Physiotherapists' pain beliefs and their influence on the management of patients with chronic low back pain

Purpose. Little is known about physiotherapists' pain beliefs and whether they influence behavior within therapeutic encounters with patients. This qualitative study explored physiotherapists' pain beliefs with the purpose of highlighting the nature of their beliefs and the role they played within their management of chronic low back pain. Methods. Six physiotherapists were purposefully sampled along with 12 of their patients with chronic low back pain ( two patients each). A qualitative exploration of physiotherapists' pain beliefs within the context of a clinical situation was carried out using semistructured interviews and observations at designated stages throughout therapeutic encounters with their patients. The data were prepared and analyzed according to a grounded theory approach. Results. The themes that emerged from the data indicated that the pain beliefs of physiotherapists in this study were determined by a number of perspectives including their beliefs regarding the development of craft knowledge needed to manage chronic low back pain, beliefs regarding the clinical characteristics of patients with chronic low back pain they considered to be "good" to treat and the challenge of patients who were "difficult" to treat, and pain beliefs within the therapeutic encounter. A tentative theory was developed which proposed that the physiotherapists' biomedically oriented pain beliefs influenced their clinical reasoning processes including the explanations given to the patients. Conclusions. The findings suggest that in order to maximize the rehabilitation potential of patients with chronic low back pain, physiotherapists need to be aware that their pain beliefs may influence their management of these patients.