Why did you decide to assess the effect of the e-learning program rather than just expecting physiotherapists to engage with published clinical practice guidelines?

Our decision to assess the effect of the e-learning program was based on the fact that many clinicians do not adhere to recommendations from clinical practice guidelines.

Common barriers include a lack of time to stay updated and difficulty understanding complex statistical or technical language.

The use of e-learning programs, which may engage clinicians and which foster evidence-based practice, is a potential way to overcome these barriers.

We therefore designed an e-learning program to save clinicians time while helping them stay up to date with evidence.

What was the format and content of the e-learning program?

The e-learning program consisted of six self-paced units delivered over six weeks, totalling 15 hours.

The content aligned with international clinical guidelines for low back pain management and included video lectures, infographics, clinical cases, links to external resources and downloadable materials.

Each unit ended with a quiz to reinforce knowledge, requiring a minimum 60 per cent pass rate to progress.

What outcomes were assessed in the study?

The study assessed beliefs about low back pain management and imaging.

The primary outcome was physiotherapists’ beliefs about low back pain.

This was measured using the Modified Back Beliefs Questionnaire, which evaluates beliefs related to prognosis, treatment and causes of low back pain on a scale of –50 (worst beliefs) to 50 (best beliefs).

Secondary outcomes were measured using the Back Pain Attitudes Questionnaire and two imaging-related belief statements about low back pain.

The Back Pain Attitudes Questionnaire assessed attitudes towards pain and recovery, using a scale from –20 (least aligned with evidence) to 20 (most aligned).

Participants rated their agreement on a Likert scale to the following statements about imaging: ‘X-rays or scans are necessary to get the best medical care for low back pain’ and ‘Everyone with low back pain should have spine imaging’.

What effect did the e-learning program have on those outcomes?

The group that had access to the e-learning program significantly improved their beliefs about low back pain management compared to the control group after six weeks.

For the primary outcome, the e-learning group improved their Modified Back Beliefs Questionnaire score by 8 points compared to the control group (with a 95% CI ranging from 5 to 10).

Similar improvements were observed for the secondary outcomes.

Participants in the e-learning group improved their Back Pain Attitudes Questionnaire score by 3.1 points compared to the control group (with a 95% CI ranging from 1.8 to 4.3).

The proportion of participants in the e-learning group who disagreed with both imaging-related statements was higher than in the control group.

Specifically, 91 per cent of participants in the experimental group disagreed with the statement ‘X-rays or scans are necessary to get the best medical care for low back pain’ compared to 53 per cent in the control group (risk difference of 38%, 95% CI of 21 to 52).

Similarly, 100 per cent of the experimental group disagreed with the statement ‘Everyone with low back pain should have spine imaging’ compared to 83 per cent in the control group (risk difference of 17%, 95% CI of 7 to 29).

Is the e-learning program publicly available now?

The e-learning program is publicly available.

Clinicians interested in accessing the program must pay a fee of approximately AUD $80 to cover the costs of the host server and personnel managing the enrolment process.

Currently, the program is only available in Portuguese.

>>Rafael Zambelli Pinto is an associate professor in physiotherapy affiliated with the Federal University of Minas Gerais in Brazil and University of Technology Sydney in Australia. He is the secretary of the International Society of Physiotherapy Journal Editors and his research interests include low back pain and evidence-based practice.

Courses of interest:

Heatwrap use in management of low back pain: what does the research say?