An e-learning program improves low back pain beliefs of physiotherapists: a randomised trial

Abstract

Question: How effective is an e-learning program based on international clinical guidelines in promoting beliefs more aligned with the current evidence for the management of low back pain among physiotherapists? Design: Randomised controlled trial with concealed allocation and intention-to-treat analysis. Participants: 106 physiotherapists who treat patients with low back pain. Interventions: The experimental group received access to an e-learning program, based on recommendations of clinical practice guidelines for the management of low back pain, over a 6-week period. The program consisted of six units, totalling 15 hours, and was offered in a self-instructional and self-paced format. The control group was instructed to continue their activities as usual. Outcome measures: The primary outcome was beliefs about low back pain measured using the Modified Back Beliefs Questionnaire (MBBQ, –50 worst to 50 best). Secondary outcomes included the Back Pain Attitudes Questionnaire (Back-PAQ, –20 worst to 20 best) and agreement with two statements (1: X-rays or scans are necessary to get the best medical care for low back pain; 2: Everyone with low back pain should have spine imaging). Participants were evaluated at baseline and 6 weeks. Results: Out of 53 participants allocated to the e-learning program, two completed only the first unit and one did not complete any units, resulting in an overall adherence rate of 94%. Compared with control, the e-learning program improved the MBBQ (MD 8 points, 95% CI 5 to 10) and the Back-PAQ score (MD 3.1 points, 95% CI 1.8 to 4.3). For the imaging beliefs statements, the e-learning program was able to increase the proportion of participants with beliefs aligned with the current evidence (statement 1: RD 38%, 95% CI 21 to 52; statement 2: RD 17%, 95% CI 7 to 29) compared with the control group. Conclusion: The e-learning program based on recommendations of clinical practice guidelines for the management of low back pain improved physiotherapists’ beliefs about the management of low back pain. Registration: NCT05661968