Attitudes, Beliefs, and Recommendations for Persistent Low Back Pain Patients: Cross-Sectional Surveys of Students and Faculty at a Chiropractic College

Abstract

Abstract Background Healthcare providers’ attitudes and beliefs about pain conditions influence those of patients and may impact outcomes. While the use of chiropractic care for persistent low back pain (PLBP) is prevalent, chiropractors’ attitudes and beliefs related to PLBP patients are not fully understood. The purpose of this study was to assess the attitudes and beliefs and activity/work recommendations of students and faculty at a chiropractic teaching institution regarding PLBP patients.Methods The Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) and clinical vignettes were requested to be completed by all chiropractic students and faculty at Parker University in April 2018 and July-December 2020. HC-PAIRS scores range from 1–7, with higher scores indicating stronger beliefs that PLBP justifies disability and limitation of activities. Activity and work recommendations from clinical vignettes were rated as “adequate”, “neutral”, or “inadequate”. Descriptive statistics and independent t-tests were used to analyze results.Results Student and faculty response rates in 2018 and 2020 were 63.6% (n = 497) and 25.9% (n = 305), and 76.7% (n = 23) and 41.5% (n = 22), respectively. Faculty mean HC-PAIRS scores (SD) (2018: 3.66 (0.88); 2020: 3.49 (0.91)) were significantly lower than students’ (2018: 4.41 (0.71); 2020: 4.22 (0.69)) in both years (p < 0.05). The decrease in student mean scores between years was statistically significant (mean change: 0.19, p < 0.05), while the decrease in faculty mean scores was insignificant (mean change: 0.17, p = 0.55). In 2018 and 2020, the percentage of faculty that provided “adequate” activity (2018: 62.1; 2020: 66.7) and work (2018: 41.0; 2020: 45.5) recommendations was significantly greater than students’ activity (2018: 33.9; 2020: 30.3) and work (2018: 21.2; 2020: 23.8) recommendations. Within-group changes in percentage of “adequate” recommendations given by students and faculty between years were not significant.Conclusions As the first study to consecutively assess the PLBP attitudes and beliefs of students and faculty of a chiropractic college, we found that there is room for improvement in these areas. Changes in attitudes and activity/work recommendations between the 2 years were minimal and found faculty scores to be more appropriate than those of students. Strategies to improve scores should be considered at chiropractic training institutions.