‘Seeing pain differently’: the impact of physiotherapists’ attitudes and treatment beliefs on postural assessment in neck pain – an eye-tracking study

Abstract

Introduction: This study investigated how physiotherapists’ pain treatment orientations (biopsychosocial or biomedical) influence visual postural assessment of individuals with neck pain, using eye-tracking analysis. Material and methods: Physiotherapists (n = 30) completed the pain attitudes and beliefs scale and were categorised as predominantly ‘biomedical’ or ‘biopsychosocial’ based on the higher score percentage of the subscales. Eye-tracking data were collected while physiotherapists conducted visual postural assessment of participants with (n = 30) and without (n = 30) neck pain. Results: Physiotherapists with a biopsychosocial orientation exhibited (mean [95%CI]) fewer fixation counts in lateral (−2.29 [−3.80; −0.78] n) and posterior views (−5.84 [−7.62; −4.06] n), lower saccade counts in the posterior view (−4.51 [−6.46; −2.56] n) and shorter mean first-time passage on all transitions (ranging from −4.08 [−6.28; −1.88] to −14.09 [−18.64; −9.54] n) than those with a biomedical orientation. However, they demonstrated longer average fixation durations in all views (anterior: 0.02 [0.01; 0.03] seconds, lateral 0.04 [0.02; 0.05] seconds) and posterior 0.04 [0.03; 0.06] seconds). Almost all transition probabilities differed across physiotherapist groups, with specific positive or negative effects observed across transitions. Mean recurrent time was also lower in physiotherapists with Biopsychosocial orientation (−0.30 [−0.53; −0.08] events). Conclusions: Biopsychosocial-oriented physiotherapists exhibited more dynamic eye-movement patterns, with faster view transitions and shorter recurrence times, potentially indicating a more holistic approach to postural assessment. Attitudes and beliefs toward pain treatment orientation of physiotherapists, but not the presence of neck pain in patients, significantly influence their visual postural assessment.