Spanish physiotherapists' explanatory models regarding low back pain and its associated factors

Background/Aims: Despite new knowledge about pain, the belief that pain and disability stem solely from structural impairments continues to prevail among physiotherapists, often correlating with poorer clinical outcomes. This study aims to describe the explanatory models (EMs) regarding low back pain (LBP) held by Spanish physiotherapists and to analyse associated factors. Methods: A cross-sectional observational study with Spanish physiotherapists (N=204). The physiotherapists’ EMs were estimated using the Relationship Between Pain and Disability in Health Care Professionals (HC-PAIRS), Beliefs and Attitudes in Pain for Physiotherapists (PABS-PT) and Fear-Avoidance (FABQ) questionaries. The associated factors studied were age, sex, training received and professional experience. Medians with a 95% confidence interval and a multivariate linear regression were performed. Findings: The factors associated with Spanish physiotherapists’ EMs were having only a 3-year bachelor’s degree in physiotherapy, having more than 25 years of professional experience and limited training in pain. Questionnaire medians show a descending gradient from 3-year degrees to 4-year degrees and postgraduate studies. However, only a 3-year degree significantly differs from postgraduate studies [HC-PAIRS Coef=7 (95% CI 2.32–11.68); PABS-PT Coef=6 (95% CI 1.70–10.30); FABQ Coef=10 (95% CI 3.04–16.96)] and does not differ from a 4-year degree. Conclusions: Spanish physiotherapists largely maintain a biomedical EMs for LBP. Postgraduate and pain-specific training are associated with a shift towards less biomedical views, whereas 3- or 4-year degree programs show no impact despite the changes in therapeutic approaches introduced in the 4-year degree. Undergraduate physiotherapy education should place greater emphasis on integrating a biopsychosocial approach.