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Back beliefs in French osteopathy students, new graduates, educators and
practitioners: a cross-sectional survey
Hakim Mhadhbi1,5(MSc, Dip.Ost), Eytan Beckmann2(MSc, Dip.Ost), Renan Bain2
(MSc, Dip.Ost), Benoît Thierry-Hildenbrand1(MSc), Hanna Le Pape1(Dip.Ost), Jorge
E. Esteves3,4 (PhD, MA, BSc Ost), Mathieu Ménard1,6 (PhD, MSc, Dip.Ost)
1Institut d’Ostéopathie de Rennes - Bretagne (IO-RB), Campus Rennes Atalante Ker-Lann,
50 Rue Blaise Pascal, 35170 Bruz, France.
2IDO Paris - Institut Dauphine d'Ostéopathie, 2 Rue Nicolas Houël, 75005 Paris, France.
3Clinical Human Research Department, Non-profit Foundation COME Collaboration, Via A.
Vespucci 188, 65126, Pescara, Italy.
4Malta ICOM Educational, 95, St. Georges Beach Complex, San Gorg Street STJ001, San
Gilijan, Malta.
5Metropolia University of Applied Sciences, Leiritie 1, 01600 Vantaa, Finland
6Univ Rennes, M2S - EA 7470, F-35000 Rennes, France.
Background
Psychological factors are known to impact the course of low back pain and predict
individual low back pain (LBP) outcomes for pain and disability. For practitioners to
adequately address these factors, an understanding of the beliefs that underlie them
appears to be crucial. Beliefs about LBP can influence the interpretation of pain
signals, the development of chronic disability, and adjustment to pain. They can also
influence self-management behaviours and suggest better coping with LBP. Evidence
indicates that a person's beliefs about pain are associated with the practitioner's
beliefs with whom they have consulted. However, few research studies have been
conducted to investigate osteopathic students' and educators' beliefs towards LBP
and whether these beliefs influence their treatment management. This study explored
the beliefs towards LBP of osteopathy students, new graduates, educators, and
non-teaching practitioners from two French Osteopathic Educational Institutions
(OEIs).
Material & Method
A two-part cross-sectional survey was conducted online between August and
November 2021. The first part included socio-demographic characteristics. The
second part measured beliefs about LBP using the Back-Pain Attitudes
Questionnaire (Back-PAQ). Total scores ranged from 34 (more helpful beliefs) to 170.
Finally, the last part consisted of a clinical vignette with questions on
recommendations for physical activity, work and bed rest. A point was given for
selecting answers that aligned with the available evidence. Therefore, a maximum of
three points could be earned for the three questions in the scenario.
Results
798 participants completed the survey (142 Year 1, 105 Year 2, 106 Year 3, 112 Year
4, 91 Year 5, 47 new graduates, 107 practitioners, and 88 educators). The lowest
Back-PAQ mean scores were obtained by new graduates (47.6 ± 7.3), followed by
practitioners (50.3 ± 6.8), educators (78.9 ± 20.9), and students (98 ± 17.6). The
results showed a decrease in the Back-PAQ scores for students from Year 1 (113 ±
10.2) to Year 5 (81.4 ± 12.1), with the greatest decrease (86 %) between Year 3 (99.1
± 12.5) and Year 4 (85.4 ± 16.6). According to the findings, the clinical vignette score
showed a consistent improvement over time, with the proportion of 3 out of 3 scores
rising from 7.7% in the first year to 45.1% in the fifth year and eventually reaching
53.5% immediately after the study concluded. The clinical orientations, which were
determined based on the three vignette questions (mean score: 1.7/3), had a
moderate association with the Back-PAQ score (r = -0.489, p < 0.05).
Conclusion
The osteopathic curriculum contributes to a gradual improvement in attitudes and
beliefs about chronic low back pain, in line with current scientific evidence.
Continuing education is necessary to enhance the expertise of educators and
practitioners, enabling them to translate new scientific knowledge into practice.
Although evidence-based orientation is already present in osteopathic teaching, it still
faces resistance and inertia. Addressing this challenge is crucial for training future
osteopaths and delivering optimal, multidisciplinary, evidence-based care to the
population at large, particularly those suffering from LBP.
Implications for practice
- Beliefs about back pain as measured by the Back-PAQ were found to develop
positively throughout the course, with new graduates showing the highest scores.
- Educators' scores were, on average, equivalent to those of 4th and 5th-year
students; however, this group had considerable variability.
- Back-PAQ scores and clinical vignette results were moderately correlated,
indicating that participants with deleterious beliefs would be more likely to give their
patients messages to avoid activities.