'Reassurance and healthcare seeking in people with persistent musculoskeletal low back pain consulting orthopaedic spine practitioners: A prospective cohort study'

Braeuninger-Weimer, Kathrin; Rooslien, Hanna; Anjarwalla, N; Pincus, Tamar

doi:10.1002/ejp.1765

Cited by 11 publications

(13 citation statements)

References 36 publications

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“…In practice, only a minority of patients consulting orthopaedic spine clinics in the UK enter their specialist consultation without imaging results. 5 For this group, reduction in imaging might be carried out through effective triage, to ensure that the majority of people turning up for surgical consultations were indeed surgical candidates. The overall message from clinicians was that people with PMLBP were not a good 'fit' to what they had to offer, and at least in part, a solution would be to ensure that they saw someone else.…”

Section: Discussionmentioning

confidence: 99%

“…4 A recent longitudinal study in six UK hospitals found that around one in five patients consulting for back pain would be offered surgery. 5 Although imaging should only be indicated for patients with 'red flags', [6][7][8] in the UK it is common practice for the majority of patients consulting orthopaedic spine clinicians to receive an MRI scan. 5 For people with PMLBP, imaging often reveals signs of degeneration 9 10 which can also be observed in asymptomatic people.…”

Section: Introductionmentioning

confidence: 99%

“…5 Although imaging should only be indicated for patients with 'red flags', [6][7][8] in the UK it is common practice for the majority of patients consulting orthopaedic spine clinicians to receive an MRI scan. 5 For people with PMLBP, imaging often reveals signs of degeneration 9 10 which can also be observed in asymptomatic people. 11 Scans are typically used to exclude the need for surgery, without offering a clear diagnosis or indicating an alternative treatment.…”

Section: Introductionmentioning

confidence: 99%

“…16 Some patients with PMLBP will be referred on for other conservative interventions, but many (around 42%) will be discharged without treatment, often because all other alternatives have been exhausted. 5 Research suggests that these patients receive less reassurance and are less satisfied: instead of accepting the need to self-manage their problem, they feel dismissed, disbelieved and abandoned. 17 The findings from a prospective cohort study of 296 patients discharged from orthopaedic care without surgery suggest that better communication in consultations with orthopaedic spine clinicians might help reduce distress and unnecessary subsequent healthcare utilisation.…”

Section: Introductionmentioning

confidence: 99%

“…17 The findings from a prospective cohort study of 296 patients discharged from orthopaedic care without surgery suggest that better communication in consultations with orthopaedic spine clinicians might help reduce distress and unnecessary subsequent healthcare utilisation. 5 Effective reassurance necessitates engaging with patients and their concerns. For clinicians in orthopaedic teams, this is particularly challenging, as there is only minimal training, if any, in psychologically-informed practice.…”

Section: Introductionmentioning

confidence: 99%

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Taking patients to the ice cream shop but telling them that they cannot have ice cream: a qualitative study of orthopaedic spine clinicians’ perceptions of persistent low back pain consultations

et al. 2021

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ObjectiveThis study aimed to explore the perceptions of orthopaedic clinicians about consultations for people with persistent musculoskeletal low back pain (PMLBP) in which surgery is not recommended. Surgery is not recommended for the majority of PMLBP consulting in secondary care settings.SettingSecondary care sector in the UK.ParticipantsSemi-structured qualitative interviews were conducted with 24 orthopaedic team clinicians from 17 different hospitals in the UK and Ireland. Interviews explored clinicians’ perceptions of the challenges in consultations where surgery is not indicated. Interviews were transcribed verbatim and analysed using thematic analysis.ResultsTwo meta-themes, Difficulties and Enablers, each consisting of several subthemes were identified. Difficulties included challenges around the choice of appropriate terminology and labels for PMLBP, managing patients’ expectations, working with mentally vulnerable patients and explaining imaging findings. Enablers included early management of expectations, use of routine imaging, triaging, access to direct referral elsewhere, including other non-surgical practitioners in the team, training to improve communication skills and understanding of psychological issues.ConclusionThe findings highlight clinicians’ perceived need for concordance in messages delivered across the care pathway and training of orthopaedic clinicians to deliver effective reassurance and address patients’ needs in circumstances where surgery is not indicated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Taking patients to the ice cream shop but telling them that they cannot have ice cream: a qualitative study of orthopaedic spine clinicians’ perceptions of persistent low back pain consultations

et al. 2021

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Reassurance regarding educational messages in people with non‐specific low back pain: A cross‐sectional study

