Limited adherence to clinical practice guidelines among Belgian Physiotherapists: Findings from a 2014-2016 cross-sectional study

Marijke Leysen; Jo Nijs; Paul Van Wilgen; Christophe Demoulin; Laurent Pitance; Kevin Kuppens; Wouter Munneke; Nathalie Roussel

doi:10.1016/j.jbmt.2025.06.010

Limited adherence to clinical practice guidelines among Belgian Physiotherapists: Findings from a 2014-2016 cross-sectional study

J Bodyw Mov Ther. 2025 Oct:44:532-540. doi: 10.1016/j.jbmt.2025.06.010. Epub 2025 Jun 18.

Authors

Marijke Leysen¹, Jo Nijs², Paul Van Wilgen³, Christophe Demoulin⁴, Laurent Pitance⁵, Kevin Kuppens¹, Wouter Munneke⁶, Nathalie Roussel⁷

Affiliations

¹ Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium; Pain in Motion International Research Group(1), Department of Physiotherapy, Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
² Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium; Pain in Motion International Research Group(1), Department of Physiotherapy, Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
³ Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium; Pain in Motion International Research Group(1), Department of Physiotherapy, Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Transcare, transdisciplinary pain managament centre, Groningen, the Netherlands.
⁴ Department of Sport and Rehabilitation Sciences, University of Liege, Liège, Belgium; Université Catholique de Louvain-Institute of Neuroscience, Brussels, Belgium.
⁵ Université Catholique de Louvain-Institute of Neuroscience, Brussels, Belgium; Stomatology and Maxillofacial Surgery Department, Brussels, Belgium.
⁶ Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium; Pain in Motion International Research Group(1), Department of Physiotherapy, Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Sport and Rehabilitation Sciences, University of Liege, Liège, Belgium.
⁷ Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium. Electronic address: nathalie.roussel@uantwerpen.be.

PMID: 40954626
DOI: 10.1016/j.jbmt.2025.06.010

Abstract

Background and purpose: Despite evidence-based clinical guidelines promoting a biopsychosocial approach to managing low back pain, physiotherapists often fail to adhere to these recommendations, influenced by their attitudes. Therefore, this study aimed to explore Belgian physiotherapists' beliefs and attitudes toward low back pain management.

Methods: An observational, cross-sectional study was conducted in Belgium between 2014 and 2016. Physiotherapists' beliefs were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), which contains a biomedical and psychosocial subscale, and Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS). A clinical vignette was used to assess physiotherapists' adherence to guidelines recommending physical activity and work for low back pain. Associations between physiotherapists' demographics, PABS-PT subscales and HC-PAIRS were assessed using Student T-tests and chi-square for group differences, and Pearson's R for correlations.

Results: A total of 565 physiotherapists participated. Out of 561 physiotherapists, 59.5 % provided guideline-adherent recommendations regarding physical activity and 33.9 % out of 560 regarding work. Physiotherapists with a stronger biomedical and weaker biopsychosocial orientation were less likely to adhere to guidelines concerning work and activity. Beliefs and adherence to guidelines were associated with years since graduation and socio-cultural differences. Sex-based differences were observed in guideline adherence related to activity, with male physiotherapists showing greater compliance.

Conclusion: The study provides evidence that between 2014 and 2016, guideline adherence among physiotherapists in Belgium was low and related to their attitudes and beliefs about low back pain. These attitudes, beliefs and guideline adherence were associated with physiotherapists' graduation year and socio-cultural factors.

Publication types

Observational Study

MeSH terms

Adult
Attitude of Health Personnel*
Belgium
Cross-Sectional Studies
Female
Guideline Adherence* / statistics & numerical data
Health Knowledge, Attitudes, Practice
Humans
Low Back Pain* / rehabilitation
Low Back Pain* / therapy
Male
Middle Aged
Physical Therapists* / psychology
Physical Therapists* / statistics & numerical data
Practice Guidelines as Topic*