Scientific Publications

@article{vanderstraeten_what_2025,

title = {What do physiotherapists find useful in e-learning interventions to improve their knowledge, attitudes and beliefs on low back pain management: a nested qualitative study from an educational randomized clinical trial},

author = {Rob Vanderstraeten and Antoine Fourré and Christophe Demoulin and Jozef Michielsen and Hilde Bastiaens and Nathalie Roussel and Sibyl Anthierens},

url = {https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-025-03032-4},

doi = {10.1186/s12875-025-03032-4},

issn = {2731-4553},

year  = {2025},

date = {2025-10-01},

urldate = {2025-10-27},

journal = {BMC Primary Care},

volume = {26},

number = {1},

pages = {325},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{braem_clarifying_2025,

title = {Clarifying the concept of advanced practice in physiotherapy for global model development},

author = {Lalit E. Braem and Fanny Lacour and Antoine Fourré and Etienne Panchout and Grégory Reychler and Joachim Van Cant},

url = {https://linkinghub.elsevier.com/retrieve/pii/S0031940625003840},

doi = {10.1016/j.physio.2025.101846},

issn = {00319406},

year  = {2025},

date = {2025-09-01},

urldate = {2025-10-09},

journal = {Physiotherapy},

pages = {101846},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{severijns_response_2025,

title = {Response to “comments on the article “physiotherapy-led care versus physician-led care for persons with Low back pain: A systematic review ”by severijns et al. 2024”},

author = {Pieter Severijns and Nina Goossens and Wim Dankaerts and Laurent Pitance and Nathalie Roussel and Corentin Denis and Antoine Fourré and Pieter Verschueren and Annick Timmermans and Lotte Janssens},

url = {https://journals.sagepub.com/doi/10.1177/02692155251340671},

doi = {10.1177/02692155251340671},

issn = {0269-2155, 1477-0873},

year  = {2025},

date = {2025-05-01},

urldate = {2025-05-01},

journal = {Clinical Rehabilitation},

pages = {02692155251340671},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{vanderstraeten_dutch_nodate,

title = {Dutch translation, cross-cultural adaptation, validation, and reliability of the Back Pain Attitudes Questionnaire (Back-PAQ)},

author = {R Vanderstraeten and A Fourré and C Demoulin and A Westerweel and E M Meuleman and S Anthierens and J Michielsen and B Darlow and N Roussel and N Hutting},

doi = {https://doi.org/10.1080/09638288.2025.2487562},

year  = {2025},

date = {2025-04-11},

urldate = {2025-04-11},

journal = {Disability and Rehabilitation},

abstract = {Purpose: To translate and cross-culturally adapt the Back Pain Attitudes Questionnaire (Back-PAQ) to Dutch for the Belgian and Dutch populations, and to investigate its measurement properties in the general population and physiotherapists. 

Methods: The adaptation followed established guidelines. Content validity, internal consistency, test–retest reliability (intraclass correlation coefficient), floor and ceiling effects, minimal detectable change (MDC), construct validity, and structural validity were assessed in physiotherapists and the general population. The modified Fear-Avoidance Beliefs Questionnaire (mFABQ) investigated the Back-PAQ’s convergent validity, and Confirmatory Factor Analysis evaluated structural validity. Discriminant validity was assessed between physiotherapists and the general population. 

Results: Two hundred and sixty participants (mean age: 29 ± 13.3) completed the initial survey and 147 completed the test–retest survey. All Back-PAQ versions (34-item, 20-item, and 10-item) demonstrated good internal consistency, good to excellent test–retest reliability. Moderate correlations with the mFABQ (p < 0.001) and adequate discriminant validity between physiotherapists and the general population supported robust construct validity. The Back-PAQ 10 exhibited a good model fit and enables meaningful sub-score comparisons. 

