Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Monash University Library, Monash University, Melbourne, Victoria, Australia.
PLoS One. 2018 Nov 8;13(11):e0204885. doi: 10.1371/journal.pone.0204885. eCollection 2018.
An improved understanding of patients' perceived needs for medical services for low back pain (LBP) will enable healthcare providers to better align service provision with patient expectations, thus improving patient and health care system outcomes. Thus, we aimed to identify the existing literature regarding patients' perceived needs for medical services for LBP.
A systematic scoping review was performed of publications identified from MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016). Descriptive data regarding each study, its design and methodology were extracted and risk of bias assessed. Aggregates of patients' perceived needs for medical services for LBP were categorised.
50 studies (35 qualitative, 14 quantitative and 1 mixed-methods study) from 1829 were relevant. Four areas of perceived need emerged: (1) Patients with LBP sought healthcare from medical practitioners to obtain a diagnosis, receive management options, sickness certification and legitimation for their LBP. However, there was dissatisfaction with the cursory and superficial approach of care. (2) Patients had concerns about pharmacotherapy, with few studies reporting on patients' preferences for medications. (3) Of the few studies which examined the patients' perceived need of invasive therapies, these found that patients avoided injections and surgeries (4) Patients desired spinal imaging for diagnostic purposes and legitimation of symptoms.
Across many different patient populations with data obtained from a variety of study designs, common themes emerged which highlighted areas of patient dissatisfaction with the medical management of LBP, in particular, the superficial approach to care perceived by patients and concerns regarding pharmacotherapy. Patients perceive unmet needs from medical services, including the need to obtain a diagnosis, the desire for pain control and the preference for spinal imaging. These issues need to be considered in developing approaches for the management of LBP in order to improve patient outcomes.
深入了解患者对腰痛（LBP）医疗服务的需求，将使医疗保健提供者能够更好地将服务提供与患者的期望保持一致，从而改善患者和医疗保健系统的结果。因此，我们旨在确定有关患者对腰痛医疗服务需求的现有文献。
对从 MEDLINE、EMBASE、CINAHL 和 PsycINFO（1990-2016 年）中确定的出版物进行了系统的范围审查。提取了每项研究的描述性数据，包括其设计和方法，并评估了偏倚风险。对腰痛医疗服务患者感知需求的集合进行了分类。
从 1829 项研究中确定了 50 项研究（35 项定性研究、14 项定量研究和 1 项混合方法研究）。出现了四个感知需求领域：（1）患有腰痛的患者寻求医疗从业者的医疗服务，以获得诊断、接受管理方案、病假证明和腰痛的合法化。然而，患者对护理的草率和肤浅方法表示不满。（2）患者对药物治疗有顾虑，很少有研究报告患者对药物的偏好。（3）在为数不多的研究中，这些研究检查了患者对侵入性治疗的感知需求，发现患者避免了注射和手术。（4）患者希望进行脊柱成像以进行诊断和症状合法化。
在许多不同的患者人群中，从各种研究设计中获得的数据都出现了共同的主题，这些主题突出了患者对腰痛医疗管理不满的领域，特别是患者对护理的肤浅态度和对药物治疗的担忧。患者对医疗服务存在未满足的需求，包括获得诊断、控制疼痛的愿望和对脊柱成像的偏好。在制定腰痛管理方法时，需要考虑这些问题，以改善患者的结局。
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