Charting physiotherapy students' attitudes toward people with chronic pain as they progress through their undergraduate programme: An observational study.

BACKGROUND: Healthcare professionals' attitudes toward people with chronic pain influence their clinical practice. OBJECTIVES: To investigate physiotherapy students' attitudes and beliefs toward people with chronic pain over the course of their Scottish undergraduate program. METHODS: In this observational study, physiotherapy students from one university were recruited in the first year and followed up to their final year (year 1 n = 62/75, year 2 n = 68/72, year 3 n = 59/69, year 4 n = 74/74) for 4 years. The Health-Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS with scores ranging from 15 to 105) was completed annually. RESULTS: A one-way ANOVA found that attitudes and beliefs improved significantly (p < .01) from the first to final year (9.2 ± 11.5 (mean±SD)). Participants showed a reduction in scores (signifying improved attitudes) annually with smaller reductions initially followed by a larger reduction in the final 2 years. CONCLUSIONS: This is the first study to chart changes in the same cohort of physiotherapy students' attitudes and beliefs toward people with chronic pain over time. Future work should explore which aspects of degree courses, if any, impact upon attitudes and beliefs toward people with chronic pain so that courses can be enhanced accordingly.

The effects of spinal manipulative therapy on lower limb neurodynamic test outcomes in adults: a systematic review.

Objective: Spinal Manipulative Therapy (SMT) is a routinely applied treatment modality for various musculoskeletal conditions, including low back pain. The precise mechanisms by which SMT elicits its effects are largely unknown, but recent research supports a multi-system explanation recognizing both biomechanical and neurophysiological mechanisms. Although the evaluation of changes in clinical presentation is complex, objective neurophysiological measures of sensitivity to movement (e.g. neurodynamic tests) can be a valuable clinical indicator in evaluating the effects of SMT. This review aimed to synthesize current literature investigating the effects of SMT on lower limb neurodynamics.Method: Eight electronic databases were systematically searched for randomized controlled trials (RCT) that applied SMT (against any control) and evaluated lower limb neurodynamics (Passive Straight Leg Raise or Slump Test). Selection and data extraction were conducted by one researcher, reviewed by a second author. Risk of bias (RoB) was assessed using the Cochrane Back Review Group criteria.Results: Eight RCTs were included, one with high RoB. SMT produced a clinically meaningful (≥6°) difference in five of these studies compared with inert control, hamstring stretching, and as an adjunct to conventional physiotherapy, but not compared with standard care, as an adjunct to home exercise and advice, or when comparing different SMT techniques. Findings compared to sham were mixed. When reported, effects tentatively lasted up to 6 weeks post-intervention.Conclusion: Limited evidence suggests SMT-improved range of motion and was more effective than some other interventions. Future research, using standardized Neurodynamic tests, should explore technique types and evaluate longer-term effects.Level of Evidence: 1a.

Returning to work after long term sickness absence due to low back pain - the struggle within: a qualitative study of the patient's experience.

BACKGROUND: Low back pain (LBP) is a major cause of work absence. Assisting individuals back into work is an important part of rehabilitation. OBJECTIVE: To explore the experiences of individuals returning to work after an episode of sickness absence due to LBP. PARTICIPANTS: Five women employed by a UK University who had returned to work. METHOD: In this qualitative study, participants underwent semi-structured interviews about their experiences. The transcripts were analysed using interpretative phenomenological analysis. RESULTS: Two primary themes emerged 1) perceived pressure to return to work and 2) strategies employed to relieve the pressure to return. Pressure to return to work arose from a number of sources including guilt and a personal work ethic, internally, and from colleagues and management, externally. This pressure led to the individual employing a number of strategies to reduce it. These ranged from a simple denial of health concerns and decision to return to work regardless of their condition, to placing the responsibility of the decision not to return to work onto a significant other, such as a family member or health care professional. CONCLUSIONS: Individuals returning to work with LBP experience considerable pressure to return and use a range of strategies to mediate that pressure.

Do medical student attitudes towards patients with chronic low back pain improve during training? a cross-sectional study.

BACKGROUND: Health care professionals with positive attitudes towards the functional abilities of patients with low back pain are more likely to encourage activity and avoidance of rest as per recommended guidelines. This study investigated whether medical student training fosters positive attitudes towards patients with back pain and their ability to function. METHODS: First (n = 202) and final (n = 146) year medical students at the University of Glasgow completed the Health Care Professionals' Pain and Impairment Relationship Scale (HC-PAIRS) questionnaire. This measures attitudes of clinicians towards the functional ability of patients with back pain. A group of first (n = 62) and final year (n = 61) business students acted as non-health care controls. Attitudes were compared using two-way ANOVA with year of study and discipline of degree as independent variables. RESULTS: Both year of study [F(1,465) = 39.5, p < 0.01] and discipline of degree [F(1,465) = 43.6, p < 0.01] had significant effects on total HC-PAIRS scores and there was a significant interaction effect [F(1,465) = 9.5, p < 0.01]. Medical students commenced their course with more positive attitudes than non-health care students (65.7 vs. 69.2 respectively; p < 0.01)--lower scores translating into more positive attitudes. In their final year, the difference between the two student groups had widened (56.4 vs. 65.3; p < 0.01). CONCLUSIONS: Undergraduate medical training promotes positive attitudes towards the functional ability of patients with back pain, suggesting that students may be more likely to develop an evidence-based approach to this patient group after qualification. Some adjustments to training may be warranted to encourage a more positive shift in attitudes.

Rethinking yellow flags.

The use of Yellow Flags has become widespread in clinical practice, as a means to identify clients with low back pain who might not respond favourably to physical treatments. However, using questionnaires to identify psychosocial risk factors that can result in ongoing pain and suffering is not a straightforward matter, and if used without due thought could result in an impoverished service for the client. This discussion article aims to raise awareness of the issues that emerge when relying on Yellow Flags; including the practicalities of using forced-choice questionnaires to identify complex interactions between a client's social environment and their psychological state. Yellow Flags are based on a biopsychosocial model of health, yet this paper argues that the use of Yellow Flags, in practice, belongs within a reductionist paradigm. By calling attention to the issues raised, we envisage a better utilization of the biopsychosocial model; whereby taking account of a client's unique experience and meaning of pain will enable the individual to be managed with a more genuine and insightful understanding than seemingly occurs at the present time.