Psychological assessments by manual physiotherapists in the Netherlands in patients with nonspecific low back pain

ABSTRACT

Background: Clinical Practice Guidelines for low back pain emphasize implementing assessment and addressing of psychosocial context. It is unknown to what extent manual physiotherapists incorporate psychological factors in their diagnostic management of patients with nonspecific low back pain.

Methods: An online survey among Dutch manual physiotherapists was conducted exploring the use of 10 psychological constructs. Frequencies of attention to psychological factors during history-taking and use of questionnaires were calculated. Associations between therapists characteristics and use of psychological questionnaires were analyzed using Spearmans rank correlation coefficient (r s) and logistic regression. In addition, a retrospective patient record review was conducted.

Results: One hundred and twelve manual physiotherapists returned completed surveys. Although respondents indicated psychological factors were assessed, they rarely used psychological questionnaires. Significant but negligible associations were found for age and working hours and the use of specific questionnaires. From 95 patient records reviewed, seven were identified that mentioned one psychological factor each during history taking.

Conclusions: Dutch MPTs, regardless of their age and work characteristics, rarely use psychological questionnaires in patients with LBP, although they report addressing these constructs implicitly during history taking. Educational and implementation strategies are needed to warrant the use of psychological constructs and validated psychological questionnaires at all phases of the clinical reasoning process.

KEYWORDS:

• Psychology
• back pain
• history taking
• psychological questionnaires
• manual physiotherapists
• clinical reasoning

Ethical approval

This voluntary practice-based research among Dutch MPTs was performed without interference in usual standard care and patients were not physically involved. To ensure the autonomy and safety of the participants the data is collected and archived anonymously. There were no risks to participation. All MPTs participated voluntarily and had the right to refuse to participate. The study therefore falls outside the scope of the Dutch Medical Research Involving Human Subjects.

Act (https://english.ccmo.nl/).

Acknowledgments

We thank all the MPTs for participating in the online survey and the MPTs for sharing their data in the EHR review.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors declared that no grants were involved in supporting this work.

Notes on contributors

Joannes M Hallegraeff

Hank Hallegraeff received his Bachelor's degree in Physiotherapy at Amsterdam University of Applied Science in 1981. He studied clinical epidemiology at the University of Amsterdam (Master of Science in 2005) and his Ph.D. in Medical Sciences was completed in 2013 at the University of Groningen. Since 2006 he has been a lecturer at SOMT University of Physiotherapy and since 2020 he is also Head of Master Education in Musculoskeletal Ultrasound.

Leonie Van Zweden

Leonie van Zweden received her Bachelor Physiotherapy at Avans University of Applied Science in Breda, the Netherlands, and her Master of Science degree in Physio- and Manual therapy at Vrije Universiteit Brussel, Brussels, Belgium in 2018. She is currently working at Physiotherapy and Manual Therapy at Fysiotherapie SaFyR Krabbendijke, Krabbendijke, the Netherlands.

Rob Ab Oostendorp

Rob Oostendorp was born (1942) in Nijmegen, the Netherlands. He received his Bachelor's degree in Physiotherapy in 1966, his MSc in Rehabilitation Science and Physiotherapy in 1984 at the Vrije Universiteit Brussel, Belgium, and his Ph.D. in Medical Sciences in 1988 at the Radboud University Nijmegen. He was appointed as professor Manual Therapy in 1989 at the Vrije Universiteit Brussel and as professor Allied Health Sciences (particularly physiotherapy) in 2000 at the Radboud University Nijmegen. He retired in 2012. He is officer in de Orde van Oranje Nassau. He is (co-) author of about 200 articles in peer-reviewed journals and supervisor of about 30 Ph.D. studies.

Emiel Van Trijffel

Emiel van Trijffel (1968) is a manual physical therapist with a background in clinical epidemiology. He is a university lecturer at SOMT University of Physiotherapy, The Netherlands, and at Vrije Universiteit Brussels, Belgium. His research focuses on diagnostics, prognostic modeling, and clinical reasoning in manual physical therapy.