Confidence in Providing Primary Care to Patients with Low Back Pain among Physiotherapists

Abstract

Background Low back pain (LBP) is a common musculoskeletal disorder with distinct clinical features. Direct access to physiotherapy (PT), with PTs acting as primary care providers, can improve the management of individuals with LBP. However, the success of these treatments is related to clinician confidence. The objectives of this study were to develop the Primary Care Confidence Scale (PCCS) and to describe the confidence of PTs in treating LBP in primary care. Methods The PCCS questionnaire was developed through a seven-stage Delphi process involving experts who modified an existing self-confidence scale. The questionnaire was completed by 314 PTs, 140 of whom completed it again after 2 weeks. Structural validity was evaluated using exploratory and confirmatory factor analysis. Reliability was assessed with Cronbach’s alpha for internal consistency and intraclass correlation coefficients (ICC) for test-retest reliability. Spearman tests assessed correlations between background characteristics and PCCS scores. Two independent t-tests estimated the effects of gender and post-graduate education. One-way ANOVA was used to evaluate the impact of the workplace. Results The PCCS had a multidimensional structure with three factors demonstrating an acceptable model fit and good reliability (α = 0.83, ICC = 0.78). The mean level of confidence was 75% (PCCS = 45 ± 6/60), with moderate positive correlations between age and years of experience (r = 0.33) and PCCS scores (r = 0.42, p < 0.001( for both. PTs working in public or private outpatient clinics had significantly higher scores (PCCS = 45.3 and 47.0, respectively) compared to PTs working in an inpatient hospital or in rehabilitation centers (PCCS = 40.6 and 40.3, respectively, p < 0.009). Conclusions The newly developed PCCS demonstrated adequate validity and high reliability, suggesting that it is suitable for measuring confidence in treating patients with LBP in primary care settings. PTs showed similar confidence levels to other healthcare professionals treating patients in primary care, which could support direct access to PT. Health policy makers and educators could incorporate the PCCS into training and evaluation programs to assess the readiness and competence of clinicians to treat LBP in primary care.