Modelos explicativos de fisioterapeutas espanhóis sobre a dor lombar e os seus fatores associados

Autores

  • Júlia Jubany Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  Avinguda Universitària 4-6, 08242, Manresa, Barcelona, Spain
  • Olga Borao Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  Avinguda Universitària 4-6, 08242, Manresa, Barcelona, Spain
  • Albert Espelt Departament de Psicologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona   08193 Cerdanyola del Vallès, Barcelona Spain
  • Daniel Paton Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  Avinguda Universitària 4-6, 08242, Manresa, Barcelona, Spain
  • Mireia Campoy-Vila Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  Avinguda Universitària 4-6, 08242, Manresa, Barcelona, Spain

DOI:

https://doi.org/10.47197/retos.v77.117865

Palavras-chave:

Dor lombar, especialidade de fisioterapia, modelo biomédico, modelo biopsicossocial, modelo explicativo

Resumo

Contexto/Objetivos: Apesar dos novos conhecimentos sobre a dor, a crença de que a dor e a incapacidade são causadas exclusivamente por deficiências estruturais continua a ser prevalente entre os fisioterapeutas, correlacionando-se frequentemente com piores resultados clínicos. Este estudo visa descrever os modelos explicativos (MEs) da dor lombar (DL) utilizados pelos fisioterapeutas espanhóis e analisar os fatores associados.

Métodos: Foi realizado um estudo observacional transversal com fisioterapeutas espanhóis (N=204). Os ME dos fisioterapeutas foram estimados através do Questionário de Relação Dor e Incapacidade em Profissionais de Saúde (HC-PAIRS), o Questionário de Crenças e Atitudes dos Fisioterapeutas em Relação à Dor (PABS-PT) e o Questionário de Medo-Evitação (FABQ). Os fatores associados estudados incluíram a idade, o sexo, a formação e a experiência profissional. Foram calculadas as medianas com intervalos de confiança de 95% e realizada regressão linear multivariada.

Resultados: Os fatores associados à abordagem biomédica dos fisioterapeutas espanhóis foram possuir apenas um diploma de fisioterapia de 3 anos, ter mais de 25 anos de experiência profissional e formação limitada em gestão da dor. As pontuações medianas dos questionários mostram uma tendência decrescente de diplomas de 3 anos para diplomas de 4 anos e pós-graduação. No entanto, apenas o diploma de 3 anos difere significativamente da pós-graduação [HC-PAIRS Coef = 7 (IC 95%: 2,32–11,68); PABS-PT Coef = 6 (IC 95%: 1,70–10,30); FABQ Coef = 10 (IC 95%: 3,04–16,96)] e não difere do diploma de 4 anos.

Conclusões: Os fisioterapeutas espanhóis mantêm, em grande parte, uma abordagem biomédica da dor lombar. A formação pós-graduada e a formação específica em dor estão associadas a uma mudança para perspetivas menos biomédicas, enquanto os cursos de licenciatura de 3 ou 4 anos não demonstram impacto, apesar das mudanças nas abordagens terapêuticas introduzidas no curso de 4 anos. A formação em fisioterapia na licenciatura deve dar maior ênfase à integração de uma abordagem biopsicossocial.

Biografias do Autor

  • Júlia Jubany, Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  Avinguda Universitària 4-6, 08242, Manresa, Barcelona, Spain

    Júlia Jubany is Head of the Department of Physiotherapy of the Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  

  • Olga Borao, Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  Avinguda Universitària 4-6, 08242, Manresa, Barcelona, Spain

    Olga Borao is the Physiotherapy Coordinator of the External Clinical Placements of the Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  

  • Albert Espelt, Departament de Psicologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona   08193 Cerdanyola del Vallès, Barcelona Spain

    Albert Espelt Albert Espelt is the Vice Dean for Student Affairs and Promotion of Departament de Psicologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona 

  • Daniel Paton, Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  Avinguda Universitària 4-6, 08242, Manresa, Barcelona, Spain

    Daniel Paton Sanchez-Migallon was a student in Master's degree in Physiotherapy of the Musculoskeletal System at the Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  

  • Mireia Campoy-Vila, Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  Avinguda Universitària 4-6, 08242, Manresa, Barcelona, Spain

    Mireia Campoy-Vila is the Coordinator of Problem-based learning for the Physiotherapy of Facultat de Ciències de la Salut de Manresa, Universitat de Vic – Universitat Central de Catalunya (UVic-UCC)  

