Physical Therapists' Beliefs Can Negatively Affect Patient Outcomes

Kinesiophobia as described in physical therapy literature is "the excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or reinjury." As PTs have been at the forefront of orthopedic injury management, it is important to consider what messages are conveyed to our patients. Traditionally, many PTs have used a biomedical approach, where pain is attributed to structural or mechanical deficits. However, newer research is shedding light on the key role that healthcare professionals' attitudes and beliefs can play on patients' health and outcomes. 

Our beliefs are a cognitive process related to our perceptions of how we think things are. It is possible that a physical therapist with kinesiophobic beliefs can transfer these feelings and behaviors to patients, both verbally and nonverbally. This is widely seen in the treatment of low back pain. Many PTs continue to recommend avoidance of daily activity such as bending, lifting, and twisting even though current research continues to show these movements are non-threatening and healthy for our spine. In fact, PTs who advocate kinesiophobic beliefs tend to provide more biomedical education to patients and fewer work and activity recommendations, which is contrary to the current treatment guidelines for low back pain as established by the American Physical Therapy Association. When examined further, a 2015 study published in Physical Therapy Journal found that these beliefs can affect healthy and pain-free individuals alike. 256 participants where administered a lifting-capacity test instructed by a physical therapist. Participants whose test was performed by a physical therapist with kinesiophobic beliefs were found to lift on average 8.0 kg (about 17.5 pounds) less than their peers whose exam was performed by a therapist without these beliefs. 

With the use of a biopsychosocial approach, a physical therapist should evaluate patients for fear avoidance and movement beliefs on their initial visit and aim to educate patients about the resilience of the human body. Further, patients should be reminded of the benefits of an active lifestyle and, with guidance, be encouraged to transition back into recreational activities.