Figure 1.
Experimental setup for data collection. Seated comfortably, physiotherapists were positioned 60 cm from the eye-tracking screen and instructed to position their face in a head support aligned with the monitor
Table 1.
Descriptive statistics of the sample of physiotherapists, split by the main score on the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT)
| Variables | Overall n = 30a | Biomedical group n = 15a | Biopsychosocial group n = 15a | Cohen’s d [95%CI] | p-valueb |
|---|---|---|---|---|---|
| Age, years | 38.2 (±11.4) | 42.7 (±13.1) | 33.7 (±7.3) | 0.85 [0.09, 1.6] | 0.029 |
| Gender | >0.999 | ||||
| Women | 20 (67%) | 10 (67%) | 10 (67%) | ||
| Men | 10 (33%) | 5 (33%) | 5 (33%) | ||
| Professional training, years | 7.8 (±8.8) | 9.0 (±10.6) | 6.5 (±6.5) | 0.28 [0.45, 0.99] | 0.457 |
| Professional experience, years | 6.8 (±7.5) | 7.2 (±8.8) | 6.3 (±6.4) | 0.12 [−0.60, 0.83] | 0.750 |
| Workplace setting | 0.492 | ||||
| Home/clinic | 13 (43%) | 7 (47%) | 6 (40%) | ||
| Home | 9 (30%) | 6 (40%) | 3 (20%) | ||
| Home/Ambulatory | 4 (13%) | 1 (7%) | 3 (20%) | ||
| Hospital | 3 (10%) | 1 (7%) | 2 (13%) | ||
| Clinic | 1 (3%) | 0 (0%) | 1 (7%) | ||
| Glasses | 5 (17%) | 2 (13%) | 3 (20%) | >0.999 | |
| PABS-PT, points | |||||
| Biomedical subscore | 27.9 (±7.2) | 31.4 (±7.4) | 24.5 (±5.2) | 1.1 [0.31, 1.8] | NT |
| Biopsychosocial subscore | 21.2 (±5.6) | 17.0 (±3.5) | 25.3 (±4.0) | −2.2 [−3.1, −1.3] | NT |
| PABS-PT,% | |||||
| Biomedical subscore | 69.8 (±18.0) | 78.5 (±18.5) | 61.2 (±12.9) | 1.1 [0.31, 1.8] | NT |
| Biopsychosocial subscore | 66.1 (±17.5) | 53.1 (±10.8) | 79.2 (±12.5) | −2.2 [−3.1, −1.3] | NT |
| Average error, ∘ | 0.3 (±0.1) | 0.3 (±0.1) | 0.3 (±0.1) | 0.03 [−0.69, 0.74] | 0.938 |
| Maximum error, ∘ | 0.8 (±0.2) | 0.8 (±0.2) | 0.8 (±0.2) | 0.04 [−0.67, 0.76] | 0.905 |
Table 2.
Descriptive statistics of the sample of patients split by group with/without neck pain
| Variables | Overall n = 60a | Asymptomatic group n = 30a | Neck pain group n = 30a | Cohen’s d [95%CI] | p-valueb |
|---|---|---|---|---|---|
| Age, years | 28.2 (±7.1) | 27.1 (±7.0) | 29.3 (±7.1) | −0.31 [−0.82, 0.20] | 0.238 |
| Gender | 0.299 | ||||
| Women | 50 (83%) | 23 (77%) | 27 (90%) | ||
| Men | 10 (17%) | 7 (23%) | 3 (10%) | ||
| Neck pain intensity, mm | - | - | 38.2 (±19.9) | - | NT |
| Nordic Musculoskeletal Questionnaire, score | <0.001 | ||||
| Not applicable | 26 (43%) | 26 (87%) | 0 (0%) | ||
| Acute | 6 (10%) | 4 (13%) | 2 (7%) | ||
| Chronic | 28 (47%) | 0 (0%) | 28 (93%) | ||
| Örebro Musculoskeletal Pain Questionnaire, score | 32.2 (±19.0) | 16.9 (±10.7) | 47.6 (±11.4) | −2.8 [−3.5, −2.1] | <0.001 |
| Örebro Musculoskeletal Pain Questionnaire, risk | <0.001 | ||||
| Low risk | 46 (77%) | 30 (100%) | 16 (53%) | ||
| High risk | 14 (23%) | 0 (0%) | 14 (47%) | ||
| Neck disability index, score | 12.8 (±10.8) | 4.1 (±4.1) | 21.6 (±7.8) | −2.8 [−3.5, −2.1] | <0.001 |
| Neck disability index, classification | <0.001 | ||||
| Nodisability | 27 (45%) | 26 (87%) | 1 (3%) | ||
| Mild disability | 27 (45%) | 4 (13%) | 23 (77%) | ||
| Moderate disability | 6 (10%) | 0 (0%) | 6 (20%) |
Figure 2.
Gaze plot in a schematic representation of a participant’s images for postural assessment in anterior, lateral and posterior (left, centre and right side of the screen) views. Notice the number of fixations and saccade events in each area of interest
Figure 3.
