Low Back Pain Treatment by Athletic Trainers and Athletic Therapists: Biomedical or Biopsychosocial Orientation?

Context Low back pain (LBP) remains a societal burden due to consistently high rates of recurrence and chronicity. Recent evidence suggested that a provider's treatment orientation influences patient beliefs, the clinical approach, and subsequently, rehabilitation outcomes. Objective To characterize American athletic trainer (AT) and Canadian athletic therapist (C-AT) treatment orientations toward LBP. Design Cross-sectional study. Setting Online survey. Patients or Other Participants A total of 273 ATs (response rate = 13.3%) and 382 C-ATs (response rate = 15.3%). Main Outcome Measure(s) Participants completed demographic questions and the Pain Attitudes and Beliefs Scale (PABS) for ATs/C-ATs. The PABS measures the biomedical and biopsychosocial treatment orientation of health care providers and is scored on a 6-point Likert scale. Descriptive statistics characterized the participants; t tests and 1-way analyses of variance identified differences between group means; and Spearman correlations assessed relationships between the biomedical and biopsychosocial scores and age, number of LBP patients per year, and years of experience. Results Athletic trainers treating 9 to 15 LBP patients per year had higher biomedical scores (35.0 ± 5.7) than ATs treating 16 to 34 (31.9 ± 5.5, P = .039) or >34 (31.7 ± 8.6, P = .018) LBP patients per year. The C-ATs treating 16 to 34 (31.8 ± 6.3, P = .038) and >34 (31.0 ± 6.7, P < .001) LBP patients per year had lower biomedical scores than those treating ≤8 LBP patients per year (34.8 ± 5.9). The C-ATs with ≤5 years of experience had higher biomedical scores than those with 10 to 15 (31.0 ± 6.7, P = .011) and 16 to 24 (29.8 ± 7.5, P < .001) years of experience. Canadian athletic therapists treating the general public had higher (31.7 ± 4.0) biopsychosocial scores than ATs treating athletes (31.3 ± 3.5, P = .006). The C-ATs ≤35.6 years of age had higher biomedical scores (33.1 ± 5.9) than those >35.6 years of age (30.5 ± 7.0, P < .001). Conclusions Athletic trainers and C-ATs who treated more LBP patients per year were more likely to score low on a biomedical treatment orientation subscale. Because this orientation has predicted poor outcomes in other health care providers, further research is needed to determine the effects of ATs' and C-ATs' biomedical orientations on rehabilitation outcomes.

Psychodynamic and Interpersonal Psychotherapies

This chapter focuses on two widely used treatments for depression: dynamic therapy (DT) and interpersonal therapy (IPT). Although each has its unique theoretical conceptualization of depression and offers relatively distinct techniques to facilitate change within depressed patients, both center on adverse and disruptive interpersonal relationships with underlying maladaptive repetitive patterns and interpersonal schemas as main contributors to depression. In this chapter, we describe how each orientation conceptualizes depression, elaborate on specific techniques each treatment orientation offers, and summarize the available research on the efficacy of each paradigm for bringing about therapeutic change in depressed patients. We also review the literature on moderators of, and candidate mechanisms underlying, these documented effects. Finally, we discuss what is known and what is yet to be learned about DT and IPT for depression.