Patients’ perceived needs for medical services for non-specific low back pain: A systematic scoping review

Abstract

BackgroundAn 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.MethodsA 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.Results50 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.ConclusionsAcross 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.

The association between believing staying active is beneficial and achieving a clinically relevant functional improvement after 52 weeks: a prospective cohort study of patients with chronic low back pain in secondary care

“…A vast majority (88%) consider MR scans important for their recovery. A scoping review of patients' needs for medical services found that the preference for spinal imaging was driven by their desire for a diagnosis but also by the need for the legitimisation of their symptoms [35].…”

Patients’ perceptions with musculoskeletal disorders regarding their experience with healthcare providers and health services: an overview of reviews

“…Each review targeted various health conditions and populations such as non-specific low back pain [ 19 , 20 , 23 , 36 , 37 , 41 , 44 , 47 , 49 , 50 , 52 ] ( n = 11 reviews, n = 37,408 participants), osteoporosis [ 21 , 39 , 45 ] ( n = 3 reviews, n = 17,534 participants), osteoarthritis [ 22 , 25 , 40 ] ( n = 3 reviews, n = 3157 participants), rheumatoid arthritis [ 26 , 38 , 42 , 43 ] ( n = 4 reviews, n = 9406 participants), and other musculoskeletal disorders (e.g., chronic pain, soft tissue injuries, lower-limb sports-related injuries, traumatic musculoskeletal injuries, mixed and unspecified) [ 10 , 24 , 46 , 48 , 51 , 53 – 56 ] ( n = 9 reviews, n = 61,772 participants) that sought unspecified physical therapy services or rehabilitative cares. Table 2 provides an overview of the characteristics of the included reviews.…”

“…All of the reviews specified their population of interest and main outcome (question 1) and all listed their databases, keywords, and inclusion/exclusion criterion in their search strategies (questions 2 and 4). Eighteen (60%) out of the 28 reviews [ 19 – 22 , 25 , 36 , 38 , 41 , 43 , 44 , 46 – 49 , 52 , 53 , 55 , 56 ] involved at least two reviewers independently performed study selection (question 5) and eighteen (60%) of them [ 20 – 22 , 25 , 36 , 38 , 41 – 43 , 45 – 51 , 53 , 56 ] involved at least two reviewers independently performing data extraction and reaching consensus (question 6). For question 8, most of the reviews ( n = 27, 90%) [ 10 , 19 – 22 , 24 – 26 , 36 , 39 – 56 ] described and organized their included studies in adequate detail, providing information such as population, outcomes, research designs, and study settings.…”

“… Information needs (education) Cross-sectional surveys, questionnaire, interviews, telephone interviews, focus groups, diaries, video recording 24 (80%) Non-specific low back pain [ 19 , 20 , 23 , 36 , 37 , 41 , 44 , 47 , 49 , 50 ], Osteoporosis [ 21 , 39 , 45 ], Osteoarthritis [ 20 , 22 ], Rheumatoid arthritis [ 26 , 38 , 42 ], Others [ 10 , 24 , 51 , 53 , 54 , 56 ] Patients’ perceived need to obtain health information from a variety of sources and health information content about the diseases [ 19 , 20 , 25 , 36 , 38 , 44 , 45 , 54 ], perceived needs for imaging for diagnostic purposes and legitimation of symptoms [ 20 , 36 , 50 ], explaining the patient’s condition such as possible symptoms and cardiovascular risks and educating the patient about treatments, self-management strategies and physical exercises [ 10 , 22 – 24 , 36 , 38 , 39 , 41 , 42 , 45 , 47 , 49 – 54 , 56 ], reasons for seeking health information, delivery modes and barriers to meeting health inform...…”

Medical and allied health service use during acute and chronic post-injury periods in whiplash injured individuals

“…The reasons for radiology imaging in the present study are unknown. Perhaps patients with on-going WAD continue to search for a diagnosis to legitimise their pain, and may request or demand additional testing [33,34]. Clinicians may not be adequately prepared to explain reasons why imaging may be inappropriate and possibly detrimental [35], or may fear missing a fracture [32].…”