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Biomedical Versus Biopsychosocial Treatment Approach of Athletic Therapists Regarding Low Back Pain

Biomedical Versus Biopsychosocial Treatment Approach of Athletic Therapists Regarding Low Back Pain MacDougall HL, Dover GC Concordia University, Montreal, Quebec Introduction: The treatment of low back pain has always focused on the biomedical aspect of the patient, but recent research has started to examine the beliefs of the therapist. Biomedical and biopsychosocial orientation of the clinician can alter treatment outcomes. Most research has measured the orientation of physical therapists in the treatment of low back pain, but there is no existing data on athletic therapists. Rationale: The purpose of this study was to measure athletic therapists’ biomedical and biopsychosocial orientation toward low back pain treatment. Methods: Participants completed a modified version of the Pain Attitudes and Beliefs Scale for Athletic Therapists online. In addition, the authors measured demographic information, which included sex, age, years of experience, average number of patients with back pain a year, and job setting. Descriptive statistics were used to characterize respondents, and independent Student’s t or ANOVA tests were used to identify any differences in scores. Results: Four hundred eighty-four people responded to the survey and 407 were analyzed. Participants comprised 137 men and 262 women whose ages ranged from 21 to 69 (35.3 ± 9.1) years. The number of respondents per job setting were 81 "college/university," 20 "secondary schools," 151 "private clinics," 44 "specialty clinics," 54 "sports teams," 3 "hospital," 7 "emerging settings," 14 "academic setting," and 12 "other." The mean biomedical score (32.1 ± 6.5) was statistically higher (P = .03) than the mean biopsychosocial score (31.3 ± 4.2). There was a significant decrease in biomedical score between individuals treating up to 5 patients per year (34.91 ± 6.01) and 100 to 500 patients per year (30.6 ± 6.8, P = .005), with a trend (P = .068) between the former and 30 to 100 patients (31.65 ± 6.84). Therapists treating the general public had statistically higher (P = .04) biopsychosocial scores (31.8 ± 4.1) than those therapists treating amateur elite athletes (30.1 ± 4.1). Therapists having 0 to 4 years of experience (34.4 ± 5.3) had significantly higher (P > .001) biomedical scores than those having 10 to 20 years of experience (30.4 ± 7.1). Discussion: Previous studies have suggested that a higher biomedical orientation in physiotherapists leads to worse treatment outcomes in patients with chronic low back pain. These findings indicate that athletic therapists maintain biomedical beliefs comparable to physical therapists. Furthermore, athletic therapists with less experience who treat lower numbers of patients with low back pain and who primarily treat athletes have a more biomedical orientation. Importance: Although a more biopsychosocial approach to low back pain treatment is recommended, athletic therapists retain biomedical practices. More research is needed on the education of best practices and biopsychosocial treatment for patients with low back pain in athletic therapy. Dynamic Single-Leg Balance Control Between Youth Hockey Players With or Without Previous Concussion During a Visuomotor Task Mitchell KM, Cinelli ME Wilfrid Laurier University, Waterloo, Ontario Introduction: The current return-to-play (RTP) protocol does not include an objective measure for the assessment of visuomotor function and dynamic stability to determine if youth athletes have truly recovered from a concussion. Baker and Cinelli (2014) identified persistent visuomotor deficits during a collision avoidance task in athletes beyond 30 days post-concussion. Furthermore, Cross et al. (2015) found that professional rugby players had a 60% increased risk of sustaining any injury following full RTP and suggested this may be due to persisting sensorimotor deficits. Rationale: The purpose of the current study was to determine whether a visuomotor dynamic balance task could objectively identify differences between youth hockey players with and without a history of concussion. Methods: Youth hockey players (N = 45; age: 12 to 17 years) were recruited from a private hockey academy. Athletes who reported sustaining ≤ 5 concussions (CONC group = 11) or no history of concussions (CONT group = 34) were included. Participants stood in single support on a Nintendo Wii Balance board sampled at 100 Hz while a Fitlight Trainer system administered a concurrent response time task. Five Fitlights were arranged on the floor anterior