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Attitudes et croyances sous-jacentes des étudiants, des enseignants et des praticiens en ostéopathie à l’égard de la lombalgie non spécifique
Abstract
Les facteurs psychosociaux jouent un rôle essentiel dans le pronostic et la prise en charge des patients présentant une lombalgie non-spécifique (LNS). Les données scientifiques indiquent que les croyances d'un individu concernant la douleur sont associées aux attitudes et aux croyances du clinicien consulté. Cette étude a exploré les attitudes, croyances et orientations cliniques des étudiants, des nouveaux diplômés, des enseignants et praticiens non-enseignants issus de deux instituts français d'enseignement de l'ostéopathie en ce qui concerne la prise en charge de la LNS. Cette population a été étudiée au moyen d'une enquête transversale réalisée en ligne entre août et octobre 2021 comprenant un recueil des caractéristiques socio-démographiques, un questionnaire (Back-PAQ) et une vignette clinique. 798 participants ont répondu à l'enquête (556 étudiants, 47 nouveaux diplômés, 88 enseignants, 107 praticiens). Les résultats des étudiants au Back-PAQ ont montré une diminution progressive des scores (croyances plus adaptées) de la première année (113 ± 10,2) à la cinquième année (81,4 ± 12,1) (p < 0,001) avec une diminution plus importante entre les étudiants de 5ème année (81,4 ± 12,1) et les nouveaux diplômés (48,4 ± 7,5) (p < 0,001). Les orientations cliniques basées sur les questions de la vignette (score moyen : 1,7/3) étaient modérément corrélées au score du Back-PAQ (r =-0,489, p < 0,001). Ainsi, les participants ayant plus de croyances délétères étaient plus susceptibles d'encourager la limitation de l'activité physique ou professionnelle. Pour que les futurs cliniciens puissent aborder de manière adéquate les facteurs psychosociaux associés à la LNS, il semble crucial d'évaluer leurs attitudes pendant leur formation afin de mieux appréhender les croyances qui les sous-tendent.
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Social media are inevitably becoming part of our lives. The increasing popularity of these platforms revolutionized communication among healthcare workers and has irrevocably changed the terms of classic learning models. Pathologists all over the world are very active on social media making it a new pedagogical paradigm in pathology education. A virtual community of pathologists is constantly present especially on Twitter and Facebook for sharing and discussing interesting cases, reporting original scientific researcher's results, or simply energizing our field. Tunisian pathologists are not taking advantage of these platforms, some do not master the use of social media, others are reluctant about their use in the health field. However, it is of crucial importance for us Tunisian pathologists, especially in these times of social distancing due to SARS-COV2 pandemic, to join this virtual community and implement new ways of learning. This article aimed primary to assess the popularity of these platforms as a pedagogic tool among Tunisian pathologist. Secondly, we introduced the basic use and rules of social media, benefits and potential risks, and to provided tips for effective social media use in pathology. résumé Nous vivons à l'ère des réseaux sociaux, c'est un fait inéluctable. La montée en popularité de ces plateformes a, d'une part, révolutionné la communication parmi les professionnels de la santé et d'autre part, bousculé les modèles traditionnels d'apprentissage. De nombreux pathologistes à travers le monde profitent de ces moyens de communication et en ont fait un excellent modèle de pédagogie active. Une véritable communauté virtuelle de pathologistes est très active notamment sur Twitter et Facebook pour partager et discuter des cas intéressants, rapporter des résultats innovants ou simplement communiquer autour de leur spécialité. En Tunisie, peu de pathologistes tirent profit de ces outils, certains ne les connaissent pas encore bien, d'autres sont réticents vis-à-vis de leur utilisation dans le domaine de la santé, les considérant futiles et chronophages. En ces temps de distanciation sociale et de confinement pédagogique imposés par la pandémie du SARS-COV2, Il est plus que jamais indispensable pour les professionnels de la santé en général et pour nous pathologistes Tunisiens en particulier d'intégrer ces plateformes communautaires et de faire évoluer nos modalités d'apprentissage et d'échanges autour de notre spécialité. Le but de cette communication était premièrement de faire un état des lieux et d'évaluer la popularité de ces plateformes en tant qu'outils d'échanges pédagogiques auprès des pathologistes Tunisiens à travers un questionnaire « d'audit ». En second lieu, nous nous sommes penchés sur les principaux réseaux sociaux utiles en anatomie pathologique en discutant leurs avantages et leurs inconvénients.
