The effect of shared decision-making on recovery from non-chronic aspecific low back pain in primary care; a post-hoc analysis from the patient, physician and observer perspectives

Abstract

Background Although shared decision-making (SDM) is increasingly accepted in healthcare and has demonstrated merits for several psychological outcomes, the effect on recovery from somatic conditions is still subject to debate. The objective of this study is to measure the effect of SDM on recovery from non-chronic aspecific low back pain (LBP). Methods This study is a post-hoc analysis of data from a cluster-randomised trial that evaluated the effectiveness of SDM on recovery in patients with non-chronic aspecific LBP. In this analysis, we re-evaluate the impact of SDM from three perspectives: that of external observers, participating GPs and participating patients. Recovery was measured with the Visual Analogue Scale (VAS) for pain and with the Roland Morris Disability questionnaire (RMD) and defined as a VAS < 30 and an RMD < 4. Logistic regression was used to analyse the effect of SDM on recovery at 6 and 26 weeks. Results At 26 weeks, 105 (74%) of all 176 included patients had recovered. No significant effect of SDM on recovery at 6 or 26 weeks after the consultation was found when considering SDM from an observer perspective or a patient perspective. From a GP perspective SDM had a significant effect on recovery, but at 26 weeks only, and with the lowest probability of recovery observed at a medium level of GP-perceived SDM. Conclusions We found no evidence that SDM as perceived by the patient or by external observation improves recovery from non-chronic aspecific low back pain. The long-term recovery may be better for patients in whom the GP perceives SDM during their consultations. Further research should highlight the hierarchy and the relation between the perspectives, which is needed to come to an integral effect evaluation of SDM. Trial registration The Netherlands National Trial Register (NTR) number: NTR1960.

Musculoskeletal physiotherapists' discharge practices for people treated with low back pain: A United Kingdom survey

“…Interestingly, the most frequent approach to determine when people are discharged was shared decision‐making between the person and physiotherapist. Shared decision‐making is regarded as a collaborative approach between a person and their healthcare professional to reach an ‘informed’ decision about healthcare delivery (Sanders et al., 2022). The findings of our survey indicate that shared decision‐making frequently occurs in this scenario, thereby following national policy and guideline recommendations for supporting shared decision‐making (NICE, 2016).…”

Mechanical Needling With Sterile Water Versus Lidocaine Injection for Lumbar Spinal Stenosis

“…Facet joint hypertrophy is a condition which the cartilage between the inferior and superior articular processes breaks down and becomes inflamed, causing pain signals to be sent to the innervated medial branch nerve endings. [6][7][8][9][10][11] The L4-L5 region of the lumbar spine is the most prevalent site of LSS. 7,[9][10][11][12][13] Radicular pain in spinal stenosis is caused by inflammation or compression of the spinal nerve root, with disc herniation being the most prevalent cause.…”

“…[6][7][8][9][10][11] The L4-L5 region of the lumbar spine is the most prevalent site of LSS. 7,[9][10][11][12][13] Radicular pain in spinal stenosis is caused by inflammation or compression of the spinal nerve root, with disc herniation being the most prevalent cause. 7,[9][10][11][12][13] Degenerative disc disease is often the first step in a series of occurrences.…”

“…7,[9][10][11][12][13] Radicular pain in spinal stenosis is caused by inflammation or compression of the spinal nerve root, with disc herniation being the most prevalent cause. 7,[9][10][11][12][13] Degenerative disc disease is often the first step in a series of occurrences. As the diffusion of nutrients reduces due to endplate degeneration, it encourages disc degradation, resulting in lower disc heights, altered biomechanics, and the development of facet arthropathy, osteophytes, spondylosis, and degenerative spinal stenosis.…”

“…Spondylolisthesis and degenerative scoliosis cause spine instability, which is unavoidable as the condition worsens. [6][7][8][9][10][11] There is moderate-quality evidence suggesting a multimodal approach that incorporates manual therapy and exercise, with or without education, is a successful treatment for LSS with neurogenic claudication, and that epidural steroids are ineffective. The quality of evidence for all other non-operative therapies was insufficient to make inferences about their efficacy.…”