‘Seeing pain differently’: the impact of physiotherapists’ attitudes and treatment beliefs on postural assessment in neck pain – an eye-tracking study
References
- Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The global spine care initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018;27(0123456789):796–801. doi: 10.1007/s00586-017-5432-9.
- Wu AM, Cross M, Elliott JM, et al. Global, regional, and national burden of neck pain, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024;6(3):e142–e155. doi: 10.1016/s2665-9913(23)00321-1.
- Kazeminasab S, Nejadghaderi SA, Amiri P, Pourfathi H, Araj-Khodaei M, Sullman MJM, et al. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord. 2022;23(1):1–13. doi: 10.1186/s12891-021-04957-4.
- Yip CHT, Chiu TTW, Poon ATK. The relationship between head posture and severity and disability of patients with neck pain. Man Ther. 2008;13(2):148–54. doi: 10.1016/j.math.2006.11.002.
- Richards KV, Beales DJ, Smith AJ, O’Sullivan PB, Straker LM. Neck posture clusters and their association with biopsychosocial factors and neck pain in Australian adolescents. Phys Ther. 2016;96(10):1576–87. doi: 10.2522/ptj.20150660.
- Vieira ÉCN, Meziat-Filho NAM, Ferreira AS. Photogrammetric variables used by physical therapists to detect neck pain and to refer for physiotherapeutic intervention: a cross-sectional study. J Manipulative Physiol Ther. 2019;42(4):254–66. doi: 10.1016/j.jmpt.2018.11.014.
- Maddaluno MLM, Ferreira APA, Tavares ACLC, Meziat-Filho N, Ferreira AS. Craniocervical posture assessed with photogrammetry and the accuracy of palpation methods for locating the seventh cervical spinous process: a cross-sectional study. J Manipulative Physiol Ther. 2021;44(3):196–204. doi: 10.1016/j.jmpt.2020.07.012.
- Correia IMT, Ferreira AS, Fernandez J, Reis FJJ, Nogueira LAC, Meziat-Filho N. Association between text neck and neck pain in adults. Spine. 2021;46(9):571–8. doi: 10.1097/BRS.0000000000003854.
- Richards KV, Beales DJ, Smith AL, O’Sullivan PB, Straker LM. Is neck posture subgroup in late adolescence a risk factor for persistent neck pain in young adults? A prospective study. Phys Ther. 2021;101(3):1–9. doi: 10.1093/ptj/pzab007.
- Correia IMT, Ferreira AS, Gomes JFM, Reis FJJ, Nogueira LAC, Meziat-Filho N. Cervical flexion posture during smartphone use was not a risk factor for neck pain, but low sleep quality and insufficient levels of physical activity were. A longitudinal investigation. Braz J Phys Ther. 2025;29(6):101258. doi: 10.1016/j.bjpt.2025.101258.
- Xavier DD, Graf RM, Ferreira AS. Short-term changes in posture and pain of the neck and lower back of women undergoing lipoabdominoplasty: a case series report. J Chiropr Med. 2023;22(2):138–47. doi: 10.1016/j.jcm.2022.07.003.
- Silva AG, Punt TD, Sharples P, Vilas-Boas JP, Johnson MI. Head posture assessment for patients with neck pain: is it useful? Int J Ther Rehabil. 2009;16(1):43–53. doi: 10.12968/ijtr.2009.16.1.37939.
- Czaprowski D, Stoliński Ł, Tyrakowski M, Kozinoga M, Kotwicki T. Non-structural misalignments of body posture in the sagittal plane. Scoliosis Spinal Disord. 2018;13(1):6. doi: 10.1186/s13013-018-0151-5.
- O’Sullivan K, O’Sullivan P, O’Sullivan L, Dankaerts W. What do physiotherapists consider to be the best sitting spinal posture? Man Ther. 2012;17(5):432–7. doi: 10.1016/j.math.2012.04.007.
- O’Sullivan K, O’Keeffe M, O’Sullivan L, O’Sullivan P, Dankaerts W. Perceptions of sitting posture among members of the community, both with and without non-specific chronic low back pain. Man Ther. 2013;18(6):551–6. doi: 10.1016/j.math.2013.05.013.
- Gerard T, Naye F, Langevin P, Decary S, Cook C. Tousignant-Laflamme Y. Deciphering classification systems for neck pain - understanding the content of classification systems to enhance physiotherapy management of neck pain. Musculoskeletal Care. 2024;22(1):1–12. doi: 10.1002/msc.1855.
