Physiotherapists' treatment approach towards neck pain and the influence of a behavioural graded activity training: an exploratory study.

Physiotherapists' treatment approach might influence their behaviour during practice and, consequently, patients' treatment outcome; however, an explicit description of the treatment approach is often missing in trials. The purpose of this prospective exploratory study was to evaluate whether the treatment approach differs between therapists who favour a behavioural graded activity (BGA) program, conservative exercise (CE) or manual therapy, and whether BGA training has influence on the treatment approach. Forty-two therapists participated. BGA therapists received a 2-day training. Treatment approach was measured at baseline and at 3-month follow-up, using the Pain Attitude and Beliefs Scale for Physiotherapists (PABS-PTs). By this method data on the adoption of biomedical or biopsychosocial approaches were generated. Differences were examined with analysis of variance (ANOVA) and independent Student's t-test. Influence of the BGA training was examined with linear regression. At baseline, there were no significant differences between BGA, CE or manual therapists use of biomedical or biopsychosocial approaches, but there was a trend for BGA therapists to score higher on the biopsychosocial approach. At follow-up, their biopsychosocial score remained higher and their biomedical score was lower compared to CE therapists. Corrected regression analysis showed a 4.4 points (95%CI -7.9; -0.8) higher decrease for therapists who followed the BGA training compared to therapists who did not. Our results indicate no significant differences in treatment approach at baseline, and that BGA training might influence therapists' treatment approach since the scores on the biomedical approach decreased.