Interaction plots for first- and third-order oculomotor metrics across Patient Group (asymptomatic vs. symptomatic) and Physiotherapist Group (biomedical [black] vs. biopsychosocial [grey]). Points show subject-level means; larger markers and 95% CIs show estimated marginal means from mixed-effects models
Figure 4.
Interaction plots for fourth-order gaze-dynamics metrics across Patient Group (asymptomatic vs. symptomatic) and Physiotherapist Group (biomedical [black] vs. biopsychosocial [grey]). Panels display transition probabilities, mean first-passage times and recurrence times for ANT, LAT and POS views. Points represent subject means; larger markers and 95% CIs represent estimated marginal means from mixed-effects models. ANT - anterior, POS - posterior, LAT - lateral
Table S1.
Results of the linear mixed models for the main and interaction effects of patients’ and physiotherapists’ groups on first-order eye-tracking output variables
| Variable | Neck pain Biomedical | Neck pain Biopsychosocial | Asymptomatic Biomedical | Asymptomatic Biopsychosocial | Main effect ‘Patient group’ | Main effect ‘Physiotherapist group’ | Interaction effect |
|---|---|---|---|---|---|---|---|
| Eye blinks, n | 14.29 (10.75) | 14.89 (12.15) | 14.19 (9.98) | 14.75 (11.87) | 0.10 (−1.53; 1.74) | 0.56 (−0.89; 2.01) | 0.04 (−2.02; 2.09) |
| Blinks, total (seconds) | 2.22 (2.71) | 2.36 (3.01) | 2.26 (2.78) | 2.27 (2.85) | −0.03 (−0.45; 0.38) | 0.01 (−0.36; 0.38) | 0.13 (−0.39; 0.65) |
Table S2.
Results of the linear mixed models for the main and interaction effects of patients’ and physiotherapists’ groups on third-order eye-tracking output variables
| Variable | Neck pain Biomedical | Neck pain Biopsychosocial | Asymptomatic Biomedical | Asymptomatic Biopsychosocial | Main effect ‘Patient group’ | Main effect ‘Physiotherapist group’ | Interaction effect |
|---|---|---|---|---|---|---|---|
| Fixation count, n | |||||||
| Anterior | 43.26 (14.22) | 43.92 (12.75) | 43.12 (13.97) | 43.64 (12.58) | 0.13 (−1.70; 1.96) | 0.51 (−1.23; 2.26) | 0.15 (−2.32; 2.62) |
| Lateral | 35.20 (12.07) | 33.09 (11.45) | 35.46 (12.16) | 33.18 (11.13) | −0.26 (−2.04; 1.51) | −2.29a (−3.80; −0.78) | 0.18 (−1.96; 2.32) |
| Posterior | 44.35 (15.44) | 37.42 (12.89) | 43.32 (13.53) | 37.48 (12.94) | 1.03 (−0.95; 3.01) | −5.84a (−7.62; −4.06) | −1.09 (−3.61; 1.43) |
| Average fixation duration, seconds | |||||||
| Anterior | 0.31 (0.07) | 0.33 (0.09) | 0.31 (0.07) | 0.33 (0.08) | 0.00 (−0.01; 0.01) | 0.02a (0.01; 0.03) | 0.00 (−0.01; 0.01) |
| Lateral | 0.30 (0.08) | 0.33 (0.11) | 0.30 (0.08) | 0.33 (0.12) | 0.00 (−0.01; 0.01) | 0.04a (0.02; 0.05) | 0.00 (−0.02; 0.02) |
| Posterior | 0.34 (0.08) | 0.38 (0.15) | 0.34 (0.08) | 0.39 (0.15) | 0.00 (−0.02; 0.01) | 0.04a (0.03; 0.06) | 0.00 (−0.03; 0.02) |
| Saccade count, n | |||||||
| Anterior | 53.11 (15.19) | 54.43 (14.53) | 52.91 (15.12) | 54.66 (14.64) | 0.20 (−1.74; 2.14) | 1.75 (−0.19; 3.69) | −0.43 (−3.17; 2.32) |
| Lateral | 43.21 (13.89) | 41.92 (13.09) | 43.44 (13.50) | 42.38 (13.14) | −0.24 (−2.18; 1.71) | −1.07 (−2.81; 0.67) | −0.22 (−2.68; 2.23) |
| Posterior | 54.47 (16.14) | 48.36 (14.86) | 53.34 (14.40) | 48.82 (14.42) | 1.14 (−0.91; 3.18) | −4.51a (−6.46; −2.56) | −1.60 (−4.36; 1.15) |
Table S3.