Conclusions: This collaboration produced a validated Dutch Back-PAQ suitable for use in both the Netherlands and Belgium. All versions demonstrated robust measurement properties, supporting their use in clinical and research settings assessing unhelpful beliefs in back pain management.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fourre_comparing_2025,

title = {Comparing the impact of interactive versus traditional e-learning on physiotherapists’ knowledge, attitudes, and clinical decision-making in low back pain management: a randomized controlled trial},

author = {Antoine Fourré and Jef Michielsen and Laurence Ris and Ben Darlow and Rob Vanderstraeten and Hilde Bastiaens and Christophe Demoulin and Nathalie Roussel},

url = {https://www.tandfonline.com/doi/full/10.1080/10669817.2025.2476670},

doi = {10.1080/10669817.2025.2476670},

issn = {1066-9817, 2042-6186},

year  = {2025},

date = {2025-03-01},

urldate = {2025-10-23},

journal = {Journal of Manual & Manipulative Therapy},

pages = {1–14},

abstract = {Introduction: Despite the recommendations to use a bio-psycho-social framework, many physiotherapists still manage their patients mainly from a biomedical point of view. The purpose of this study is to analyze the impact of two different e-learning interventions on knowledge, attitudes, and clinical decision-making of physiotherapists managing low back pain (LBP) to increase guideline-consistent care. 

Methods: Physiotherapists were allocated (1/1) either to an experimental or a traditional e-learning intervention. Baseline and post-intervention assessment included the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), and a clinical vignette. Participants had 2 weeks to complete the post-intervention assessment. Statistics were processed using ANCOVA and Fisher’s t-tests. Results: Four hundred nineteen physiotherapists were included in the analysis. Mean scores of HC-PAIRS, Back-PAQ, and NPQ significantly improved post-intervention in both groups. There was a significant effect of the intervention type (experimental versus traditional) on the scores of HC-PAIRS (p < .001; η2p = .243) and Back-PAQ (p < .001; η2p = .135) but not on NPQ scores. Return to work, recommendations assessed with the clinical vignette were significantly more guideline-consistent in the experimental group (p < .001) post-intervention. 

Conclusion: An interactive e-learning intervention which includes concrete clinical examples and focused on patient’s reassurance, self-management, and importance of screening psychosocial factors had more impact than a traditional e-learning intervention to enhance physiotherapists’ knowledge, attitudes, and clinical decision-making regarding LBP.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{severijns_physiotherapy-led_2024,

title = {Physiotherapy-led care versus physician-led care for persons with low back pain: A systematic review},

author = {Pieter Severijns and Nina Goossens and Wim Dankaerts and Laurent Pitance and Nathalie Roussel and Corentin Denis and Antoine Fourré and Pieter Verschueren and Annick Timmermans and Lotte Janssens},

url = {https://journals.sagepub.com/doi/10.1177/02692155241282987},

doi = {10.1177/02692155241282987},

issn = {0269-2155, 1477-0873},

year  = {2024},

date = {2024-09-01},

urldate = {2024-10-01},

journal = {Clinical Rehabilitation},

pages = {02692155241282987},

abstract = {Objective: To summarise the evidence on the effect of physiotherapy-led versus physician-led care on clinical outcomes, healthcare use, and costs in persons with low back pain. Data sources: PubMed, Web of Science, CINAHL, Embase, and PEDro were systematically searched with the latest search performed in July 2024. Reference lists of articles were hand-searched. Review methods: Studies comparing clinical outcomes, healthcare use, or costs between adults with low back pain first consulting a physiotherapist and those first consulting a physician were included. Methodological quality was assessed with the Newcastle-Ottawa Scale. Study design, clinical setting, patient characteristics, and group effects were extracted. Findings on outcomes assessed in two or more studies were synthesised narratively. Certainty of evidence was determined using the GRADE approach. 

Results: Eighteen studies comprising 1,481,980 persons with low back pain were included. Most studies were non-randomised retrospective or prospective cohort studies. In primary care (15 studies), consistent evidence, though of mostly very low certainty, indicated that physiotherapy-led care leads to higher patient satisfaction, less use of medication, injections and imaging, fewer physician’s visits, lower total healthcare costs, and less sick leave compared to physician-led care, without increased harm. In emergency care (three studies), evidence of very low certainty showed that physiotherapy-led care leads to shorter waiting and treatment times, and fewer hospital admissions. 

