Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Rehabilitation Services, Northwestern Memorial Hospital, Chicago, IL.
Ann Emerg Med. 2023 Aug;82(2):154-163. doi: 10.1016/j.annemergmed.2022.12.028. Epub 2023 Feb 8.
Low back pain is a common reason for visiting the emergency department (ED), yet little is known about patient motivations for seeking emergency care. The purpose of this study was to explore patient perspectives on visiting the ED for low back pain to inform a more patient-centered approach to emergency care.
We conducted focus group discussions and individual interviews among patients visiting an urban academic ED for acute low back pain. We recruited participants from an ongoing prospective study of 101 patients receiving either ED-initiated physical therapy or usual care. We conducted discussions, and interviews using an a priori developed discussion guide. We audio recorded, transcribed, and iteratively content analyzed the data using a consensual qualitative approach until thematic saturation was reached.
We conducted 4 focus group discussions among 18 participants (median age 46.5 years, 66.7% women, 61.1% Black) and individual interviews with 27 participants (median age 45 years, 55.6% women, 44.4% White). No new themes emerged during the fourth and final focus group. We identified 5 summary themes: (1) the decision to seek emergency care for low back pain is motivated by severe pain, resulting disability, and fears about a catastrophic diagnosis, (2) participants sought various goals from their ED visit but emphasized the primacy of pain control, (3) participants were reluctant to use pain medications but also acknowledged their benefit, (4) participants perceived a number of benefits from direct access to an ED physical therapist in the ED, and (5) participation in physical therapy ultimately facilitated recovery, but the pain was a barrier to performing exercises.
These patient perspectives and resulting themes may be used to inform a more patient-centered emergency care experience and contextualize quantitative research findings on ED care for low back pain.
下腰痛是前往急诊部（ED）就诊的常见原因，但对于患者寻求急诊护理的动机知之甚少。本研究旨在探讨患者因下腰痛前往 ED 的就诊原因，以便为更以患者为中心的急诊护理方法提供信息。
我们在因急性下腰痛前往城市学术 ED 的患者中进行了焦点小组讨论和个人访谈。我们从一项正在进行的 101 名患者的前瞻性研究中招募参与者，这些患者接受 ED 启动的物理治疗或常规护理。我们使用预先制定的讨论指南进行讨论和访谈。我们对数据进行音频记录、转录，并使用共识定性方法进行迭代内容分析，直到达到主题饱和。
我们在 18 名参与者（中位数年龄 46.5 岁，66.7%为女性，61.1%为黑人）中进行了 4 次焦点小组讨论，在 27 名参与者（中位数年龄 45 岁，55.6%为女性，44.4%为白人）中进行了个人访谈。第四次也是最后一次焦点小组讨论中没有出现新的主题。我们确定了 5 个总结性主题：（1）因剧烈疼痛、导致残疾和对灾难性诊断的担忧而决定因下腰痛寻求急诊护理，（2）参与者从他们的 ED 就诊中寻求各种目标，但强调疼痛控制的首要地位，（3）参与者不愿意使用止痛药，但也承认它们的益处，（4）参与者认为直接在 ED 接受 ED 物理治疗师治疗有许多好处，（5）参与物理治疗最终促进了康复，但疼痛是进行锻炼的障碍。
这些患者的观点和由此产生的主题可以用于为更以患者为中心的急诊护理体验提供信息，并将 ED 治疗下腰痛的定量研究结果纳入背景。