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.
Background
Physiotherapists' biomedical orientation influences the implementation of evidenced-based care for low back pain (LBP) management. However, information on physiotherapists’ own beliefs about their back and LBP and the influence of these on clinical decisions and advice is lacking.
Objectives
To identify attitudes and beliefs about LBP among physiotherapists and to analyse the association of these beliefs with physiotherapists’ individual characteristics and clinical decisions and advice.
Design
Cross-sectional survey.
Method
Attitudes and beliefs about LBP were measured with the Back-Pain Attitudes Questionnaire (Back-PAQ) among French-speaking Swiss physiotherapists. Physiotherapists’ clinical decisions and advice were assessed with a clinical vignette to determine their association with the Back-PAQ score.
Results
The study included 288 physiotherapists. The mean Back-PAQ score (82.7; SD 17.2) indicated the presence of helpful beliefs in general, but unhelpful beliefs in relation to back protection and the special nature of LBP (nature of pain, impact, complexity) were frequently identified. Individual characteristics explained 17% of the Back-PAQ score. Unhelpful beliefs were associated with clinical decisions toward back protection and movement avoidance (r = - 0.47, p < 0.001).
Conclusions
While helpful beliefs and guidelines consistent decisions were generally identified, unhelpful beliefs about back protection and the special nature of LBP were frequently present among physiotherapists. These unhelpful beliefs were associated with less optimal clinical decisions. Educational approaches should challenge unhelpful beliefs and empower physiotherapists to provide explanations and management that increases patients’ confidence in the back. Future research should investigate the effect of educational strategies on implementation of best practice for LBP management.
Background
Unhelpful beliefs about non-specific low back pain (LBP) are associated with poorer coping strategies and unhelpful behaviours. Furthermore, targeting unhelpful beliefs about back pain has been advanced as a major priority to decrease the burden of LBP. Therefore, studies exploring these beliefs are needed to adapt the message delivered to the population.
Objectives
To identify attitudes and beliefs about LBP in the general population in French-speaking Switzerland and to analyse their association with individual characteristics and the belief that exercise is an effective treatment for LBP.
Design
Cross-sectional study.
Method
Attitudes and beliefs were measured with the Back-Pain Attitudes Questionnaire (Back-PAQ). Individual characteristics and participants’ beliefs about the effectiveness of exercise for LBP were collected to determine their association with Back-PAQ score.
Results
The questionnaire was completed by 1129 participants. Unhelpful beliefs were widespread (mean (SD) Back-PAQ score: 113.2 (10.6)), especially those that the back needs protection, is easy to injure and that the nature of LBP is special. Only 55% of the participants believed exercise to be one of the most effective treatment for LBP. Individual characteristics only explained 4% of the Back-PAQ score variance.
Conclusion
French-speaking Swiss general population has high levels of unhelpful beliefs and moderate confidence in the effectiveness of exercise for LBP, though the message “staying active is good for LBP” was well understood. The messages to decrease the level of unhelpful beliefs about LBP in the population should specifically target the vulnerability, protection and special nature of LBP, and promote exercise therapy.
