Attitudes, Beliefs, and Clinical Decision-Making Regarding Low Back Pain: A Cross-Sectional Study of Pakistani Medical Practitioners, Physiotherapists, and Exercise Professionals.

BACKGROUND

Low back pain (LBP) is a leading global cause of disability, particularly burdensome in LMICs like Pakistan, where biomedical approaches remain dominant in clinical care. This study examined how healthcare professionals' (HCPs) beliefs, attitudes, and confidence influence clinical decision-making for LBP.

METHODS

A cross-sectional survey of 343 HCPs comprising medical practitioners (n = 123), physiotherapists (n = 124), and exercise professionals (n = 96) in Pakistan was conducted between August 2023 and December 2024. Participants completed the PABS-PT, Medical Scans Beliefs Questionnaire (MSBQ), two clinical vignettes, and rated their confidence in the use of various LBP treatments. Group differences were tested with ANOVA and chi-square. Stepwise linear regression and binary logistic regression identified predictors of confidence, decision-making, and treatment practices.

RESULTS

Physiotherapists demonstrated the strongest biomedical orientation (p = 0.01), with no significant group differences in biopsychosocial orientation. MSBQ scores (mean = 17.27) were moderate across all groups, with high agreement that imaging is essential for LBP care. Clinical decisions were predicted by experience, physical activity, gender, and biomedical orientation. Biopsychosocial beliefs predicted greater confidence in pain education, exercise, and CBT (p < 0.001) but not in their actual use. Physiotherapists and exercise professionals were significantly more likely than medical practitioners to employ pain education as a treatment strategy (physiotherapists: OR = 5.7, 95% CI = 3.1-10.7; exercise professionals: OR = 6.0, 95% CI = 3.2-11.3; both p < 0.001).

CONCLUSIONS

Pakistani HCPs show a prevalent biomedical orientation and share some persistent misconceptions about the value of imaging in LBP care. While biopsychosocial beliefs enhance confidence in evidence-based treatments, translation into practice remains limited. We recommend targeted educational interventions, curricular reforms, and interdisciplinary collaborations to facilitate biopsychosocially informed care.