Eye tracking in postural assessment by visual inspection in people with neck pain

Abstract

Objective: To investigate the influence of physiotherapists’ biopsychosocial and biomedical attitudes and beliefs towards pain treatment orientation on postural visual assessment of people with neck pain using eye-tracking analysis. Methods: Physiotherapists (n=30) completed the Pain Attitudes and Beliefs Scale (PABS-PT) and were categorized 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: Biopsychosocial orientation group exhibited fewer ([95%CI]) lateral ([-3.81; - 0.76] n) and posterior fixations ([-7.64; -4.05] n), and fewer saccades on posterior view ([-6.47; -2.56] n). Conversely, they had longer fixation durations in all views (anterior [0.01; 0.03] s, lateral [0.025] s, and posterior ([0.03; 0.06] s) views. Almost all transition probabilities between views were influenced by physiotherapists’ orientation (with different effect directions), whereas mean first time passage in all transitions was lower in the biopsychosocial orientation group. Mean recurrent time was higher in patients with neck pain ([0.00; 0.46] s) but lower in the biopsychosocial orientation group ([-0.53; -0.08] s). Conclusion: Biopsychosocial orientation was associated with fewer eye fixations and saccades, lower mean first time passage, and longer fixation durations. Presence of neck pain leads to few specific phisiotherapists’ eye-tracking characteristics, particularly in mean recurrent time. Significance: Attitudes and beliefs towards pain treatment orientation of physiotherapists but not the presence of neck pain in patients significantly influence their visual postural assessment.