{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:58:24Z","timestamp":1760147904096,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T00:00:00Z","timestamp":1678320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Low back pain (LBP) is a major cause of discomfort and disability. Physicians\u2019 attitudes and beliefs influence the way patients with LBP are diagnosed and treated. The objective of the study is the assessment of military primary care physicians\u2019 attitudes towards LBP and the effect of an enhanced transtheoretical model intervention (ETMI) workshop on them. We evaluated the impact of a 90-min ETMI workshop on the attitudes and beliefs of primary care physicians in the Israeli Navy on LBP. Outcomes were assessed using the Attitudes to Back Pain Scale in Musculoskeletal Practitioners questionnaire (ABS-mp). Participants responded before and after the workshop, and responses were compared to a control group of primary care physicians in the Air and Space Force. The intervention group included 22 participants and the control group included 18 participants. Both groups were heterogenic (gender, age, seniority). In both groups, primary care physicians reported the common use of non-steroidal anti-inflammatory drugs (NSAIDs) and over-the-counter (OTC) pain medications and often included physical activity and physiotherapy in the treatment plan. Physicians mentioned reassurance and suggestions of early return to physical activity as part of their appointment. There was a positive correlation between questionnaire items suggesting the physician tended to a biomedical approach and reporting the use of imaging modalities (r = 0.451, p = 0.005). After attending the workshop, physicians were significantly more likely to recommend an early return to physical activity (18 \u00b1 0.48 vs. 16.4 \u00b1 0.52, p = 0.04). An ETMI workshop had a minor impact on the attitudes and beliefs of primary care physicians regarding LBP, but a statistically significant impact was noted on return to physical activity recommendations. These findings may be important in the military setting.<\/jats:p>","DOI":"10.3390\/ijerph20064854","type":"journal-article","created":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T02:30:33Z","timestamp":1678415433000},"page":"4854","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of an Enhanced Transtheoretical Model Intervention (ETMI) Workshop on the Attitudes and Beliefs Regarding Low Back Pain of Primary Care Physicians in the Israeli Navy"],"prefix":"10.3390","volume":"20","author":[{"given":"Omri","family":"Besor","sequence":"first","affiliation":[{"name":"Israel Defense Forces, Medical Corps, Ramat Gan 5262000, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronen","family":"Brand","sequence":"additional","affiliation":[{"name":"Israel Defense Forces, Medical Corps, Ramat Gan 5262000, Israel"},{"name":"Meuhedet Health Services, Haifa 3350127, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2072-0198","authenticated-orcid":false,"given":"Ron","family":"Feldman","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Science, Ariel University, Ariel 40700, Israel"},{"name":"Maccabi Healthcare Services, Tel Aviv 6812509, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0870-3723","authenticated-orcid":false,"given":"Yaniv","family":"Nudelman","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Science, Ariel University, Ariel 40700, Israel"},{"name":"Maccabi Healthcare Services, Tel Aviv 6812509, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yair","family":"Shahar","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Science, Ariel University, Ariel 40700, Israel"},{"name":"Department of Physiotherapy, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1956-5557","authenticated-orcid":false,"given":"Aharon S.","family":"Finestone","sequence":"additional","affiliation":[{"name":"Israel Defense Forces, Medical Corps, Ramat Gan 5262000, Israel"},{"name":"Department of Orthopaedic Surgery, Shamir Medical Centre (Assaf HaRofeh), Rhison Lezyon, Zerifin 7033001, Israel"},{"name":"Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5067-5178","authenticated-orcid":false,"given":"Noa","family":"Ben Ami","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Science, Ariel University, Ariel 40700, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2384","DOI":"10.1016\/S0140-6736(18)30488-4","article-title":"Low back pain: A call for action","volume":"391","author":"Buchbinder","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1016\/S0140-6736(18)30489-6","article-title":"Prevention and treatment of low back pain: Evidence, challenges, and promising directions","volume":"391","author":"Foster","year":"2018","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","article-title":"What low back pain is and why we need to pay attention","volume":"391","author":"Hartvigsen","year":"2018","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1056\/NEJMoa1209250","article-title":"Magnetic resonance imaging in follow-up assessment of sciatica","volume":"368","author":"Jacobs","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/S0140-6736(09)60172-0","article-title":"Imaging strategies for low-back pain: Systematic review and meta-analysis","volume":"373","author":"Chou","year":"2009","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1126\/science.847460","article-title":"The need for a new medical model: A challenge for