Racial Bias and False Beliefs Among Doctor of Physical Therapy Students and Their Impact on Pain Management Decisions

Purpose/Hypothesis: This study aimed to determine (1) if DPT students evaluate and approach the management of pain differently based on the race of hypothetical patients, and (2) the prevalence of false beliefs about biological differences between Blacks and Whites among DPT students. Methods: All DPT program directors across the United States were asked to distribute the survey to currently enrolled students. The survey consisted of questions on (1) the estimated pain intensity and treatment parameters for patient cases with randomized race (one with an ankle sprain and another with low back pain), as well as (2) beliefs of biological differences between races. Results: Of 472 respondents, from 47 states, 72% were female and 80% were White non-Hispanic. Differences favored higher pain appraisals and treatment intensity for Black patients, but these differences were below the minimal detectable change threshold for pain appraisal. 71% held at least one false belief, and endorsement of false beliefs did not moderate differences in pain appraisals and treatment. Conclusions: While DPT students appraised and proposed management differently for Black and White patients, these differences did not reach clinical significance. A majority of students held misconceptions regarding biological differences between races, which were not associated with clinical decisions. Study limitations include the use of a non-validated survey and demographic imbalance. Clinical relevance: Less than 5% of physical therapists in the United States are Black, and racial bias among physical therapists has not been widely studied. Therefore, this study provides valuable information on the readiness and barriers for our future workforce to provide equitable care.