This narrative review presents key concepts from neurophysiology, phenomenology, psychology, and narrative medicine which underpin a developing enactive-ecological framework for osteopathic practice. This framework aims to provide a coherent theoretical basis for understanding healthcare processes and outcomes, based on the neuroscience principles of active inference and enactivism. It offers insights into factors that influence patients’ pain perception and behaviour and foster or inhibit the development of effective therapeutic relationships. Although this approach offers promising opportunities to increase the scope of care by harnessing potential in the unique embodied ecological niches created between patients and osteopaths, it raises challenges to traditional treatment agendas. Healthcare which frames the patient-as-a person, and acknowledges the multidimensional nature of the self, requires practitioners to be collaborative and self-aware, and be able to elicit patients’ lived experiences and body stories. Phenomenological and psychological studies into enactivism emphasise the complex, dynamic nature of therapeutic relationships and the need to understand each person’s unique lifeworld context. The new framework represents an important step forward, but further research is now needed to explore ways of integrating active and enactive inference into practice, of developing psychological or mindful self- and body-awareness, and narrative communication skills for shared sense-making.
Background
Lower back pain is a leading cause of disability and a common condition seen by osteopaths. Evidence and advice for the safest lifting posture vary, as do healthcare practitioners' attitudes and beliefs towards back pain.
Objectives
The aim of this study was to understand osteopaths' beliefs about safe lifting postures in relation to their attitudes towards back pain, and to compare these findings with published data from physiotherapists and manual handling advisors.
Design
Cross-sectional study.
Method
Between October and November 2018 a cross-sectional electronic survey was used to invite a sample of UK osteopaths to select images that best represent their perception of safe lifting posture (straight or rounded back), and to complete the Back Pain Attitudes Questionnaire (Back-PAQ). Data was analysed to assess lifting posture selection and relationship to back pain attitudes.
Results
46 (85.2%) out of 54 osteopaths selected straight back posture as safest, these participants had significantly more negative attitudes to back pain injury (i.e. higher Back-PAQ scores), than the 8 osteopaths who selected a rounded back posture (p = 0.007). Data from 266 physiotherapists and 132 manual handling advisors revealed an overall agreement about straight back lifting posture, and differences in Back-PAQ attitude between the professions.
Conclusion
Despite a lack of evidence and inconsistent recommendations, osteopaths in this study believed that straight back lifting posture is the safest. Practitioners' attitudes vary and are known to influence their patients' attitudes and recovery behaviour. Further research is recommended to identify reasons for different beliefs, and their impact on advice-giving and patient outcomes.
Background
Beliefs can be assessed using explicit measures (e.g. questionnaires) that rely on information of which the person is ‘aware’ and willing to disclose. Conversely, implicit measures evaluate beliefs using computer-based tasks that allow reduced time for introspection thus reflecting ‘automatic’ associations. Thus far, physiotherapists' beliefs about back posture and safety have not been evaluated with implicit measures.
Objectives
(1) Evaluate implicit associations between bending lifting back posture (straight-back vs round-back) and safety (safe vs danger); (2) Explore correlations between implicit and explicit measures of beliefs towards vulnerability of the back.
Design
Exploratory cross-sectional quantitative study.
Methods
47 musculoskeletal physiotherapists completed explicit measures of fear of movement (TSK-HC), back beliefs (BackPAQDanger) and beliefs related to bending and lifting back posture and safety (BSB). An Implicit Association Test (IAT) was used to assess implicit associations between (i) images of people bending/lifting with a ‘round-back’ or with a ‘straight-back’ posture, and (ii) words representing ‘safety’ and ‘danger’. A one-sample t-test assessed the degree and direction of the sample's IAT score. Cohen's d provided an effect size of the estimated bias. Correlation between IAT and each explicit measure was assessed using Pearson's coefficient.
Results
The sample displayed an implicit association between ‘round-back’ and ‘danger’ (μ = 0.213, 95% CI [0.075-0.350], p = .003), with an effect size magnitude of 0.45. There were fair to moderate correlations between IAT and BSB (r = 0.320, 95% CI [0.036-0.556], p = .029) and, IAT and BackPAQDanger (r = 0.413, 95%CI [0.143-0.626], p = .004).
Conclusions
Physiotherapists displayed an implicit bias towards bending and lifting with a round-back as dangerous.