Referências

Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. The Lancet, 379(9814), 482–491. https://doi.org/10.1016/S0140-6736(11)60610-7

Beauchemin, C., & González-Ferrier, A. (2011). Sampling international migrants with origin-based snowballing method: New evidence on biases and limitations. Demographic Research, 25, 103–134. https://doi.org/10.4054/DemRes.2011.25.3

Brunner, E., et al. (2019). Factor structure of the German version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Physiotherapy Theory and Practice, 35(10), 995–1003. https://doi.org/10.1080/09593985.2018.1461285

Buchbinder, R., et al. (2018). Low back pain: A call for action. The Lancet, 391(10137), 2384–2388. https://doi.org/10.1016/S0140-6736(18)30488-4

Bunzli, S., et al. (2017). Making sense of low back pain and pain-related fear. Journal of Orthopaedic & Sports Physical Therapy, 47(9), 628–636. https://doi.org/10.2519/jospt.2017.7434

Cowell, I., et al. (2018). Perceptions of physiotherapists towards the management of non-specific chronic low back pain from a biopsychosocial perspective: A qualitative study. Musculoskeletal Science and Practice, 38, 113–119. https://doi.org/10.1016/j.msksp.2018.10.006

Dalkilinc, M., Cirak, Y., Yilmaz, G. D., & Parlak Demir, Y. (2015). Validity and reliability of Turkish version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Physiotherapy Theory and Practice, 31(3), 186–193. https://doi.org/10.3109/09593985.2014.986351

Darlow, B., et al. (2012). The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: A systematic review. European Journal of Pain, 16(1), 3–17. https://doi.org/10.1016/j.ejpain.2011.06.006

Daykin, A. R., & Richardson, B. (2004). Physiotherapists’ pain beliefs and their influence on the management of patients with chronic low back pain. Spine, 29(7), 783–795. https://doi.org/10.1097/01.brs.0000115135.19082.97

Domenech, J., et al. (2013). Psychometric properties and factor structure of the Spanish version of the HC-PAIRS questionnaire. European Spine Journal, 22(5), 985–994. https://doi.org/10.1007/S00586-012-2604-5

Emilson, C., et al. (2016). Physical therapists’ assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: Direct observations in primary health care. BMC Musculoskeletal Disorders, 17(1), 316. https://doi.org/10.1186/s12891-016-1173-x

Foster, N. E., et al. (2018). Prevention and treatment of low back pain: Evidence, challenges, and promising directions. The Lancet, 391(10137), 2368–2383. https://doi.org/10.1016/S0140-6736(18)30489-6

Foster, N. E., & Delitto, A. (2011). Embedding psychosocial perspectives within clinical management of low back pain: Integration of psychosocially informed management principles into physical therapist practice. Physical Therapy, 91(5), 790–803. https://doi.org/10.2522/ptj.20100326

França, A. A., et al. (2019). ‘It’s very complicated’: Perspectives and beliefs of newly graduated physiotherapists about the biopsychosocial model for treating people experiencing non-specific low back pain in Brazil. Musculoskeletal Science and Practice, 42, 84–89. https://doi.org/10.1016/j.msksp.2019.04.011

Gardner, T., et al. (2017). Physiotherapists’ beliefs and attitudes influence clinical practice in chronic low back pain: A systematic review of quantitative and qualitative studies. Journal of Physiotherapy, 63(3), 132–143. https://doi.org/10.1016/j.jphys.2017.05.017

George, S. Z., et al. (2021). Interventions for the management of acute and chronic low back pain: Revision 2021 clinical practice guidelines. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1–CPG60. https://doi.org/10.2519/jospt.2021.0304

Gremeaux, V., et al. (2015). Do teaching general practitioners’ fear-avoidance beliefs influence their management of patients with low back pain? Pain Practice, 15(8), 730–737. https://doi.org/10.1111/papr.12248

Harris, P. A., et al. (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208

Houben, R. M. A., et al. (2005). Health care providers’ orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity. European Journal of Pain, 9(2), 173–183. https://doi.org/10.1016/j.ejpain.2004.05.002

Houben, R. M. A., et al. (2004). Health care providers’ attitudes and beliefs towards common low back pain: Factor structure and psychometric properties of the HC-PAIRS. The Clinical Journal of Pain, 20(1), 37–44. https://doi.org/10.1097/00002508-200401000-00008

Jeffrey, J. E., & Foster, N. E. (2012). A qualitative investigation of physical therapists’ experiences and feelings of managing patients with nonspecific low back pain. Physical Therapy, 92(2), 266–278. https://doi.org/10.2522/ptj.20100416

Kamper, S., et al. (2014). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database of Systematic Reviews, (2), CD000963. https://doi.org/10.1002/14651858.CD000963.pub3

Kleinman, A. (1988). The illness narratives: Suffering, healing, and the human condition. Basic Books.

