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Osteopathic and Podiatric Medical Students’ Attitudes Toward Low Back Pain

Journal: Journal of Osteopathic Medicine Date: 2022/12, 122(12):Pages: A32-A34. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2022-2000/html)

Keywords:

attitude [117]
cross sectional study [597]
low back pain [413]
medical students [402]
osteopathic medicine [1540]
podiatry [2]
USA [1086]

Abstract:

Statement of Significance: Primary care practitioners managing low back pain (LBP) have a range of beliefs from biomedical to biopsychosocial. Previous studies found a positive association between biopsychosocial beliefs about pain and adherence to evidence based guidelines (1,2). Past research has focused on training clinicians on pain science and treatment recommendations to improve patient outcomes, though it’s been shown that LBP beliefs develop early in education and can be resistant to change (3). Research Methods: The Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) questionnaire is a 7-point Likert scale, measuring the level of belief that back pain justifies disability and activity limitations on 4 subscales: “functional expectations,” “social expectations,” “need for cure,” and “projected cognition.” The total score ranges from 15 to 105. A higher HC-PAIRS score indicates belief that LBP justifies disability and the limitation of physical activity, bias toward a biomechanical attitude which is associated with lower adherence to guidelines (4). A lower score indicates more biopsychosocial attitudes. This survey was submitted in June 2022 to all osteopathic (DO) and podiatric (DPM) students currently enrolled at Western University of Health Sciences classes of 2022-2025. DO programs located on two campuses, Lebanon, OR and Pomona, CA. DPM programs located only on Pomona campus. Pre-clinical students are students of DO/DPM classes 2024 and 2025 who are enrolled in didactic curriculum before interacting with patients. Clinical students are DO/DPM classes of 2023 and 2022 who are participating in clinical rotations in hospitals and clinical practices. The HC-PAIRS score for each group was averaged and standard deviation calculated. A Mann-Whitney Test was used to analyze statistical significance. Data Analysis/Results: The survey was sent to 705 preclinical and 685 clinical DO students, as well as 88 preclinical and 61 clinical DPM students. 175 surveys were completed, consisting of 85 (12.1% response rate) preclinical and 66 (9.6% response rate) clinical DO students, as well as 13 (14.8% response rate) preclinical and 11 (18% response rate) clinical DPM students. After analysis, average scores between clinical and preclinical groups were not significantly different using a Mann-Whitney Test. Clinical DO students and preclinical DO students scored an average of 60.8 ±9.4 and 61.7 ±8.1, respectively. Clinical podiatric medicine students and preclinical podiatric students scored an average of 61.3 ±7.7, and 69.7±8.3, respectively. Conclusion: No significant difference in HC-PAIRS scores were observed in all groups. In particular no difference was found comparing preclinical and clinical cohorts. Compared to other health professional students in previous studies, these students’ scores were more consistent with biomedical attitudes toward LBP (5). This serves to show that medical school didactic and clinical education may not significantly steer student’s attitudes toward biopsychosocial perspectives of low back pain. This may suggest the need for a shift in medical education to include more pain science and pain management content, including content that discusses the psychosocial component of low back pain, leading to more guideline adherent care. This was a single university study, which may limit results. Additionally, as is often the case with survey-driven studies, the response rate was low. This may have been exacerbated by the COVID-19 pandemic and a mostly online education. There are limited studies evaluating low back pain attitudes in medical students in the United States using the HC-PAIRS questionnaire. Therefore, the validity of the correlation of the survey score with adherence to clinical guidelines should be confirmed in this population as well. Additionally, the COVID-19 pandemic could have some effect on the delivery of educational content. Assessing results at different points in time may show varied outcomes. A future multi-centric study that follows each class longitudinally may be useful in further identifying the impact that didactic and clinical exposure have on DO and DPM attitudes towards LBP and association with adherence to clinical guidelines and patient outcomes.


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