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Physiotherapists’ Knowledge, Attitudes, and Intolerance of Uncertainty Influence Decision Making in Low Back Pain

Simmonds, Maureen J. PhD, PT*,†,‡; Derghazarian, Tamar MS, PT§; Vlaeyen, Johan W. S. PhD∥,¶

doi: 10.1097/AJP.0b013e31825bfe65
Special Topic Series

Background: Low back pain (LBP) remains a common health problem that is characterized by ambiguity and can progress to chronic disability. In recent years researchers have started to focus on understanding whether and how the attitudes and beliefs of the health care providers influence the management and the outcome of LBP.

Objectives: The purpose of this study was to characterize Quebec physiotherapists’ (PTs’) knowledge, attitudes, and beliefs about LBP and their intolerance of uncertainty (IU) to determine whether and how these characteristics predict judgments of assessment and treatment recommendations.

Methods: A total of 108 PTs from Quebec, Canada completed the Pain Attitudes and Beliefs Scale for Physiotherapists, the Fear of Pain Questionnaire, and the Intolerance of Uncertainty Scale. Participants also read 2 vignettes that described patients with LBP and reported their assessment and treatment recommendations.

Results: Only 13 PTs (12%) were able to identify clinical practice guidelines for LBP. In addition, PTs did not generally agree with recommendations to return to work or activity. A biomedical orientation was a significant predictor of clinical judgments of spinal pathology and was associated with an increased sense of IU. In contrast, a behavioral approach better predicted treatment recommendations for return-to-work or activity. Finally, the association between IU and treatment decisions was mediated by treatment orientation.

Discussion: Health care practitioners play a significant role in the management of LBP. Research on the process of knowledge translation, clinical decision making, and dealing with uncertainty to avoid aggravating LBP disability is clearly warranted.

*Department of Physical Therapy, School of Allied Health Professionals, University of Texas Health Sciences Centre at San Antonio

Centre for Research to Advance Community Health, University of Texas Health Sciences Centre at San Antonio, TX

AT Still Research Institute, AT Still University of Health Sciences, Kirksville, MO

§School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada

Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands

Department of Psychology, University of Leuven, Leuven, Belgium

Supported by the following grants: Centre for Interdisciplinary Rehabilitation Research and McGill University, Montreal, QC, Canada to M.J.S.; Ordre Professionel de la Physiothérapie du Québec (OPPQ) to T.D, Québec; and Odysseus Fund for Scientific Research (FWO)—Flanders, Belgium, Canada to J.W.S.V. The authors declare no conflict of interest.

Reprints: Maureen J. Simmonds, PhD, PT, Department of Physical Therapy, School of Health Professions, University of Texas Health Sciences Centre at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 (e-mail:

Received August 17, 2011

Accepted April 24, 2012

© 2012 Lippincott Williams & Wilkins, Inc.