Alamam

Alrushud

Alodaibi

et al. 2022

Musculoskeletal Care

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Introduction/Objectives: Educational messages related to Low back pain (LBP) are often contradictory and drive maladaptive beliefs, as they conflict with the latest research evidence. This study aims to examine participants' reassurance levels in relation to educational messages regarding LBP among the Saudi population with the condition compared to those without it, and to assess the association between levels of reassurance and fear avoidance.Methods: A list of 13 educational messages about LBP was generated from LBPeducational resources in Saudi Arabia, and from expert consensus on a set of evidence-based key messages for people with LBP. Consented respondents with LBP of various durations and those without the condition completed a questionnaire containing questions on demographic characteristics, the absence or presence of LBP and its intensity, and the fear-avoidance beliefs questionnaire (FABQ). We also asked them to rate their level of perceived reassurance regarding the educational messages using a Likert-type scale from 0 to 10. Results:Participants (n = 1652) reported that the 13 educational messages had reassured them about LBP. However, there was no significant difference between participants with and without LBP (p ≥ 0.05). There was an overall weak association between the responses to the 13 educational messages and the fear-avoidance questionnaire. However, reassurance levels regarding most of the educational messages were negatively associated with the FABQ. Discussion and conclusion:We demonstrate that people with and without LBP need reassurance about the condition. Furthermore, we show that as reassurance increases, fear-avoidance decreases, confirming the complex nature of LBP.

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What are Brazilian orthopaedists' views on the diagnosis and treatment of patients with chronic nonspecific low back pain? A qualitative investigation

Murray

Costa

Jesus-Moraleida

et al. 2023

Musculoskeletal Care

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BackgroundOrthopaedists are often the first point of contact for patients who present with low back pain (LBP) and chronic LBP in Brazil.AimTo explore the views of orthopaedists on therapeutic approaches for chronic non‐specific low back pain (CNLBP) with a view to gain insights into aspects of clinical practice considered important to them.MethodsA qualitative design underpinned by interpretivism was employed. Participants were (n = 13) orthopaedists with experience in treating patients with CNLBP. Following the pilot interviews, semi‐structured interviews were conducted, audio‐recorded, transcribed and de‐identified. Interview data were thematically analysed.ResultsFour themes were identified. (1) Biophysical aspects are important and predominate, but sometimes their relevance can be unclear; (2) Psychosocial aspects and lifestyle factors influence the therapeutic approach; (3) Treatment of CNLBP ‐ including medication, physical activity, surgery and other invasive procedures and other therapeutic modalities; and (4) Nuances of clinical practice – “it goes beyond medicine”.ConclusionBrazilian orthopaedists value identifying the biophysical cause(s) of chronic low back pain. Psychological factors were often discussed secondary to biophysical aspects, whereas social aspects were rarely mentioned. Orthopaedists highlighted their difficulties in navigating patients' emotions and reassuring patients without referrals to imaging tests. Orthopaedists may benefit from training that targets communication and other relational aspects of care in order to work with people who present with CNLBP.

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'Reassurance and healthcare seeking in people with persistent musculoskeletal low back pain consulting orthopaedic spine practitioners: A prospective cohort study'

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 11 publications

References 36 publications

Taking patients to the ice cream shop but telling them that they cannot have ice cream: a qualitative study of orthopaedic spine clinicians’ perceptions of persistent low back pain consultations

Taking patients to the ice cream shop but telling them that they cannot have ice cream: a qualitative study of orthopaedic spine clinicians’ perceptions of persistent low back pain consultations

Reassurance regarding educational messages in people with non‐specific low back pain: A cross‐sectional study

What are Brazilian orthopaedists' views on the diagnosis and treatment of patients with chronic nonspecific low back pain? A qualitative investigation

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