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Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M.
Clin J Pain. 2021 Aug 1;37(8):598-606. doi: 10.1097/AJP.0000000000000946.
Reassurance is an important part of treatment for low back pain (LBP). The Consultation-based Reassurance Questionnaire measures patients' perceived reassurance after health care consultations on 4 subdomains (ie, Data-gathering, Relationship-building, Generic reassurance, Cognitive reassurance). The objectives of this study were to investigate associations between the level of reassurance and outcomes and to investigate if the associations were moderated by patients' risk profile.
Adult patients consulting chiropractors for LBP were emailed the Consultation-based Reassurance Questionnaire directly after the consultation. Outcomes were Global Perceived Effect (GPE) after 2 weeks, and pain (Numeric Rating Scale) and disability (Roland-Morris Disability Questionnaire) 2 weeks and 3 months following treatment. Associations with GPE were tested in logistic mixed models. Associations between each reassurance domain and pain and disability were tested in longitudinal analyses using linear mixed models. Moderations by risk profile were tested by introducing an interaction between risk groups and reassurance level. All models were controlled for several potential confounders.
A total of 2056 patients were included in the study, with 46% reporting LBP for less than a week. Associations between reassurance level and improvement in LBP intensity and disability were weak but positive, whereas associations with GPE were potentially clinically relevant. None of the associations were moderated by psychological risk profile.
Identified associations between reassurance and outcomes were weak, however, for GPE the association might be of a clinically relevant magnitude. The causal relationship is unclear, but with communication always present in a consultation these results suggest that efforts to optimize clinician-patient communication might be worthwhile, also for people with very recent onset of LBP.
对于下背痛（LBP）患者来说，安慰是治疗的重要组成部分。基于咨询的安慰问卷（Consultation-based Reassurance Questionnaire）通过 4 个亚领域（即数据收集、关系建立、通用安慰、认知安慰）来衡量患者在医疗保健咨询后的感知安慰程度。本研究的目的是调查安慰程度与结果之间的关联，并研究这些关联是否受患者风险特征的调节。
成年 LBP 患者在向脊椎按摩师就诊后，会立即通过电子邮件收到基于咨询的安慰问卷。结果是 2 周后的总体感知效果（GPE），以及治疗后 2 周和 3 个月的疼痛（数字评分量表）和残疾（Roland-Morris 残疾问卷）。使用逻辑混合模型测试 GPE 的关联。使用线性混合模型进行纵向分析，测试每个安慰域与疼痛和残疾之间的关联。通过引入风险组与安慰水平之间的交互作用来测试风险特征的调节作用。所有模型均控制了几个潜在的混杂因素。
共纳入 2056 名患者，其中 46%的患者 LBP 持续时间不到一周。安慰水平与 LBP 严重程度和残疾改善之间的关联较弱但呈阳性，而与 GPE 的关联可能具有临床相关性。这些关联均不受心理风险特征的调节。
确定的安慰与结果之间的关联较弱，但对于 GPE，关联可能具有临床相关的重要性。因果关系尚不清楚，但由于咨询中始终存在沟通，这些结果表明，努力优化医患沟通可能是值得的，对于近期发作的 LBP 患者也是如此。