- Korakakis V, O’Sullivan K, O’Sullivan PB, Evagelinou V, Sotiralis Y, Sideris A, et al. Physiotherapist perceptions of optimal sitting and standing posture. Musculoskelet Sci Pract. 2019;39:24–31. doi: 10.1016/j.msksp.2018.11.004.
- Iunes D, Bevilaqua-Grossi D, Oliveira A, Castro F, Salgado H. Análise comparativa entre avaliação postural visual e por fotogrametria computadorizada. Braz J Phys Ther. 2009;13(4):308–15. doi: 10.1590/S1413-35552009005000039.
- Souza JA, Pasinato F, Basso D, Corrêa ECR, da Silva AMT. Biofotogrametria confiabilidade das medidas do protocolo do software para avaliação postural (SAPO). Rev Bras Cineantropometria Desempenho Hum. 2011;13(4):299–305. doi: 10.5007/1980-0037.2011v13n4p299.
- Paz CKA, de Oliveira JA, da Silva Cruz R. Photogrammetry in the postural assessment of students in a particular faculty in the municipality of Boa Vista-RR. Rev Cathedral. 2022;4(1):1–11.
- Ferreira APA, Póvoa LC, Zanier JFC, Ferreira AS. Locating the seventh cervical spinous process: development and validation of a multivariate model using palpation and personal information. J Manipulative Physiol Ther. 2017;40(2):89–97. doi: 10.1016/j.jmpt.2016.10.012.
- Ferreira APA, Póvoa LC, Zanier JFC, Ferreira AS. Locating the seventh cervical spinous process: accuracy of the thorax-rib static method and the effects of clinical data on its performance. J Manipulative Physiol Ther. 2017;40(2):98–105. doi: 10.1016/j.jmpt.2016.10.011.
- Ferreira APA, Zanier JFC, Santos EBG, Ferreira AS. Accuracy of palpation procedures for locating the C1 transverse process and masseter muscle as confirmed by computed tomography images. J Manipulative Physiol Ther. 2022;45(5):337–45. doi: 10.1016/j.jmpt.2022.07.005.
- Póvoa LC, Ferreira APA, Silva JG. Validation of palpatory methods for evaluating anatomical bone landmarks of the cervical spine: a systematic review. J Manipulative Physiol Ther. 2015;38(4):302–10. doi: 10.1016/j.jmpt.2015.04.002.
- Ferreira APA, Póvoa LC, Zanier JFC, Machado DC, Ferreira AS. Sensitivity for palpating lumbopelvic soft-tissues and bony landmarks and its associated factors: a single-blinded diagnostic accuracy study. J Back Musculoskelet Rehabil. 2017;30(4):735–44. doi: 10.3233/BMR-150356.
- Gegenfurtner A, Lehtinen E, Säljö R. Expertise differences in the comprehension of visualizations: a meta-analysis of eye-tracking research in professional domains. Educ Psychol Rev. 2011;23(4):523–52. doi: 10.1007/s10648-011-9174-7.
- McDuff K, Benaim A, Wong M, Burley A, Gandhi P, Wallace A, et al. Analyzing the eye gaze behaviour of students and experienced physiotherapists during observational movement analysis. Physiother Can. 2021;73(2):129–35. doi: 10.3138/ptc-2019-0047.
- Penedo T, Rodrigues ST, Gotardi GC, Simieli L, Barela JA, Polastri PF, et al. Gaze behavior data in the vitrine of human movement science: considerations on eye-tracking technique. Braz J Mot Behav. 2023;17(4):75–88. doi: 10.20338/bjmb.v17i4.352.
- Sharafi Z, Sharif B, Guéhéneuc YG, Begel A, Bednarik R, Crosby M. A practical guide on conducting eye tracking studies in software engineering. Empir Softw Eng. 2020;25(5):3128–74. doi: 10.1007/s10664-020-09829-4.
- Dunn MJ, Alexander RG, Amiebenomo OM, Arblaster G, Atan D, Erichsen JT, et al. Minimal reporting guideline for research involving eye tracking (2023 edition). Behav Res Methods. 2023;56(5):4351–7. doi: 10.3758/s13428-023-02187-1.
