The influence of low back pain-related attitudes and beliefs on the clinical decision making of physical therapists.

BACKGROUND: The LBP-related attitudes and beliefs of clinicians may impact the experience of patients by influencing clinician decision-making and by shaping the attitudes, beliefs, and actions of patients. The purpose of this study was to identify the specific LBP-related attitudes and beliefs of US-based physical therapists and determine if those beliefs correlate with clinical decision-making. METHODS: An electronic survey was sent to US-based physical therapists. Attitudes and beliefs were measured using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain and Impairment Relationship Scale for Physiotherapists (PABS-PT). The survey also included 2 patient vignettes that collected information about clinical decision-making. RESULTS: Complete survey responses were recorded from 420 physical therapists. Eleven of the 27 attitude and beliefs questions were answered in a more biomedically oriented way by at least 20% of respondents. Physical therapist low back pain-related attitudes and beliefs were associated with activity and management strategies for both vignettes in the expected direction. Higher scores on HC-PAIRS and PABS-BM were associated with more restrictive work and activity recommendations, lower-intensity exercise choices, biomechanical rationale for manual therapy and motor control exercises, pathoanatomical-focused education, and use of modalities. CONCLUSION: Some physical therapists hold biomedically oriented beliefs about the connection between pain and physical activity. Clinician beliefs were associated with activity and work recommendations, and treatment choices. Physical therapists with more biomedically oriented beliefs were more likely to limit physical activity and work, and less likely to incorporate psychologically informed interventions.

A novel model for developing thrust joint manipulation skills: a teaching and learning perspective.

Spinal and extremity thrust joint manipulation (TJM) has been shown to be an effective intervention when treating patients with various musculoskeletal conditions. Learning skilled TJM requires the proper execution of many discrete tasks. If any of these are missing, effectiveness and safety may be limited. While it is accepted that practice and feedback are important when physical therapists are learning clinical tasks, the best type of practice has not been identified for learning to perform TJM tasks. In this paper, we propose an educational model for instruction of joint manipulation that: 1) standardizes feedback terminology and 2) describes a core set of four discrete tasks (lift, drop, pull, and combination-rotation) that apply to most TJM tasks. The model includes instructing TJM tasks followed by identifying key errors related to the components of setup and thrust. Once these key errors have been identified, intentional practice activities are provided to address the noted positional and movement errors. Finally, reassessment is performed to determine if errors have diminished. This model is similar to the test-retest approach that is commonly used when treating patients. We hope this educational model will provide a framework for teaching TJM and will also foster future research.

Factors associated with the low back pain-related attitudes and beliefs of physical therapists.

BACKGROUND: Clinicians who believe in a strong connection between pain and disability, and who have biomedically oriented beliefs recommend less physical activity, more time off work, and promote unhelpful beliefs in patients. Understanding how these beliefs develop may assist in identifying ways to reduce unhelpful beliefs in clinicians. OBJECTIVE: To identify factors that are associated with the LBP-related attitudes and beliefs of US-based physical therapists. DESIGN: Cross-sectional design METHOD: An electronic survey was sent to US-based physical therapists. Attitudes and beliefs were measured using the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), pain science knowledge was measured using the Neurophysiology of Pain Questionnaire (NPQ), and professional and demographic information were collected. RESULTS: Completed surveys were obtained from 420 physical therapists. More helpful attitudes and beliefs were associated with board certification in orthopedics or sports, higher NPQ scores, and working in a hospital-based clinic. Less helpful attitudes and beliefs were associated with working in private practice and a personal history of LBP that had a minimum or significant impact on life. The factors included in this study explained 16.8% of the variability in HC-PAIRS scores (p < .001), 13% of the variability in PABS-BM scores (p < .001), and 8.3% of the variability in PABS-BPS scores (p < .001). CONCLUSION: Several modifiable and non-modifiable factors are associated with the LBP-related attitudes and beliefs of US physical therapists.

Does the Direction of Kinesiology Tape Application Influence Muscle Activation in Asymptomatic Individuals?

