Exploring Beliefs about Pain and their Relationship with Treatment Recommendations: A Pilot Online Survey for Occupational Therapists

Abstract

Background: Previous research has suggested that an association exists between clinician held beliefs about pain and clinicians’ treatment recommendations for clients with chronic low back pain. Such treatment recommendations are more likely to lessen the activity demands on clients and conflict with best practice guidelines for chronic low back pain. While it seems clinician held ‘fear avoidance beliefs’ could be important for treatment outcome, no research has been carried out on these beliefs in occupational therapists.

Purpose: The purpose of this pilot study was to administer an online survey to explore New Zealand occupational therapists’ beliefs about pain, and their association with treatment recommendations for clients with low back pain. The use of an online survey was innovative: there is no published research on the use of such methods within the New Zealand occupational therapy workforce.

Methods: An online survey was developed and tested. This included demographics, two fear avoidance beliefs questionnaires, a video case study of a client with chronic low back pain, and a series of questions about treatment recommendations for the ‘case’. An invitation to complete the survey was emailed directly to targeted occupational therapists, and to those receiving the New Zealand Occupational Therapy Board email newsletter.

Results: Sixty-three online surveys were completed. The study found that there was a statistically significant positive association between ‘fear avoidance beliefs’, held by respondents, and the recommendation of home help for the case study. The response rate was approximately 8%, from emailing respondents directly, and 0.5%, from the New Zealand Occupational Therapy Board Newsletter. Feedback on the online survey process, including the use of video for the case study, was positive.

Discussion: Findings were consistent with previous research which found that ‘fear avoidance beliefs’ were associated with treatment recommendations, and that these treatment recommendations were more orientated to lessening the activity demands, potentially unhelpfully, upon clients with chronic low back pain. The study also found that the use of the online survey research method may be a useful research tool with occupational therapists in New Zealand; additional strategies to improve response rate would be needed for future studies.

Conclusion: Based on this pilot study, a larger and more robust study on the topic of fear avoidance beliefs in occupational therapists is indicated. Such a study may aid in further understanding of the factors influencing occupational therapists when they develop treatment recommendations for those with chronic low back pain.