- Harezlak K, Kasprowski P. Application of eye tracking in medicine: a survey, research issues and challenges. Comput Med Imaging Graph. 2018;65:176–90. doi: 10.1016/j.compmedimag.2017.04.006.
- Liu Z, Makino K, Nakamura M, Ishida K, Hanagata Y, Ueda S, et al. Analysis of eye tracking of physiotherapist during Walk Rehabilitation. In: IECON 2019 - 45th Annual Conference of the IEEE Industrial Electronics Society. IEEE; 2019: 6832–6837. doi:10.1109/IECON.2019.8926863.
- Mutsaers JHAM, Pool-Goudzwaard AL, Ostelo RWJG, Peters R, Koes BW, Verhagen AP. The psychometric properties of the PABS-PT in neck pain patients: a validation study. Man Ther. 2014;19(3):208–14. doi: 10.1016/j.math.2013.12.004.
- Eland ND, Kvåle A, Ostelo RWJG, De Vet HCW, Strand LI. Discriminative validity of the pain attitudes and beliefs scale for physical therapists. Phys Ther. 2019;99(3):339–53. doi: 10.1093/ptj/pzy139.
- Ferreira EAG, Duarte M, Maldonado EP, Burke TN, Marques AP. Postural assessment software (PAS/SAPO): validation and reliabiliy. Clinics. 2010;65(7):675–81. doi: 10.1590/S1807-59322010000700005.
- Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. JAAOS Glob Res Rev. 2018;2(3):e088. doi: 10.5435/jaaosglobal-d-17-00088.
- De Barros ENC, Alexandre NMC. Cross-cultural adaptation of the Nordic musculoskeletal questionnaire. Int Nurs Rev. 2003;50(2):101–8. doi: 10.1046/j.1466-7657.2003.00188.x.
- Fagundes FRC, Costa LOP, Fuhro FF, Manzoni ACT, de Oliveira NTB, Cabral CMN. Örebro Questionnaire: short and long forms of the Brazilian-Portuguese version. Qual Life Res. 2015;24(11):2777–88. doi: 10.1007/s11136-015-0998-3.
- Cook C, Richardson JK, Braga L, Menezes A, Soler X, Kume P, et al. Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Neck Disability Index and Neck Pain and Disability Scale. Spine. 2006;31(14):1621–7. doi: 10.1097/01.brs.0000221989.53069.16.
- Pastukhov A. eyelinkReader: Import gaze data for eyelink eye tracker; 2025. doi:10.32614/CRAN.package.eyelinkReader.
- Bates D, Machler M, Bolker B, Walker S. Fitting linear mixed-effects models using Lme4. 2015;67. doi: 10.18637/jss.v067.i01.
- Spedicato GA. Discrete time markov chains with r. Vol 9; 2017.
https://journal.r-project.org/archive/2017/RJ-2017-036/index.html . - Gohel D, Moog S, Heckmann M. Officer: manipulation of microsoft word and powerpoint documents; 2025. doi:10.32614/CRAN.package.officer.
- Rich B. Table 1: Tables of descriptive statistics in HTML; 2025. doi:10.32614/CRAN.package.table 1.
- Sjoberg DD, Whiting K, Curry M, Lavery JA, Larmarange J. Reproducible summary tables with the Gtsummary package. 2021;13:570–80. doi: 10.32614/RJ-2021-053.
- Gohel D, Skintzos P. Flextable: functions for tabular reporting; 2025. doi:10.32614/CRAN.package.flextable.
- Hollander J, Huette S. Extracting blinks from continuous eye-tracking data in a mind wandering paradigm. Conscious Cogn. 2022;100:103303. doi: 10.1016/j.concog.2022.103303.
- SR Research Ltd. EyeLink 1000 plus user manual [Version 1.0.20]. SR Research Ltd. 2021.
- Mahanama B, Jayawardana Y, Rengarajan S, Jayawardena G, Chukoskie L, Sinder J, et al. Eye movement and pupil measures: a review. Front Comput Sci. 2022;3:1–22. doi: 10.3389/fcomp.2021.733531.
- Spedicato GA. Discrete time Markov chains with R. R J. 2017;9(2):84. doi: 10.32614/RJ-2017-036.
DOI: https://doi.org/10.2478/advrehab-2026-0002 | Journal eISSN: 1734-4948
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
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© 2026 Pérsia Nascimento Abrahão et al., published by Józef Piłsudski University of Physical Education in Warsaw
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