Association Between Physical Therapists' Attitudes and Beliefs and the Functional Outcomes of Patients With Low Back Pain: A Multilevel Analysis Study.

It was an observational cohort study, so it cannot show that therapist attitudes caused better or worse patient function. The initial dataset had 17,859 episodes, and the final analysis used 1043 patients; many patients were excluded because they did not complete discharge assessments. Excluded patients had more chronic symptoms and lower predicted functional change, and the final patient sample had better baseline function and pain than the excluded patients. Only 68 physical therapists were in the final analysis, although 540 were employed and 353 participated in the initial survey, and the final therapist sample differed slightly in age from excluded therapists (mean difference = 0.6 year, P = .045). The study was done in one public health care organization in Israel, so findings may not apply to other health care settings. Most physical therapists in the sensitivity analysis did not complete the second attitude survey, so changes in attitudes over time were not fully assessed. The attitude questionnaire may not capture the complexity of clinician attitudes, and workload or organizational factors may weaken the link between attitudes and practice.

The study was funded by the D.L. Hart Memorial Outcomes Research Grant provided by Focus On Therapeutic Outcomes, Inc. The funders played no role in the design, conduct, or reporting of the study. The data system used a customized version of the Focus on Therapeutic Outcomes software.

Do not conclude that changing physical therapists' attitudes will improve patient function. The study was observational, and the biomedical attitude association was small and became weaker after adjustment.