BACKGROUND: Despite the popularity of tape among athletes and rehabilitation practitioners, there is controversy regarding the specific effects of kinesiology tape. Based on conflicting results and limitations of the literature, a well-designed study was desired to examine kinesiology tape application direction on muscle activation. HYPOTHESIS/PURPOSE: The purpose of this pilot study was to determine if the direction of kinesiology tape application influences quadriceps activation. This study compared taping techniques with outcome measures selected to assess quadriceps muscle activation. The outcome measures included EMG, isokinetic strength, and functional hop and jump performance. STUDY DESIGN: Double-blind Crossover study. METHODS: A total of fifteen asymptomatic participants (10 females and 5 males) completed the study. Mean age was 23.3 years. KinesioⓇ Tex GoldTM was applied to the dominant lower extremity of each participant using a Y-strip method. Two taping conditions (proximal to distal, distal to proximal) were applied to the quadriceps. Participants and testers were blinded to tape condition. Pretest and posttest measures included electromyographic output during isokinetic testing of quadriceps muscle torque at 60°s-1 and 120°s-1, single leg triple hop for distance, and vertical jump. RESULTS: Two-way, repeated measures analysis of variance resulted in no significant differences in baseline to taped condition for quadriceps electromyographic output, quadriceps isokinetic knee extension muscle torque at 60°s-1 and 120°s-1, single leg triple-hop distance or vertical jump height. CONCLUSION: The results of this pilot study do not support the hypothesis that kinesiology tape application direction influences muscle performance as measured in this study. LEVELS OF EVIDENCE: Level 1 - Controlled Clinical Trial. CLINICAL RELEVANCE: Kinesiology tape is commonly used as an intervention for a wide range of musculoskeletal conditions and for promoting performance including sporting activities. Kinesiology tape is popular among athletes and health care providers yet the specific effects of tape are not well understood.

The use of pain neuroscience education in older adults with chronic back and/or lower extremity pain.

Introduction: Chronic pain due to musculoskeletal disorders is the leading cause of disability among older adults and is associated with a lower quality of life, reduced function, and increased risk of institutionalization. Pain Neuroscience Education (PNE) has demonstrated effectiveness in reducing pain and improving pain self-efficacy in individuals under 60 years of age, but there is a paucity of research examining its use with older adults. If PNE has similar effects in older adults, it has the potential to be a useful non-pharmacological intervention for this population. Methods: This quasi-experimental feasibility study included 25 subjects over the age of 65 with a 3 month or greater history of lower back and/or lower extremity pain. Subjects participated in two semi-standardized one-on-one PNE sessions and were asked to read a booklet (Why Do I Hurt, Louw, International Spine and Pain Institute, USA) in between sessions. Subjects' perception of PNE was measured after the second session and gait speed, pain disability, and fear of movement were measured pre- and post-PNE. Results: Subjects consistently reported a positive experience with PNE. There were statically significant positive improvements in gait speed, pain disability, and fear of movement after the intervention. Conclusion: PNE is a feasible and potentially efficacious treatment for older adults with chronic pain.

Variation in perceived providers of ambulatory physical therapy in the United States, 2009-2012: An analysis using data from the Medical Expenditure Panel Survey.

Introduction: Little is known about public perception of physical therapy (PT) delivery by type of provider in the United States (US). Purpose: This study aimed to describe differences in ambulatory PT visits and expenditures according to perceived provider type, and to determine if visits and expenditures varied by provider type. Methods: This study employed the Medical Expenditure Panel Survey (MEPS), which is a nationally representative survey of US households that used a complex, stratified, cluster sample design. Data from cross-sectional samples over 4 years of the MEPS Household Component were used to study adults with musculoskeletal conditions who reported receiving ambulatory PT. National-level, average annual estimates of numbers of visits, and reported total expenditures by perceived provider type were computed. Associations between perceived provider type and visits and expenditures were determined by linear regression, accounting for the sample design, and adjusting for demographic and clinical covariates. Results: Estimated annual perceived PT visits were 60.00 million with physical therapists, 39.66 million with non-physical therapist providers, and 20.66 million with multiple providers. Estimated annual expenditures for PT were $9.37 billion with physical therapists, $4.62 billion with non-physical therapist providers, and $3.09 billion with multiple providers. Compared with non-physical therapist providers, physical therapist provider status and multiple provider status were associated with higher numbers of visits and expenditures. Conclusion: Non-physical therapist providers are responsible for a substantial amount of PT delivery in the US. Numbers of visits and total expenditures varied by the type of provider delivering PT.

