‘Seeing pain differently’: the impact of physiotherapists’ attitudes and treatment beliefs on postural assessment in neck pain – an eye-tracking study

Pérsia Nascimento Abrahão; Ney Meziat Filho; Erika Rodrigues; Talita Peixoto Pinto; Arthur de Sá Ferreira

doi:10.2478/advrehab-2026-0002

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‘Seeing pain differently’: the impact of physiotherapists’ attitudes and treatment beliefs on postural assessment in neck pain – an eye-tracking study

Advances in Rehabilitation

Volume 40 (2026): Issue 1 (March 2026)

By: Pérsia Nascimento Abrahão , Ney Meziat Filho , Erika Rodrigues , Talita Peixoto Pinto and Arthur de Sá Ferreira

Open Access

|Mar 2026

Abstract

Introduction

This study investigated how physiotherapists’ pain treatment orientations (biopsychosocial or biomedical) influence visual postural assessment of individuals with neck pain, using eye-tracking analysis.

Material and methods

Physiotherapists (n = 30) completed the pain attitudes and beliefs scale and were categorised as predominantly ‘biomedical’ or ‘biopsychosocial’ based on the higher score percentage of the subscales. Eye-tracking data were collected while physiotherapists conducted visual postural assessment of participants with (n = 30) and without (n = 30) neck pain.

Results

Physiotherapists with a biopsychosocial orientation exhibited (mean [95%CI]) fewer fixation counts in lateral (−2.29 [−3.80; −0.78] n) and posterior views (−5.84 [−7.62; −4.06] n), lower saccade counts in the posterior view (−4.51 [−6.46; −2.56] n) and shorter mean first-time passage on all transitions (ranging from −4.08 [−6.28; −1.88] to −14.09 [−18.64; −9.54] n) than those with a biomedical orientation. However, they demonstrated longer average fixation durations in all views (anterior: 0.02 [0.01; 0.03] seconds, lateral 0.04 [0.02; 0.05] seconds) and posterior 0.04 [0.03; 0.06] seconds). Almost all transition probabilities differed across physiotherapist groups, with specific positive or negative effects observed across transitions. Mean recurrent time was also lower in physiotherapists with Biopsychosocial orientation (−0.30 [−0.53; −0.08] events).

Conclusions

Biopsychosocial-oriented physiotherapists exhibited more dynamic eye-movement patterns, with faster view transitions and shorter recurrence times, potentially indicating a more holistic approach to postural assessment. Attitudes and beliefs toward pain treatment orientation of physiotherapists, but not the presence of neck pain in patients, significantly influence their visual postural assessment.

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Articles in this issue

DOI: https://doi.org/10.2478/advrehab-2026-0002 | Journal eISSN: 1734-4948

Journal RSS Feed

Language: English

Page range: 16 - 35

Submitted on: May 5, 2025

Accepted on: Dec 3, 2025

Published on: Mar 31, 2026

Published by: University of Physical Education in Warsaw

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

biopsychosocial models,

eye-tracking technology,

Related subjects:

Physical and rehabilitation medicine,

Rheumatology,

Cardiology,

Sports and recreation,

Sports and recreation, other

© 2026 Pérsia Nascimento Abrahão et al., published by Józef Piłsudski University of Physical Education in Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Volume 40 (2026): Issue 1 (March 2026)