Department of Psychology, Royal Holloway, University of London, London, UK.
Department of Orthopaedics, Wexham Park Hospital, Slough, UK.
Eur J Pain. 2021 Aug;25(7):1540-1550. doi: 10.1002/ejp.1765. Epub 2021 Apr 2.
Guidelines recommend self-management for most people living with persistent musculoskeletal low back pain (PMLBP) when surgery is ruled out. Conveying this message to patients can be challenging. This study examined patients' perceptions of reassuring communications from surgical spine team practitioners attempting to deliver this message in a single consultation.
Pre-consultation baseline measures included levels of pain, disability and previous consultation history. Patients' perceptions of reassuring communications were measured within 1-week post-consultation. The outcome variables, measured at 3-month follow-up, included patients' report of subsequent GP visits for back pain, the number of other healthcare providers consulted for back pain and distress.
Data from 296 patients (9.8% loss to follow-up) were analysed using hierarchical regression models, controlling for demographic, clinical and study-related factors. In each model, perceived reassurance accounted for a small but significant variance, above and beyond other predictors. Further GP visits were predicted by disability at baseline and perceived reassurance (adjusted R of 14.6%). Subsequent consultations with any healthcare professionals were predicted by a shorter duration of back pain, disability at baseline and perceived reassurance (adj. R = 10.6%). Distress was predicted by older age, disability and reassurance (adj. R = 59.5%).
Findings suggest that better communication in consultations with orthopaedic spine clinicians might help reduce unnecessary subsequent healthcare utilization and distress.
Low back pain patients' perceptions of their communication with orthopaedic spine practitioners are associated with subsequent healthcare seeking and distress at follow-up. This study examines the intersection of two important but fairly neglected areas in the pain research: provider communication and patient healthcare utilization.
指南建议大多数持续性肌肉骨骼下背痛（PMLBP）患者在排除手术治疗后进行自我管理。向患者传达这一信息具有挑战性。本研究检查了患者对脊柱外科团队医生在单次咨询中传递这一信息时的安抚性沟通的看法。
在咨询前基线测量包括疼痛、残疾和以前的咨询史。在咨询后 1 周内测量患者对安抚性沟通的看法。在 3 个月随访时测量的结果变量包括患者因背痛而后续就诊于全科医生的次数、因背痛而咨询的其他医疗保健提供者的数量和痛苦。
使用分层回归模型对 296 名患者（10.8%的随访丢失）的数据进行了分析，控制了人口统计学、临床和研究相关因素。在每个模型中，感知到的安慰解释了除其他预测因素之外的较小但显著的差异。基线残疾和感知到的安慰进一步预测了更多的 GP 就诊（调整后的 R 为 14.6%）。任何医疗保健专业人员的后续咨询均由疼痛持续时间较短、基线残疾和感知到的安慰（调整后的 R 为 10.6%）预测。痛苦由年龄较大、残疾和安慰（调整后的 R 为 59.5%）预测。
研究结果表明，与骨科脊柱临床医生的咨询沟通有所改善，可能有助于减少不必要的后续医疗利用和痛苦。
下背痛患者对与骨科脊柱医生沟通的看法与后续医疗保健需求和随访时的痛苦有关。本研究探讨了疼痛研究中两个相当被忽视的重要领域的交叉点：提供者沟通和患者医疗保健利用。