Conclusion: Physiotherapy-led care is a clinically, time- and cost-effective care pathway for low back pain, although the certainty of evidence was overall very low. Further high-quality research with a greater focus on clinical outcomes is warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hage_rethinking_2023,

title = {Rethinking neck-related arm pain: hypothetical clinical scenarios to differentiate the underlying IASP-defined pain mechanisms},

author = {Renaud Hage and Nathalie Roussel and Frédéric Dierick and Joël Da Natividade and Mark Jones and Antoine Fourré},

url = {https://www.tandfonline.com/doi/full/10.1080/10669817.2023.2292909},

doi = {10.1080/10669817.2023.2292909},

issn = {1066-9817, 2042-6186},

year  = {2023},

date = {2023-12-01},

urldate = {2024-01-04},

journal = {Journal of Manual & Manipulative Therapy},

pages = {1–12},

abstract = {Neck-related arm pain is frequently encountered in clinical settings, yet its underlying pain mechanisms remain elusive. While such pain radiating from the neck to the arm is often attributed to injuries or diseases of the nervous system (neuropathic pain), it can also arise from nociceptive (referred) or nociplastic sources. Regrettably, patients exhibit­ ing this specific pain distribution are frequently diagnosed with varying terms, including ‘cervicobrachialgia', ‘cervicobrachial neuralgia', ‘cervicobrachial pain syndrome', and ‘cervi­ cal radiculopathy'. The ambiguity surrounding these diagnostic labels complicates the clinical reasoning process. It is imperative for clinicians to discern and comprehend the dominant pain mechanism. Three distinct hypothetical clinical scenarios depict patients with almost identical pain distribution but divergent dominant pain mechanisms. Within these scenarios, both subjective and objective examinations are employed to elucidate the dominant pain mechanism associated with neck-related arm pain: nociceptive, neuro­ pathic, and nociplastic. Furthermore, clinicians must remain aware that the dominant pain mechanism can evolve over time.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hage_description_2023,

title = {Description and rules of a new card game to learn clinical reasoning in musculoskeletal physiotherapy},

author = {Renaud Hage and Antoine Fourré and Laura Ramonfosse and Sébastien Leteneur and Mark Jones and Frédéric Dierick},

url = {https://doi.org/10.1080/10669817.2022.2132346},

doi = {10.1080/10669817.2022.2132346},

issn = {1066-9817},

year  = {2023},

date = {2023-07-01},

journal = {Journal of Manual & Manipulative Therapy},

volume = {31},

number = {4},

pages = {287–296},

note = {Publisher: Taylor & Francis},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{vanderstraeten_how_2023,

title = {How Do Physiotherapists Explain Influencing Factors to Chronic Low Back Pain? A Qualitative Study Using a Fictive Case of Chronic Non-Specific Low Back Pain},

author = {Rob Vanderstraeten and Antoine Fourré and Isaline Demeure and Christophe Demoulin and Jozef Michielsen and Sibyl Anthierens and Hilde Bastiaens and Nathalie Roussel},

url = {https://www.mdpi.com/1660-4601/20/10/5828},

doi = {10.3390/ijerph20105828},

issn = {1660-4601},

year  = {2023},

date = {2023-05-01},

urldate = {2023-05-30},

journal = {International Journal of Environmental Research and Public Health},

volume = {20},

number = {10},

pages = {5828},

abstract = {Background: While pain is influenced by multiple factors including psychosocial factors, previous research has shown that physiotherapists still favour a biomedical approach. Purpose: To evaluate: (1) how physiotherapists explain the patient’s chronic non-specific low back pain (LBP); (2) whether physiotherapists use one or multiple influencing factors, and (3) whether these factors are framed in a biopsychosocial or biomedical approach. Materials and methods: This exploratory qualitative study uses a vignette depicting chronic non-specific LBP and employs a flexible framework analysis. Physiotherapists were asked to mention contributing factors to the pain based on this vignette. Five themes were predefined (“Beliefs”, “Previous experiences”, “Emotions”, “Patients behaviour”, “Contextual factors”) and explored. Results: Physiotherapists use very brief explanations when reporting contributing factors to chronic pain (median 13 words). Out of 670 physiotherapists, only 40% mentioned more than two different themes and 2/3rds did not see any link between the patients’ misbeliefs and pain. Only a quarter of the participants mentioned the patient’s worries about pain and movement, which is considered to be an important influencing factor. Conclusion: The lack of a multifactorial approach and the persistent biomedical beliefs suggest that it remains a challenge for physiotherapists to fully integrate the biopsychosocial framework into their management of chronic LBP.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fourre_management_2023,