Physical activity participation among families of children with visual impairments and blindness.

PURPOSE: Physical activity (PA) provides multiple benefits to children with visual impairments (VI) and their families. However, the empirical literature base is underdeveloped on how family PA experiences impact participation for children with VI. The purpose of this study was two-fold; that is: (a) to explore why families with children with VI seek out and participate in PA, and (b) to describe the strategies and supports needed by families of children with VI to improve PA participation. METHOD: The research method was descriptive-qualitative positioned in the theoretical framework of the theory of planned behavior. Participants were parents of children with VI (n = 10) who took part in one-on-one semi-structured telephone interviews. Interview recordings were transcribed and analyzed using a thematic line-by-line analysis. RESULTS: Three salient, recurrent, and interrelated themes emerged from the data analyses. These themes were: (a) committed, (b) challenged, and (c) access. CONCLUSIONS: Findings revealed that parents valued PA, but they lacked the skills to teach and advocate for their children regarding PA. As a consequence, parents voiced the need for a support system that would allow their families to be more physically active. Implications for Rehabilitation Results of this study demonstrated that parents valued physical activity, but they lacked the skills necessary to confidently engage their children in physical activity. Physical activity interventions are needed to enhance the quality of life of children with visual impairments and their families. Physical activity programs and interventions are most likely to enhance intentions to engage in physical activity among children with visual impairments and their parents. Results demonstrated that parents of children with visual impairments were interested to work side-by-side with physical activity professionals to enhance recreational physical activity opportunities available to their children.

Referral source and outcomes of physical therapy care in patients with low back pain.

STUDY DESIGN: Retrospective longitudinal cohort. OBJECTIVES: To describe the clinical characteristics of patients with low back pain according to physician referral source, and to identify associations between referral source and discharge functional status, as well as number of physical therapy visits. BACKGROUND: Little is known about associations between physician referral source and outcomes of physical therapy care for patients with low back pain. Exploring these associations can contribute to better understanding of physician-physical therapist relationships and may lead to improved referral patterns. METHODS: Data from a proprietary clinical database were examined retrospectively. Physician referral source was classified as primary care, specialist, or occupational medicine. Outcomes were overall health status at discharge and number of physical therapy visits. Descriptive statistics and bivariate associations between referral source and each outcome were assessed by calculating differences and 95% confidence intervals (CIs) in means and proportions. To account for potential confounding, multilevel linear regression was used to adjust for baseline clinical covariates, effects related to clustering of patients treated by individual clinicians, and clinicians working within individual clinics. RESULTS: Bivariate and multilevel analyses revealed significant associations between referral source and discharge overall health status, as well as number of visits. After multilevel adjustment for covariate and clustering effects, primary care and occupational medicine referrals were associated, on average, with point increases of 1.6 (95% CI: 0.7, 2.6) and 4.8 (95% CI: 2.7, 6.9) in discharge overall health status scores, respectively, compared to specialist referral. Similarly, primary care and occupational medicine referrals were associated, on average, with 0.44 (95% CI: 0.27, 0.61) and 0.83 (95% CI: 0.44, 1.22) fewer visits, respectively, compared to specialist referral. CONCLUSION: After accounting for clinical covariates and clustering, patients with low back pain who were referred by occupational medicine and primary care physicians tended to have better functional outcomes and required fewer physical therapy visits per episode of care. LEVEL OF EVIDENCE: Prognosis, level 2c.