Physiotherapists' Attitudes Toward Low Back Pain

Background: Chronic non-specific low back pain (CNSLBP) is a leading cause of disability worldwide. Clinical guidelines recommend a biopsychosocial approach and avoidance of unnecessary imaging and passive treatments. Physiotherapists play a key role in CNSLBP management; however, guideline adherence remains inconsistent. No previous study has examined how Slovenian physiotherapists understand and apply CNSLBP guidelines. Methods: A cross-sectional survey was conducted among physiotherapists working in Slovenian primary healthcare settings (public and private sectors). An online questionnaire assessed guideline familiarity, beliefs about pain, activity, work, and spinal vulnerability, and clinical reasoning using a case vignette. Three validated instruments were used: HC-PAIRS, Back-PAQ, and guideline-related clinical decision-making questions. Responses were summarized descriptively and dichotomized as guideline-concordant or discordant. Results: A total of 104 physiotherapists (≈14% of the eligible primary care workforce) participated. Although most reported familiarity with CNSLBP guidelines, substantial discordance with evidence-based recommendations was observed. Only 54% provided guideline-concordant advice regarding physical activity, while recommendations concerning work restrictions (89% discordant) and bed rest (64% discordant) deviated markedly from guidelines. Back-PAQ responses revealed prevalent fear-based beliefs, with 68% agreeing or being unsure that the back is easily injured and 31% endorsing spinal fragility. HC-PAIRS scores indicated a predominantly biomedical orientation. Similar patterns were observed in responses to the clinical vignette. Conclusions: Slovenian physiotherapists in primary care demonstrate a significant gap between guideline recommendations and clinical beliefs. Misconceptions about spinal vulnerability, activity, and work appear to drive guideline-discordant reasoning, highlighting the need for targeted education and improved dissemination of biopsychosocial guidelines for CNSLBP management.