Concordance of patient beliefs and expectations regarding the management of low back pain with guideline recommendations – a cross-sectional study in Germany

Abstract

Background Low back pain is a common reason for patients to seek medical care. Physician non-adherence to clinical guidelines has been observed. We investigated the extent to which patient expectations correspond to recommendations of the German national guideline for management of low back pain (G-LBP) and whether patient characteristics, history of LBP and previous treatment experience are associated with expectations. Methods A cross-sectional study including patients from 13 general practices was conducted. Data were collected using a questionnaire. Inverse probability weights were used to address non-response bias. Descriptive analysis and multivariate logistic regression models were performed. Results A total of 977 patients were included in analyses (median age 57 years, 39% male). 75% of patients reported experiencing LBP currently or within the last year. More than 65% indicated they would agree to forgo further examinations if their LBP was judged by their physician to be of no serious concern. This was associated with the highest level of education and no prior imaging, and negatively associated with good-to-poor health status and moderate-to-severe pain intensity. 40% of participants expected imaging. The highest educational level, female gender and no prior imaging were associated with a decreased expectation of imaging. 70% expected prescriptions for massages. Females, participants with good-to-poor health status, current LBP or LBP in the last 12 months had an increased expectation for massages. Expectations for injection therapy (45%) were mainly associated with previous injections. Expectations for physiotherapy (64%) were associated with female gender, lower educational level, good-to-poor health status, current LBP or in the last 12 months. The perspective that daily activities should be continued (66%) was associated with female gender and higher educational level. Participants who agreed to the statement ‘There is no effective treatment for LBP’ (11%) had a poor health status, current LBP and a severe pain intensity. Conclusion Patient views regarding LBP management are partially concordant with guideline recommendations and are strongly influenced by previous treatment experiences and education level. Exploration of patient expectations and experiences in LBP treatment may help minimize dissatisfaction of patients expecting treatments not endorsed by guidelines and simultaneously increase physician guideline adherence.

Guideline adherence of physiotherapists in the treatment of patients with low back pain: A qualitative study

“…On the other hand, no participant was completely adherent in the diagnostic phase, treatment phase and in the use of questionnaires. These findings are in concordance with the study of Bahns et al, 20 Kiel et al 19 and Rutten et al 6…”

“…In these studies, physiotherapy practices reported discrepancies between the current treatment and the recommendations in the guidelines because they received negative responses from the patients, stating that patients were very focused on pain and expected ‘real’ (hands‐on) treatment instead of (hands‐off) exercise therapy and education 24 . ‘Patient views are strongly influenced by previous treatment experiences and education level’ 19 . In addition to these results, Poitras et al reported in a qualitative study that physiotherapists thought that management recommendations could conflict with patient expectations 23…”

“…24 'Patient views are strongly influenced by previous treatment experiences and education level'. 19 In addition to these results, Poitras et al reported in a qualitative study that physiotherapists thought that management recommendations could conflict with patient expectations. 23 In the present study, the majority of participating physiotherapists mentioned the health insurance coverage or financial situation of the patient as a reason to be non-adherent to the guideline.…”

“…An increase in adherence to guidelines may lead to better outcomes and may reduce costs of treatment 6–12 . Yet, in quantitative studies, adherence rates to these guidelines show room for improvement 6,13–19 . Rutten et al studied the adherence rates of physiotherapist to the Dutch physiotherapy guideline for LBP.…”

“…[6][7][8][9][10][11][12] Yet, in quantitative studies, adherence rates to these guidelines show room for improvement. 6,[13][14][15][16][17][18][19] Rutten et al studied the adherence rates of physiotherapist to the Dutch physiotherapy guideline for LBP. They reported percentages of adherence ranging from 2% to 99% for the individual steps of the diagnostic process and from 47% to 88% for the individual steps of the therapeutic process.…”