Why We Still Get Back Pain Wrong: Beliefs and Attitudes Towards Low Back Pain Among Austrian Physiotherapists and Healthcare Students: A Cross-Sectional Study

Musculoskeletal Care. 2026 Mar;24(1):e70195. doi: 10.1002/msc.70195.

ABSTRACT

BACKGROUND: Healthcare practitioners' beliefs and attitudes towards low back pain (LBP) influence patients' beliefs, pain experience, and treatment outcomes. This study examined beliefs, attitudes, and conceptual understanding of LBP among practicing physiotherapists (PTs) in Austria and compared them with first-semester healthcare students.

METHODS: This cross-sectional online survey was conducted between May and November 2025. Beliefs about LBP were assessed using the Back Beliefs Questionnaire (BBQ; range 14-70, higher scores indicate more positive beliefs) and the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS; range 15-105, higher scores indicate stronger pain-disability beliefs). Participants included practicing Austrian PTs and first-semester students enrolled in healthcare-related programs at two universities.

RESULTS: In total, 517 participants completed the survey (391 PTs, 99 students; 27 others excluded). PTs demonstrated significantly more positive beliefs than students, with higher BBQ scores (34.5 ± 5.9 vs. 28.7 ± 5.4; p < 0.001) and lower HC-PAIRS scores (54.9 ± 12.9 vs. 65.5 ± 10.8; p < 0.001). These differences remained significant after adjustment for age, education, and professional experience. Despite this, both groups predominantly held negative, pain-implies-disability-oriented beliefs about LBP. Notably, greater professional experience among PTs was associated with more negative, disability-oriented and biomedical pain beliefs.

CONCLUSION: Although PTs held more positive beliefs about LBP than students, increasing professional experience was paradoxically linked to more negative pain-disability beliefs. These findings underscore the need for improved, longitudinal educational strategies that reinforce contemporary, evidence-based perspectives on LBP throughout clinical careers.

TRIAL REGISTRATION: We registered our study at https://osf.io/kr7ag.

PMID:41760402 | DOI:10.1002/msc.70195