Applied Evidence

The impact of a brief online education intervention on the knowledge, attitudes and beliefs of qualified physiotherapists about chronic low back pain: Pre- and post-intervention survey.

The South African journal of physiotherapy · 2026 · Other · PT

Lara Davis, Benita Olivier, Lorraine Jacobs and 1 others

PMID 42266205

A 5-hour online webinar on pain neuroscience and risk stratification moved 536 South African physiotherapists away from biomedical thinking toward biopsychosocial care, with measurable gains in pain knowledge.

No control group, so we cannot say the webinars caused the change.

Key findings

1Biomedical orientation scores fell from a mean of 53.74 to 43.04 (mean difference 10.60, p < 0.001), indicating a shift away from tissue-damage and activity-restriction beliefs.

2Biopsychosocial orientation scores rose from 35.52 to 39.62 (mean difference 4.09, p < 0.001), reflecting stronger endorsement of psychosocial and patient-centred principles.

3Pain neurophysiology knowledge (NPQ, scored out of 13) improved from 10.19 to 11.04 (mean difference 0.86, p < 0.001), with the largest item-level gains where baseline understanding was weakest.

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What it does not show

No control group: participants only compared themselves to themselves, so natural maturation, testing effects, or simply the act of completing questionnaires could explain part of the change. Convenience sampling: only physiotherapists who chose to attend the webinars were included, so the sample likely over-represents those already interested in pain science and biopsychosocial care. Self-reported measures: all outcomes were questionnaires about beliefs and knowledge, not observations of clinical behaviour or patient outcomes. No follow-up: the study captured scores immediately after the webinars and did not assess whether the changes lasted or translated into different treatment decisions. High prior training: 66.8% of participants had already completed some postgraduate pain neuroscience content, so the intervention was building on an already-informed base rather than starting from scratch. Unequal data: only 201 of 536 participants had paired NPQ data (the pre-intervention NPQ was added midway through recruitment), so the knowledge findings rest on a smaller subset.

Declared interests

The authors state the research received no specific grant from any public, commercial, or not-for-profit funding agency. No other conflicts of interest are declared.

The easy way to misread this

Do not read the significant pre-post score changes as proof that the webinars caused the shift. There was no control group, no randomisation, and participants self-selected into the intervention; the 8.8% drop in biomedical scores and 6.6% gain in pain knowledge could partly reflect practice effects, motivation, or the passage of time between the two questionnaires. The study also measured only what physiotherapists reported believing, not whether they treated patients differently.

Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →


The study

Participants
536 qualified South African physiotherapists (521 with paired PABS-PT data, 201 with paired NPQ data)
Certainty of evidence
Low

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Lara Davis, Benita Olivier, Lorraine Jacobs, et al. The impact of a brief online education intervention on the knowledge, attitudes and beliefs of qualified physiotherapists about chronic low back pain: Pre- and post-intervention survey. The South African journal of physiotherapy. 2026.

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