Knezevic, N. N., et al. (2021). Low back pain. The Lancet, 398(10294), 78–92. https://doi.org/10.1016/S0140-6736(21)00733-9

Koes, B. W., van Tulder, M. W., & Thomas, S. (2006). Diagnosis and treatment of low back pain. BMJ, 332(7555), 1430–1434. https://doi.org/10.1136/bmj.332.7555.1430

Kovacs, F. M., et al. (2006). Psychometric characteristics of the Spanish version of the FAB Questionnaire. Spine, 31(1), 104–110. https://doi.org/10.1097/01.brs.0000193912.36742.4f

Linton, S. J., Vlaeyen, J., & Ostelo, R. (2002). The back pain beliefs of health care providers: Are we fear-avoidant? Journal of Occupational Rehabilitation, 12(4), 223–232. https://doi.org/10.1023/A:1020218422974

Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736–747. https://doi.org/10.1016/S0140-6736(16)30970-9

Mescouto, K., Olson, R. E., Hodges, P. W., & Setchell, J. (2022). A critical review of the biopsychosocial model of low back pain care: Time for a new approach? Disability and Rehabilitation, 44(13), 3270–3284. https://doi.org/10.1080/09638288.2020.1851783

National Statistics Institute. (2023). Distribution of the number of physiotherapists by Autonomous City and Community of registration, age and sex. https://datos.gob.es/en/catalogo/ea0010587-distribucion-del-n-de-fisioterapeutas-por-comunidades-y-ciudades-autonomas-de-colegiacion-edad-y-sexo-identificador-api-67346

Paredes-Gómez, R., Redondo-Delgado, M., Potosí-Moya, V., & Garcia Tingo, C. P. (2025). Impacto del dolor, la kinesiofobia y la incapacidad lumbar en los objetivos de intervención del fisioterapeuta. Retos, 73, 770–783. https://doi.org/10.47197/retos.v73.117542

Pincus, T., et al. (2013). Twenty-five years with the biopsychosocial model of low back pain: Is it time to celebrate? Spine, 38(24), 2118–2123. https://doi.org/10.1097/BRS.0b013e3182a8c5d6

Sullivan, P. O., Caneiro, J. P., O’Keeffe, M., & O’Sullivan, K. (2016). Unraveling the complexity of low back pain. Journal of Orthopaedic & Sports Physical Therapy, 46(11), 932–937. https://doi.org/10.2519/jospt.2016.0609

Synnott, A., et al. (2015). Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: A systematic review. Journal of Physiotherapy, 61(2), 68–76. https://doi.org/10.1016/j.jphys.2015.02.016

Tagliaferri, S. D., et al. (2020). Domains of chronic low back pain and assessing treatment effectiveness: A clinical perspective. Pain Practice, 20(2), 211–225. https://doi.org/10.1111/papr.12846

Van Dijk, H., et al. (2023). Physiotherapists using the biopsychosocial model for chronic pain: Barriers and facilitators—A scoping review. International Journal of Environmental Research and Public Health, 20(2), 1634. https://doi.org/10.3390/ijerph20021634

Waddell, G., et al. (1993). A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain, 52(2), 157–168. https://doi.org/10.1016/0304-3959(93)90127-B

Wong, J. J., et al. (2017). Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Journal of Pain, 21(2), 201–216. https://doi.org/10.1002/ejp.931

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Publicado

01-04-2026

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Artigos de caráter científico: trabalhos de pesquisas básicas e/ou aplicadas.

Como Citar

Jubany, J., Borao, O., Espelt, A., Paton, D., & Campoy-Vila, M. (2026). Modelos explicativos de fisioterapeutas espanhóis sobre a dor lombar e os seus fatores associados. Retos, 77, 143-153. https://doi.org/10.47197/retos.v77.117865