Background: The Back-Pain Attitudes (Back-PAQ) questionnaire measures back beliefs across 6 domains. Our previous study showed that manual handling advisors (MHAs) have more negative beliefs than physiotherapists (PTs), and those who think straight back lifting is safer than a rounder back have more negative beliefs. However, exactly which domains of the Back-PAQ are most negative is unknown. Objectives: Gain deeper understanding of how MHAs and PTs construct their back beliefs, and relate this safe lifting posture beliefs. Design: Data was collected via an electronic survey. Method: Participants’ back beliefs were collected via the Back-PAQ. They were also asked to select the safest lifting posture from four options: two with a straight back; two with a rounder back. Back beliefs were analysed in the 6 domains that construct the Back-PAQ. Relationships were investigated using multiple linear and regression models. Results: 400 PTs and MHAs completed the survey. MHAs scored higher (more negative beliefs) than PTs across all 6 domains, and those who perceive straight back lifting as safest scored higher across five of the 6 domains. The belief to keep active with back pain was common among all groups, but MHAs and those who prefer straight back lifting believe the back is vulnerable and more in need of protection. Conclusion: While all believe staying active is beneficial for back pain, residual negative beliefs regarding the vulnerability of the spine persist. Education campaigns may need to emphasise a ‘trust your back’ message rather than a ‘protect your back’ message while encouraging activity.
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.
Introduction
Compte tenu de l’existence repandue des croyances deleteres relatives au mal de dos [1] ; [2] et des limites des questionnaires existant, le « back pain attitudes questionnaire (Back-PAQ) » a recemment ete developpe pour mieux les identifier [3]. L’objectif de cette etude etait de traduire en francais la version courte (10 items) de ce questionnaire et d’evaluer les qualites psychometriques de cette nouvelle version (le Back-PAQ-Fr).
Materiel, population et methode
Le processus de traduction a ete realise en respectant les differentes etapes decrites dans les recommandations internationales [4] (Figure 1). Le Back-PAQ-Fr a ete soumis a 105 patients presentant une lombalgie (LB), afin de rechercher la presence d’un eventuel effet plancher/plafond et d’examiner sa coherence interne. Pour examiner la validite de construit, les patients ont egalement ete soumis au « back beliefs questionnaire (BBQ) » et au « brief illness perception questionnaire (Brief IPQ) ». Enfin, 55 patients ont ete invites a completer a nouveau le Back-PAQ-Fr une semaine plus tard (re-test) pour examiner sa reproductibilite.
Resultats
Les patients etaient âges en moyenne de 45,3 ans et 71 % d’entre eux souffraient de LB chronique. Seuls 2 patients n’ont pas complete tous les items du questionnaire. L’analyse des scores totaux minimum et maximum n’a indique aucun effet plancher/plafond. Le coefficient alpha de Cronbach caracterisant la coherence interne du questionnaire etait 0,54. De facon attendue, l’etude de validite a confirme l’existence de correlations significatives entre les scores BACK-PAQ-Fr et les scores aux questionnaires Brief IPQ (rho = 0,25, p < 0,05) et BBQ (rho = −0,26, p < 0,01). Les resultats de l’etude de reproductibilite (Figure 2) indiquent une bonne reproductibilite du BACK-PAQ-Fr.
Conclusion ou discussion
Compte tenu des consequences potentiellement importantes de certaines croyances relatives a la LB [1] ; [2], contribuer au developpement d’outils permettant d’identifier les croyances deleteres de facon a pouvoir les corriger est indispensable. En plus de traduire en francais le Back-PAQ, cette etude a permis de mettre en evidence les qualites psychometriques satisfaisantes de la version francophone de ce nouvel outil. Des etudes ulterieures s’averent necessaires pour examiner la sensibilite au changement du questionnaire et examiner ses qualites et son interet lors de son utilisation, pour examiner les croyances de sujets sains ou de therapeutes.