title: Implementation of clinical guidelines on physical therapy for patients with low back pain: randomized trial comparing patient outcomes after a standard and active implementation strategy. Beliefs About Low Back Pain in the Norwegian General Population: Are They Related to Pain Experiences and Health Professionals? Prediction of physician visits and prescription medicine use for back pain Physician perceptions of the value of physical modalities in the treatment of musculoskeletal disease. Why is a treatment aimed at psychosocial factors not effective in patients with (sub)acute low back pain? Adherence of Irish general practitioners to European guidelines for acute low back pain: a prospective pilot study. Musculoskeletal pain: concepts of disease, illness, and sickness certification in health professionals in Norway.
abstract: BACKGROUND AND PURPOSE An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain . The effect of this strategy on patients ' physical functioning , coping strategy , and beliefs regarding their low back pain was studied . SUBJECTS One hundred thirteen primary care physical therapists treated a total of 500 patients . METHODS The physical therapists were r and omly assigned to 1 of 2 groups . The control group received the guidelines by mail ( st and ard passive method of dissemination ) . The intervention group , in contrast , received an additional active training strategy consisting of 2 sessions with education , group discussion , role playing , feedback , and reminders .  Patients with low back pain , treated by the participating therapists , completed question naires on physical functioning , pain , sick leave , coping , and beliefs . RESULTS Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks . Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up . DISCUSSION AND CONCLUSION The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain . Active implementation strategies are not recommended if patient outcomes are to be improved Study Design . A baseline study of the general population and the health care providers in 3 Norwegian counties . Objective . To investigate if beliefs about low back pain ( LBP ) are related to personal experiences and profession sought for care . Summary of Background Data . Myths about LBP that are ab and oned by health professionals are still alive in the public . Such myths represent pain avoidance beliefs and passive coping strategies that may hinder normal spontaneous recovery from an episode of LBP . Methods . A sample of 1502 r and omly selected people was interviewed  by telephone , and all the 1105 physicians , physiotherapists , and chiropractors in the area were sent a question naire in April 2002 . All respondents gave their responses in terms of degree of agreement to 6 statements reflecting beliefs about LBP . Results . Personal back pain experiences were important for beliefs about LBP . People with a history of previous back pain had more faith in the 2 statements “ Back pain recovers best by itself ” ( 52.2 % ) and “ In most cases back pain recovers by itself in a couple of weeks ” ( 32.5 % ) than those with current pain ( 36.9 % and 20.9 % , respectively , P < 0.000 ) . There were significant differences in beliefs between physicians and the chiropractors concerning the same 2 statements , and these differences were also reflected in the beliefs of patients treated by the different professional groups . Conclusions . Belief in spontaneous recovery from LBP seems to be positively correlated to previous experience with LBP without current pain . Patients of the various health care providers seem to have a faith in spontaneous recovery similar to that of their health care provider . These differences may frustrate the public and patients who visit more than one provider , and hinder collaboration among professional groups The primary purpose of this study was to examine the extent to which specific patient attitudes and beliefs about medical care and  self-care for back pain predict future healthcare use . An automated data base allowed examination of the predictive relationships in two primary care patient sample s. In general , beliefs that physicians should find a definitive cause and permanent cure for back pain predicted neither physician visits nor prescription medication fills . Patient attitudes endorsing the benefits of medical treatment for back pain ( as opposed to a permanent cure ) predicted the use of these specific healthcare services . In a third sample of primary care back pain patients , we assessed whether a four-session self-care intervention modified those attitudes and beliefs shown to predict future healthcare use . The group intervention was associated with changes in attitudes about use of physician services but not medication use . A secondary purpose was to examine initial psychometric properties of a proposed back pain Self-Care Orientation Scale made up of the original 11 items . Factor analyses of the item set yielded three factors , but inconclusive results ; the internal consistency of the identified sub-scales was only moderate . However , findings that a subset of items predicted physician visits and prescriptions medication fills , and was sensitive to change following a self-care intervention , suggest avenues for improving measurement of self-care orientation . These findings help clarify specific patient attitudes and beliefs that are related to healthcare utilization and suggest that a subset of these beliefs can be modified through a brief educational intervention We r and omly surveyed 100 specialists in rehabilitation medicine and 100 rheumatologists concerning their perceptions of the value of 11 different physical modalities -- cold , active and passive exercise , interferential current , laser , magnetotherapy , microwave , shortwave diathermy , traction , ultrasound and transcutaneous nerve stimulation in the treatment of seven different musculoskeletal conditions -- acute arthritis , joint contracture , neck pain , back pain , tendinitis , reflex sympathetic dystrophy and frozen shoulder . There were significant differences in the perceived benefits of modalities which varied by modality and condition . Overall , rehabilitation medicine specialists regarded modalities to be helpful more often than rheumatologists ( P < 0.001 ) & NA ; Psychosocial factors have been shown to play an important role in the development of chronic low back pain ( LBP ) . In our recently completed cluster‐r and omized trial we found , however , no evidence of an effect of our minimal intervention strategy ( MIS ) aim ed at psychosocial factors , over usual care ( UC ) in patients with (sub)acute LBP . To explore the reasons why , this paper presents an evaluation of the processes presumably underlying the effectiveness of MIS . General practitioner ( GP ) attitude was evaluated by the Pain Attitudes and Beliefs Scale and two additional questions . GP behaviour was evaluated by analysing treatment registration forms and patients ' responses to items regarding treatment content . Patients also scored items on satisfaction and compliance . Modification of psychosocial measures was evaluated by analysing changes after 6 and 52 weeks on the Fear Avoidance and Beliefs Question naire , the Coping Strategies Question naire and the 4‐Dimensional Symptom Question naire . A total of 60 GPs and 314 patients participated in the study . GPs in the MIS‐group adopted a less biomedical orientated attitude than in the UC‐group , but were only moderately successful in identification of psychosocial factors . Treatment contents as perceived by the patient and patient satisfaction differed significantly between both groups . Changes on psychosocial measures , however , did not differ between groups . The suboptimal identification of psychosocial factors in the MIS‐group and the absence of a relevant impact on psychosocial factors may explain why MIS was not more effective than UC There are no national low back pain ( LBP ) clinical guidelines in Irel and , and neither the level of adherence of General Practitioners ( GPs ) to the European guidelines , nor the cost of LBP to the patient and the state , have been investigated . A prospect i ve pilot study was conducted on 54 consenting patients ( 18 M , 36F : mean age ( SD ) : 40.5 ( 14.3 ) years ) with a new episode of acute LBP ( <3 months ) attending one of nine participating GPs . Baseline demographic , LBP classification [ i.e. simple back ache ( SBA ) , nerve root pain ( NRP ) , serious spinal pathology ( SSP ) ] and primary care management data were recorded over a three month period . Adherence and costs were estimated based on : medication prescription , referral for investigations , treatment or consultations , and wage replacement costs ( time signed off work ) . For both SBA and NRP , medication prescriptions were consistent with European guideline recommendations , but not for referral for further treatment ( 39 % of SBA patients were referred on first visit ) , secondary care ( 54 % of NRP patients were referred on first visit ) , or discontinuation of work ( 50 % NRP patients on first GP visit ) . The average total cost ( direct and wage replacement ) for a single episode of LBP over 12 weeks was 20,531 Euros ( 20,300 - 20,762 ) . Direct costs accounted for 43 % [ 8874.36 Euros , ( 8643.37 - 9105.37 Euros ) ] and wage replacement costs 57 % ( 11,657 Euros ) . In conclusion , management of acute LBP in a cohort of GPs in Irel and was not consistent with European clinical guideline recommendations , and warrants higher levels of postgraduate education among GPs , as well as restructuring of primary care services , which should improve patient outcome and reduce costs Concepts of disease , illness ( being ill ) , and criteria for issuing sickness certificate for musculoskeletal pain have been investigated by a postal survey based on case histories . Question naires were filled in by 898 individuals ; 194 General Practitioners , 76 medical consultants working for the National Insurance Administration , 307 insurance clerks , and a representative sample ( N = 321 ) of the general public . The concepts disease and illness are meaningful and used consistently by medical doctors for infectious disease and somatic problems . Discrepancies between the medical profession representatives and the general public were , in general , attributable to differences in information and knowledge about these somatic conditions . However , for musculoskeletal pain all groups had conceptual problems . In particular , there was a lack of consensus for issuing sickness certificates . For musculoskeletal pain conditions the doctors , as a group , seemed to score at r and om or 50 - 50 level for sickness certification . All groups , including medical doctors , were reluctant to accept depression and social problems as diseases , or to accept social problems as reasons for sickness certification . The decision criteria should be identified and systematized in order to establish whether it is possible to reach a consensus for subjective complaints
target: Themes that emerged included doctors ' attitudes and beliefs , and four factors that influenced attitudes and beliefs : doctors ' specialty , demographic factors , personal beliefs and education .
  There was consistent evidence that doctors ' specialty impacted their attitudes and beliefs : lack of consensus regarding the natural history of LBP , around treatment options , and issues regarding work .
  There was inconsistent evidence that demographic factors ( age ) and level of education impacted doctors ' attitudes and beliefs .
  Long term , these changes in these areas have the potential to maximise patient-care , and reduce costs to health services
background: The aim of this systematic review was to determine the attitudes and beliefs of doctors to acute low back pain , and the factors that influence these .