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

Marijke Leysen
, Jo Nijs
, Paul van Wilgen
, Christophe Demoulin
, Laurent Pitance
, Kevin Kuppens
, Wouter Munneke
, Nathalie Roussel^*

^*Corresponding author for this work

University of Antwerp
Vrije Universiteit Brussel
Transcare
University of Liege
Université catholique de Louvain
Stomatology and Maxillofacial Surgery Department

Research output: Contribution to journal › Article › Academic › peer-review

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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.

Original language	English
Pages (from-to)	532-540
Number of pages	9
Journal	J. Bodywork Mov. Ther.
Volume	44
DOIs	https://doi.org/10.1016/j.jbmt.2025.06.010
Publication status	Published - 1 Oct 2025
Externally published	Yes

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@article{595d282c68b04578992a6033772fa6d8,

title = "Limited adherence to clinical practice guidelines among Belgian Physiotherapists: Findings from a 2014{\textendash}2016 cross-sectional study",

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{\textquoteright} 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{\textquoteright} graduation year and socio-cultural factors.",

author = "Marijke Leysen and Jo Nijs and \{van Wilgen\}, Paul and Christophe Demoulin and Laurent Pitance and Kevin Kuppens and Wouter Munneke and Nathalie Roussel",

note = "Publisher Copyright: {\textcopyright} 2025",

year = "2025",

month = oct,

day = "1",

doi = "10.1016/j.jbmt.2025.06.010",

language = "English",

volume = "44",

pages = "532--540",

journal = "J. Bodywork Mov. Ther.",

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TY - JOUR

T1 - Limited adherence to clinical practice guidelines among Belgian Physiotherapists

T2 - Findings from a 2014–2016 cross-sectional study

AU - Leysen, Marijke

AU - Nijs, Jo

AU - van Wilgen, Paul

AU - Demoulin, Christophe

AU - Pitance, Laurent

AU - Kuppens, Kevin

AU - Munneke, Wouter

AU - Roussel, Nathalie

PY - 2025/10/1

Y1 - 2025/10/1

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/105008937782

U2 - 10.1016/j.jbmt.2025.06.010

DO - 10.1016/j.jbmt.2025.06.010

M3 - Article

C2 - 40954626

SN - 1360-8592

VL - 44

SP - 532

EP - 540

JO - J. Bodywork Mov. Ther.

JF - J. Bodywork Mov. Ther.

ER -

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

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