice to avoid return to normal activity. Qualitative studies revealed two main themes attributed to beliefs and attitudes of physiotherapists who have a relationship to their management of chronic low back pain: treatment orientation and patient factors. Conclusion: Both quantitative and qualitative studies showed a relationship between treatment orientation and clinical practice. The inclusion of qualitative studies captured the influence of patient factors in clinical practice in chronic low back pain. There is a need to recognise that both beliefs and attitudes regarding treatment orientation of physiotherapists, and therapist-patient factors need to be considered when introducing new clinical practice models, so that the adoption of new clinical practice is maximised. [Gardner T, Refshauge K, Smith L, McAuley J, Hübscher M, Goodall S (2017) Physiotherapists' beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. Journal of Physiotherapy XX: XX-XX].
Investigation of four self-report instruments (FABT, TSK-HC, Back-PAQ, HC-PAIRS) to measure healthcare practitioners' attitudes and beliefs toward low back pain: Reliability, convergent validity and survey of New Zealand osteopaths and manipulative physiotherapists
Article
  • Aug 2017
Background: Healthcare practitioner beliefs influence advice and management provided to patients with back pain. Several instruments measuring practitioner beliefs have been developed but psychometric properties for some have not been investigated. Aims: To investigate internal consistency, test-retest reliability and convergent validity of the Fear Avoidance Beliefs Tool (FABT), the Tampa Scale of Kinesiophobia for Health Care Providers (TSK-HC), the Back Pain Attitudes Questionnaire (Back-PAQ), and the Health Care Pain and Impairment Relationship Scale (HC-PAIRS). A secondary aim was to explore beliefs of New Zealand osteopaths and physiotherapists regarding low back pain. Method: FABT, TSK-HC, Back-PAQ, and HC-PAIRS were administered twice, 14 days apart. Results: Data from 91 osteopaths and 35 physiotherapists were analysed. The FABT, TSK-HC and Back-PAQ each demonstrated excellent internal consistency, (Cronbach's α = 0.92, 0.91, and 0.91 respectively), and excellent test-retest reliability (lower limit of 95% CI for intraclass correlation coefficient >0.75). Correlations between instruments (Pearson's r = 0.51 to 0.77, p < 0.001) demonstrated good convergent validity. There was a medium to large effect (Cohen's d > 0.47) for mean differences in scores, for all instruments, between professions. Conclusions: This study found excellent internal consistency, test-retest reliability and good convergent validity for the FABT, TSK-HC, and Back-PAQ. Previously reported internal consistency, test-retest and convergent validity of the HC-PAIRS were confirmed, and test-retest reliability was excellent. There were significant scoring differences on each instrument between professions, and while both groups demonstrated fear avoidant beliefs, physiotherapist respondent scores indicated that as a group, they held fewer fear-avoidant beliefs than osteopath respondents.
The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: A systematic review
Article
It has been suggested that health care professional (HCP) attitudes and beliefs may negatively influence the beliefs of patients with low back pain (LBP), but this has not been systematically reviewed. This review aimed to investigate the association between HCP attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of this patient population. Electronic databases were systematically searched for all types of studies. Studies were selected by predefined inclusion criteria. Methodological quality was appraised and strength of evidence was determined. Seventeen studies from eight countries which investigated the attitudes and beliefs of general practitioners, physiotherapists, chiropractors, rheumatologists, orthopaedic surgeons and other paramedical therapists were included. There is strong evidence that HCP beliefs about back pain are associated with the beliefs of their patients. There is moderate evidence that HCPs with a biomedical orientation or elevated fear avoidance beliefs are more likely to advise patients to limit work and physical activities, and are less likely to adhere to treatment guidelines. There is moderate evidence that HCP attitudes and beliefs are associated with patient education and bed rest recommendations. There is moderate evidence that HCP fear avoidance beliefs are associated with reported sick leave prescription and that a biomedical orientation is not associated with the number of sickness certificates issued for LBP. HCPs need to be aware of the association between their attitudes and beliefs and the attitudes and beliefs and clinical management of their patients with LBP.
Do health care providers' attitudes towards back pain predict their treatment recommendations? Differential predictive validity of implicit and explicit attitude measures
Article
  • May 2005
The current study aimed to measure the differential predictive value of implicit and explicit attitude measures on treatment behaviour of health care providers. Thirty-six physiotherapy students completed a measure of explicit treatment attitude (Pain Attitudes And Beliefs Scale For Physiotherapists-PABS-PT) and a measure of implicit treatment attitude (Extrinsic Affective Simon Task-EAST). Furthermore, they gave treatment recommendations for a patient simulating back pain on three video scenes. The implicit and explicit measures of attitudes were only weakly related to each other. However, both were differentially related to treatment recommendations. The implications of the differential predictive value of implicit and explicit attitude measures for treatment behaviour are discussed.
  • Jan 2009
  • EUR J PAIN
  • 60935-60941
  • M A Laekeman
  • H Sitter
  • R A B Oostendorp
Laekeman, M. A.; Sitter, H.; Oostendorp, R.A.B. (2009): 932 PHYSIOTHERAPY STUDENTS' BELIEFS ABOUT HARMFULNESS OF PHYSICAL ACTIVITIES IN BACK PAIN PATIENTS. In: European Journal of Pain 13, S264. DOI: 10.1016/S1090-3801(09)60935-6.