Low back pain treatment by athletic trainers and athletic therapists: Biomedical or biopsychosocial orientation?

Abstract

Context: Low back pain (LBP) remains a societal burden due to consistently high rates of recurrence and chronicity. Recent evidence suggested that a provider’s treatment orientation influences patient beliefs, the clinical approach, and subsequently, rehabilitation outcomes. Objective: To characterize American athletic trainer (AT) and Canadian athletic therapist (C-AT) treatment orientations toward LBP. Design: Cross-sectional study. Setting: Online survey. Patients or Other Participants: A total of 273 ATs (response rate ¼ 13.3%) and 382 C-ATs (response rate ¼ 15.3%). Main Outcome Measure(s): Participants completed demographic questions and the Pain Attitudes and Beliefs Scale (PABS) for ATs/C-ATs. The PABS measures the biomedical and biopsychosocial treatment orientation of health care providers and is scored on a 6-point Likert scale. Descriptive statistics characterized the participants; t tests and 1-way analyses of variance identified differences between group means; and Spearman correlations assessed relationships between the biomedical and biopsychosocial scores and age, number of LBP patients per year, and years of experience. Results: Athletic trainers treating 9 to 15 LBP patients per year had higher biomedical scores (35.0 6 5.7) than ATs treating 16 to 34 (31.9 6 5.5, P ¼ .039) or .34 (31.7 6 8.6, P ¼ .018) LBP patients per year. The C-ATs treating 16 to 34 (31.8 6 6.3, P ¼ .038) and .34 (31.0 6 6.7, P, .001) LBP patients per year had lower biomedical scores than those treating 8 LBP patients per year (34.8 6 5.9). The C-ATs with 5 years of experience had higher biomedical scores than those with 10 to 15 (31.0 6 6.7, P ¼ .011) and 16 to 24 (29.8 6 7.5, P, .001) years of experience. Canadian athletic therapists treating the general public had higher (31.7 6 4.0) biopsychosocial scores than ATs treating athletes (31.3 6 3.5, P ¼ .006). The C-ATs 35.6 years of age had higher biomedical scores (33.1 6 5.9) than those .35.6 years of age (30.5 6 7.0, P, .001). Conclusions: Athletic trainers and C-ATs who treated more LBP patients per year were more likely to score low on a biomedical treatment orientation subscale. Because this orientation has predicted poor outcomes in other health care providers, further research is needed to determine the effects of ATs’ and C-ATs’ biomedical orientations on rehabilitation outcomes.