biomedicine","volume":"196","author":"Engel","year":"1977","journal-title":"Science"},{"doi-asserted-by":"crossref","unstructured":"Farre, A., and Rapley, T. (2017). The new old (And old new) medical model: Four decades navigating the biomedical and psychosocial understandings of health and illness. Healthcare, 5.","key":"ref_7","DOI":"10.3390\/healthcare5040088"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S57","DOI":"10.1097\/j.pain.0000000000001869","article-title":"The Lancet Series call to action to reduce low value care for low back pain: An update","volume":"161","author":"Buchbinder","year":"2020","journal-title":"Pain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"423","DOI":"10.2471\/BLT.18.226050","article-title":"Care for low back pain: Can health systems deliver?","volume":"97","author":"Traeger","year":"2019","journal-title":"Bull. World Health Organ."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/01.ajp.0000178223.85636.49","article-title":"The attitudes to back pain scale in musculoskeletal practitioners (ABS-mp)","volume":"22","author":"Pincus","year":"2006","journal-title":"Clin. J. Pain."},{"doi-asserted-by":"crossref","unstructured":"George, S.Z., Childs, J.D., Teyhen, D.S., Wu, S.S., Wright, A.C., Dugan, J.L., and Robinson, M.E. (2011). Brief psychosocial education, not core stabilization, reduced incidence of low back pain: Results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial. BMC Med., 9.","key":"ref_11","DOI":"10.1186\/1741-7015-9-128"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1097\/BRS.0b013e3181f40ddd","article-title":"The incidence of low back pain in active duty United States military service members","volume":"36","author":"Knox","year":"2011","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"57","DOI":"10.2519\/jospt.2017.7057","article-title":"Increasing recreational physical activity in patients with chronic low back pain:a pragmatic controlled clinical trial","volume":"47","author":"Chodick","year":"2017","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e019928","DOI":"10.1136\/bmjopen-2017-019928","article-title":"Is an enhanced behaviour change intervention cost-effective compared with physiotherapy for patients with chronic low back pain? Results from a multicentre trial in Israel","volume":"8","author":"Canaway","year":"2018","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102463","DOI":"10.1016\/j.msksp.2021.102463","article-title":"Cross-cultural adaptation, validation and psychometric evaluation of the attitudes to back pain scale in musculoskeletal practitioners\u2014Hebrew version","volume":"56","author":"Nudelman","year":"2021","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_16","first-page":"369","article-title":"Can the enhanced transtheoretical model intervention (ETMI) impact the attitudes and beliefs regarding low back pain of family medicine Residents","volume":"24","author":"Shahar","year":"2022","journal-title":"IMAJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"491","DOI":"10.2519\/jospt.2018.7670","article-title":"Outcomes in distressed patients with chronic low back pain: Subgroup analysis of a clinical trial","volume":"48","author":"Shapiro","year":"2018","journal-title":"J. Orthop. Sports Phys. Ther."},{"unstructured":"Seaman, J. (2018). Discovering Statistics Using IBM SPSS Statistics, SAGE Publications Ltd.. [5th ed.].","key":"ref_18"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"514","DOI":"10.7326\/M16-2367","article-title":"Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians","volume":"166","author":"Qaseem","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1007\/s00586-018-5673-2","article-title":"Clinical practice guidelines for the management of non-specific low back pain in primary care: An updated overview","volume":"27","author":"Oliveira","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e1858","DOI":"10.1002\/pri.1858","article-title":"Adherence to key domains in low back pain guidelines: A cross-sectional study of Danish physiotherapists","volume":"25","author":"Husted","year":"2020","journal-title":"Physiother. Res. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E1386","DOI":"10.1503\/cmaj.170527","article-title":"Diagnosis and management of low-back pain in primary care","volume":"189","author":"Traeger","year":"2017","journal-title":"CMAJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e037820","DOI":"10.1136\/bmjopen-2020-037820","article-title":"Clinician and patient beliefs about diagnostic imaging for low back pain: A systematic qualitative evidence synthesis","volume":"10","author":"Sharma","year":"2020","journal-title":"BMJ Open"},{"key":"ref_24","first-page":"10","article-title":"Low back pain and sciatica: Summary of NICE guidance","volume":"6748","author":"Bernstein","year":"2017","journal-title":"Brows. J. Spec."},{"key":"ref_25","first-page":"6","article-title":"How physicians make referrals","volume":"13","author":"Javalgi","year":"1993","journal-title":"J. Health Care Mark."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/4854\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:51:25Z","timestamp":1760122285000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/4854"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,9]]},"references-count":25,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20064854"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20064854","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2023,3,9]]}}}