Effects of biopsychosocially-informed low back pain education on physiotherapy students' back pain-related attitudes and beliefs

Purpose: Low back pain (LBP) continues to represent a significant clinical, economic and personal burden globally. Despite a growing evidence-base supporting a biopsychosocial model of care, physiotherapeutic approaches to LBP remain biomedically orientated and clinical guideline adherence is poor. The LBP beliefs of physiotherapists are associated with their clinical decisions, treatment selection and the subsequent beliefs of their patients. Educational interventions of varying durations and intensity have been successful in improving LBP beliefs. Despite this, little is known about the LBP attitudes and beliefs of pre-registration physiotherapy students and whether similar educational interventions are effective at aligning these attitudes and beliefs with contemporary evidence.
This study aims to evaluate the effects of a single-day biopsychosocially-informed LBP educational workshop on the back pain related attitudes and beliefs of physiotherapy students.
Methods: This study used a single cohort design. This study included Coventry University (CU) Physiotherapy students who had enrolled on a single-day LBP workshop hosted by the CU Physiotherapy Society. Workshop content was designed and delivered by a specialist physiotherapist with experience in providing education sessions on evidence-based LBP management, which included a recorded patient interaction. LBP beliefs were measured using an online version of the Back Pain Attitudes Questionnaire (Back-PAQ). Descriptive analysis identified mean (±SD) Back-PAQ scores pre- and post-workshop with statistical analysis assessing for statistical significance (p<0.05).
Results: 4 physiotherapy students enrolled in the study (mean age 28.3 years, 75% male, 75% BSc full-time students). There was a statistically significant improvement (–12.8 ± 7.1, 95%CI –1.5 to –24.0, p <0.02) between Back-PAQ scores before (85.0 (± 17.9) and after (72.3 (± 23.9) the workshop. This improvement met minimal detectable change (MDC) thresholds for the Back-PAQ with 90% confidence (-12.0).
Conclusion(s): The study demonstrated statistically significant and clinically meaningful improvements to physiotherapy students' LBP-related attitudes and beliefs following evidence-based education. The small sample size, however, means the effectiveness of the education cannot be reliably determined. Further studies with a larger sample size and representation for students across their pre-registration education journey are needed to determine reliability of these results.
Impact: This study explores the potential of an evidence-based educational intervention to improve physiotherapy students’ beliefs and attitudes towards LBP. By targeting students early in their professional development, this shows the potential to influence future practice, and therefore clinical outcomes, by improving person-centred care and guideline adherence within the future workforce. Though this study was small and locally delivered, the findings suggest a scalable, low-resource format with broader applicability across physiotherapy education. Given the opportunity to replicate it on a larger scale, this approach could contribute meaningfully to national and multinational efforts aimed at reducing the burden of LBP.