Results of the linear mixed models for the main and interaction effects of patients’ and physiotherapists’ groups on forth-order eye-tracking output variables
| Variable | Neck pain Biomedical | Neck pain Biopsychosocial | Asymptomatic Biomedical | Asymptomatic Biopsychosocial | Main effect ‘Patient group’ | Main effect ‘Physiotherapist group’ | Interaction effect |
|---|---|---|---|---|---|---|---|
| Transition matrix, probability | |||||||
| ANT-->ANT | 0.90 (0.08) | 0.90 (0.06) | 0.90 (0.07) | 0.90 (0.06) | 0.00 (−0.01; 0.01) | −0.01 (−0.02; 0.00) | 0.00 (−0.01; 0.02) |
| ANT-->LAT | 0.08 (0.07) | 0.08 (0.06) | 0.08 (0.06) | 0.09 (0.05) | 0.00 (−0.01; 0.01) | 0.01a (0.00; 0.02) | 0.00 (−0.01; 0.01) |
| ANT-->POS | 0.02 (0.03) | 0.02 (0.02) | 0.02 (0.03) | 0.02 (0.03) | 0.00 (0.00; 0.00) | 0.00 (0.00; 0.00) | 0.00 (−0.01; 0.00) |
| LAT-->ANT | 0.09 (0.07) | 0.10 (0.07) | 0.09 (0.07) | 0.10 (0.07) | 0.00 (−0.01; 0.01) | 0.02a (0.01; 0.02) | 0.00 (−0.01; 0.01) |
| LAT-->LAT | 0.81 (0.12) | 0.78 (0.13) | 0.81 (0.12) | 0.78 (0.12) | 0.00 (−0.02; 0.01) | −0.03a (−0.05; −0.02) | 0.01 (−0.02; 0.03) |
| LAT-->POS | 0.11 (0.08) | 0.11 (0.07) | 0.10 (0.08) | 0.12 (0.07) | 0.00 (−0.01; 0.02) | 0.02a (0.01; 0.03) | −0.01 (−0.02; 0.01) |
| POS-->ANT | 0.02 (0.03) | 0.03 (0.04) | 0.02 (0.03) | 0.03 (0.04) | 0.00 (0.00; 0.01) | 0.01a (0.01; 0.02) | 0.00 (−0.01; 0.00) |
| POS-->LAT | 0.07 (0.06) | 0.08 (0.07) | 0.07 (0.08) | 0.08 (0.07) | −0.01 (−0.02; 0.00) | 0.01a (0.00; 0.02) | 0.00 (−0.01; 0.01) |
| POS-->POS | 0.90 (0.12) | 0.88 (0.10) | 0.90 (0.10) | 0.88 (0.09) | 0.00 (−0.02; 0.01) | −0.02a (−0.04; −0.01) | 0.01 (−0.01; 0.02) |
| Mean first time passage, events | |||||||
| ANT-->LAT | 19.06 (12.81) | 17.22 (12.05) | 20.16 (15.47) | 16.00 (10.14) | −1.10 (−2.91; 0.71) | −4.17a (−5.82; −2.51) | 2.32 (−0.02; 4.66) |
| ANT-->POS | 37.68 (29.66) | 31.09 (20.68) | 38.81 (31.54) | 30.49 (21.35) | −1.13 (−4.89; 2.64) | −8.32a (−11.73; −4.92) | 1.73 (−3.09; 6.54) |
| LAT-->ANT | 35.10 (28.85) | 25.73 (23.69) | 34.23 (30.12) | 24.24 (21.56) | 0.87 (−2.56; 4.30) | −9.99a (−13.42; −6.56) | 0.62 (−4.23; 5.48) |
| LAT-->POS | 24.79 (21.80) | 20.52 (13.48) | 26.15 (22.68) | 20.26 (15.12) | −1.36 (−3.90; 1.19) | −5.89a (−8.32; −3.45) | 1.61 (−1.84; 5.06) |
| POS-->ANT | 47.46 (38.13) | 34.17 (32.05) | 46.17 (39.29) | 32.08 (28.88) | 1.29 (−3.26; 5.84) | −14.09a (−18.64; −9.54) | 0.81 (−5.63; 7.24) |
| POS-->LAT | 22.23 (17.37) | 18.38 (15.06) | 22.38 (19.46) | 18.30 (15.24) | −0.15 (−2.45; 2.14) | −4.08a (−6.28; −1.88) | 0.23 (−2.88; 3.34) |
| Mean recurrence time, events | |||||||
| ANT | 3.51 (2.26) | 2.97 (1.32) | 3.28 (1.52) | 2.98 (1.30) | 0.23a (0.00; 0.46) | −0.30a (−0.53; −0.08) | −0.23 (−0.55; 0.09) |
| LAT | 4.24 (1.88) | 4.13 (1.88) | 4.16 (1.91) | 4.17 (2.52) | 0.07 (−0.22; 0.37) | 0.01 (−0.27; 0.29) | −0.11 (−0.51; 0.29) |
| POS | 2.69 (1.40) | 2.95 (1.39) | 2.85 (2.99) | 3.07 (1.43) | −0.17 (−0.45; 0.12) | 0.21 (−0.04; 0.46) | 0.05 (−0.30; 0.41) |