Holopainen Riikka, Piirainen Arja, Heinonen Ari, Karppinen Jaro, O'Sullivan Peter
University of Jyväskylä, Jyväskylä, Finland.
Medical Research Center Oulu, University of Oulu and Oulu University Hospital, and Finnish Institute of Occupational Health, Oulu, Finland.
Musculoskeletal Care. 2018 Jun;16(2):269-277. doi: 10.1002/msc.1230. Epub 2018 Jan 12.
Low back pain is a considerable health problem which affects people around the world, causing major healthcare costs. The use of qualitative research methods enables us to describe and understand patients' experience of, and attitudes to, healthcare. The aim of the present phenomenographic study was to identify and describe the contextual nature of the conceptions of patients with low back pain of their encounters in the HCS. Seventeen patients with chronic or episodic low back pain classified as "high risk" were interviewed in open recall interviews, using videos of patients' initial physiotherapy sessions that had been recorded previously. The data were analysed using the phenomenographic method. Patients' conceptions of their clinical journey were formulated by a variety of themes: convincing care, lifestyle change, participation, reciprocality and ethicality of encounters. The themes varied in four categories: "non-encounters", seeking support, empowering collaboration and autonomic agency. The results showed a range of clinical interactions - from very negative and disempowering, to empowering and life changing. The key differences between the first and second categories were professionals "being present" and patients starting to understand their low back pain. Between the second and third category, the key aspects were strong therapeutic alliance and the active participation of the patient. Finally, the key differences between the third and fourth categories were the patient being in charge and taking responsibility while knowing that help was available if required. The results may help in improving the care of patients with low back pain.
腰痛是一个严重的健康问题，影响着世界各地的人们，造成了巨大的医疗成本。定性研究方法的运用使我们能够描述和理解患者对医疗保健的体验及态度。本现象学研究的目的是识别和描述腰痛患者在医疗保健系统（HCS）中就医经历概念的背景性质。17名被归类为“高风险”的慢性或发作性腰痛患者参与了开放式回忆访谈，访谈使用了之前录制的患者初次物理治疗课程的视频。数据采用现象学方法进行分析。患者对其临床就医过程的概念由多种主题构成：令人信服的护理、生活方式改变、参与、互动的互惠性和道德性。这些主题分为四类：“无接触”、寻求支持、赋能协作和自主行动。结果显示了一系列临床互动——从非常消极和剥夺权力的，到赋能和改变生活的。第一类和第二类之间的关键差异在于专业人员的“在场”以及患者开始理解自己的腰痛。第二类和第三类之间的关键方面是强大的治疗联盟和患者的积极参与。最后，第三类和第四类之间的关键差异在于患者在知道必要时可获得帮助的情况下负责并承担责任。这些结果可能有助于改善腰痛患者的护理。
