Does Training in Psychosocial Methods for Treatment Providers Improve Outcome for Pain Patients at Risk of Long-Term Disability? A Randomised Controlled Trail of a Course for Physical Therapists

Neck and back pain continue to be extremely common, with a high prevalence and wide socio-economic consequences all over the industrialized world. Through the years a growing interest has risen for other factors than the pure biomedical or biomechanical. This has led to a new clinical model for the treatment of back pain; the biopsychosocial model of illness. Treatment based on the biopsychosocial model not only must address the biological basis of symptoms, but must incorporate the full range of social and psychological factors that have been shown to affect pain, distress and disability.

Since there is today strong evidence indicating that psychosocial factors have a greater impact on disability then biomechanical or biomedical factors and strong evidence that psychosocial factors are strongly linked to the transition from acute to chronic pain, concept of psychosocial risk factors has been developed. Although the concept of psychosocial risk factors still is relatively new, there seems to be an international consensus about the importance of psychosocial risk factors for the prevention of the development of chronic pain but there appears to be considerable uncertainty about the clinical application.

Health care providers' (HCPs') attitudes and beliefs appear to influence the information they provide to patients. This may subsequently result in different patient outcome depending on the HCPs' attitudes and beliefs. Physical therapists attitudes and beliefs are relatively unexplored but seem to have an effect on patients' attitudes and beliefs, which can affect patient outcome in terms of sick leave, health care use and function.

HCP attitudes and beliefs towards psychosocial factors are relatively unexplored. Yet, it seems physical therapists do not necessarily accept new evidence-based information and may have difficulties in applying evidence-based information in their clinical practice. Implementation and dissemination of evidence-based psychosocial factors requires favourable attitudes, knowledge and skills to ensure a behavioural change on behave of the physical therapists.