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

Objective: This study aimed to investigate the association of physical therapists' attitudes and beliefs about low back pain treatment outcomes within a publicly funded health care system.

Methods: Data from a national outpatient physical therapist service provider were analyzed. Functional status data were collected at intake and discharge. The Attitudes to Back Pain Scale in Musculoskeletal Practitioners Questionnaire was used to assess physical therapists' attitudes. Multilevel regression models were employed to examine the effects of physical therapists' attitudes while controlling for patient and physical therapist characteristics.

Results: The study included 68 physical therapists and 1043 patients. The physical therapist level explained a small portion of the variance in patients' function (2%-4%). A more biomedically oriented attitude was associated with a slightly lower patient function level (β = -.08), but patient characteristics largely influenced this effect. Other attitude factors were not significantly associated with function. Sensitivity analyses aligned with the main findings.

Conclusions: The study suggests that physical therapists' attitudes have a limited impact on low back pain treatment outcomes within a publicly funded health care system. While a more biomedically oriented attitude was associated with slight negative effects, the clinical relevance is questionable. Further research in diverse settings is needed to validate and contextualize these findings. The study underscores the importance of considering patient-level factors and health care system context in interpreting practitioner effects on treatment outcomes.

Impact: Patient characteristics are more significant in explaining functional outcomes than physical therapists' characteristics and attitudes. A marginally small association was observed, indicating that a more biomedically oriented attitude among physical therapists was linked to slightly lower patient functioning. Despite the observed association, the clinical relevance of physical therapists' attitudes in low back pain treatment outcomes remains modest.