title = {Management of Low Back Pain: Do Physiotherapists Know the Evidence-Based Guidelines?},

author = {Antoine Fourré and Rob Vanderstraeten and Laurence Ris and Hilde Bastiaens and Jozef Michielsen and Christophe Demoulin and Ben Darlow and Nathalie Roussel},

url = {https://www.mdpi.com/1660-4601/20/9/5611},

doi = {10.3390/ijerph20095611},

issn = {1660-4601},

year  = {2023},

date = {2023-04-01},

urldate = {2023-04-27},

journal = {International Journal of Environmental Research and Public Health},

volume = {20},

number = {9},

pages = {5611},

abstract = {Background: Clinical practice guidelines promote bio-psychosocial management of patients suffering from low back pain (LBP). The objective of this study was to examine the current knowledge, attitudes and beliefs of physiotherapists about a guideline-adherent approach to LBP and to assess the ability of physiotherapists to recognise signs of a specific LBP in a clinical vignette. Methods: Physiotherapists were recruited to participate in an online study. They were asked to indicate whether they were familiar with evidence-based guidelines and then to fill in the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), as well as questions related to two clinical vignettes. Results: In total, 527 physiotherapists participated in this study. Only 38% reported being familiar with guidelines for the management of LBP. Sixty-three percent of the physiotherapists gave guidelineinconsistent recommendations regarding work. Only half of the physiotherapists recognised the signs of a specific LBP. Conclusions: The high proportion of physiotherapists unfamiliar with guidelines and demonstrating attitudes and beliefs not in line with evidence-based management of LBP is concerning. It is crucial to develop efficient strategies to enhance knowledge of guidelines among physiotherapists and increase their implementation in clinical practice.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fourre_low-back_2023,

title = {Low-back related leg pain: is the nerve guilty? How to differentiate the underlying pain mechanism},

author = {Antoine Fourré and Félix Monnier and Laurence Ris and Frédéric Telliez and Jef Michielsen and Nathalie Roussel and Renaud Hage},

url = {https://doi.org/10.1080/10669817.2022.2092266},

doi = {10.1080/10669817.2022.2092266},

issn = {1066-9817},

year  = {2023},

date = {2023-03-01},

journal = {Journal of Manual & Manipulative Therapy},

volume = {31},

number = {2},

pages = {57–63},

abstract = {Low back pain (LBP) that radiates to the leg is not always related to a lesion or a disease of the nervous system (neuropathic pain): it might be nociceptive (referred) pain. Unfortunately, patients with low-back related leg pain are often given a variety of diagnoses (e.g. ?sciatica?; ?radicular pain?; pseudoradicular pain?). This terminology causes confusion and challenges clinical reasoning. It is essential for clinicians to understand and recognize predominant pain mechanisms. This paper describes pain mechanisms related to low back-related leg pain and helps differentiate these mechanisms in practice using clinical based scenarios. We illustrate this by using two clinical scenarios including patients with the same symptoms in terms of pain localization (i.e. low-back related leg pain) but with different underlying pain mechanisms (i.e. nociceptive versus neuropathic pain).},

note = {Publisher: Taylor & Francis},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{fourre_interactive_2022,

title = {An interactive e-learning module to promote bio-psycho-social management of low back pain in healthcare professionals: a pilot study},

author = {Antoine Fourré and Auriane Fierens and Jef Michielsen and Laurence Ris and Frédéric Dierick and Nathalie Roussel},

url = {https://doi.org/10.1080/10669817.2021.1988397},

doi = {10.1080/10669817.2021.1988397},

issn = {1066-9817},

year  = {2022},

date = {2022-03-01},

journal = {Journal of Manual & Manipulative Therapy},

volume = {30},

number = {2},

pages = {105–115},

note = {Publisher: Taylor & Francis},

keywords = {},

pubstate = {published},

tppubtype = {article}

}