Patient Expectations of Treatment for Back Pain

Verbeek, Jos; Sengers, Marie-José; Riemens, Linda; Haafkens, Joke A.

doi:10.1097/01.brs.0000142007.38256.7f

Cited by 303 publications

(103 citation statements)

References 51 publications

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“…The review reported that there were two 'treatment aspects' (p. 2310) 194 that occurred most frequently. These were that (i) patients want to know the cause of their pain and (ii) patients want information or instruction.…”

Section: Support For Self-managementmentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

337

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Support For Self-managementmentioning

confidence: 99%

“…l Self-management support needs to address 'noncongruence' (p. 2313) 194 between patients and professionals. This includes differences in opinions about the definition and cause of LBP and how it should be identified and treated.…”

Section: Support For Self-managementmentioning

confidence: 99%

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

337

451

View full text Add to dashboard Cite

show abstract

“…Potentially a referral for imaging is a procedure that health care providers view as providing reassurance that no serious pathology exists and justification for providing advice to staying active through the period of pain. In a study on patients' expectations and satisfaction, the unenviable position of the health care providers was underlined: on the one hand guidelines recommend refraining from imaging examination on nonspecific LBP while patients often have expectations about finding an exact cause of the pain (21).…”

Section: Discussionmentioning

confidence: 99%

Untitled

Werner¹,

Gross²

2009

Nor J Epidemiol

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Aims: Several authors have reported an overuse of imaging examinations for unspecific low back pain conditions. In this study, we examined the influence of a media campaign for better understanding and management of back pain in the general population on utilization of imaging examinations. Methods: The media campaign Active Back ran for three years (2002)(2003)(2004)(2005) in two Norwegian counties and the results were compared to the adjacent control county. Numbers of imaging examinations were collected manually from every radiology department in each of the three counties, while belief measures were collected through a telephone survey before, during and after the campaign. Beliefs of the health care providers were collected through questionnaires. Results: We observed a decrease of X-rays by 35% in the intervention counties and by 33% in the control county. The number of CT scans decreased by 51% and 57% respectively. The number of MRI scans increased by 152% in the intervention counties and by 596% in the control. Combining all modalities, the number of imaging examinations increased by 3% in the intervention counties and by 56% in the control county. There was a tendency both in the general public and among the health care providers towards less trust in the usefulness of X-rays in all counties during the study period. The health care providers in the control county seemed to recommend imaging more often than their colleagues in the intervention counties. Conclusion: Despite slightly increased scepticism among the general public and health care providers, we observed an overall increase in utilization of imaging modalities. The dramatically increased utilization in the control group was likely explained by an increased capacity for MRI examinations obtained by the opening of a new radiology clinic, and not as an effect of the media campaign.Low back pain (LBP) is a common disorder with a lifetime prevalence of 70-85% in industrialised countries (1). In a recent Norwegian study the incidence rate of LBP complaints lasting more than 15 days during the past month was found to be 2.8% among men and 2.3% among women (2). Back pain patients constitute 3.5-5% of all consultations at Norwegian general practitioners (3,4). Evaluation of the Active Back campaign indicated that 82% of all treatments at chiropractic clinics were for back pain, whereas 27% of visits to physiotherapists and 10% of visits to family doctors were concerning patients with LBP (5).In most cases of acute and chronic back pain, the pathoanatomical aetiology remains unknown (1,6). 85% of acute LBP is accordingly labelled non-specific back pain, while 10-15% is recognised as nerve root pain (radicular pain) and 1-5% serious spinal pathology (7). Despite this high level of uncertainty regarding aetiology, diagnostic imaging is still commonly performed in medical practice.

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“…Zudem helfen klare Absprachen über das gestufte, an abgesprochenen Kriterien orientierte Vorgehen und der Einbezug des Patienten in die Entscheidungsprozesse. Da die Erwartungen der Schmerzpatienten in der Regel zunächst primär die somatische Einordnung ihrer Beschwerden wie auch die grundlegende Anerkenntnis ihrer Schmerzen betreffen, trägt es zur Erhö-hung der Motivation bei, wenn dieser Erwartung insbesondere am Anfang der Behandlung entsprochen wird [46].…”

Section: Therapiemotivationunclassified

Multimodale Schmerztherapie

Arnold

Brinkschmidt

Casser

et al. 2009

Schmerz

192

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Multimodal pain therapy describes an integrated multidisciplinary treatment in small groups with a closely coordinated therapeutical approach. Somatic and psychotherapeutic procedures cooperate with physical and psychological training programs. For chronic pain syndromes with complex somatic, psychological and social consequences, a therapeutic intensity of at least 100 hours is recommended. Under these conditions multimodal pain therapy has proven to be more effective than other kinds of treatment. If monodisciplinary and/or outpatient therapies fail, health insurance holders have a legitimate claim to this form of therapy.Medical indications are given for patients with chronic pain syndromes, but also if there is an elevated risk of chronic pain in the early stadium of the disease and aiming at delaying the process of chronification. Relative contraindications are a lack of motivation for behavioural change, severe mental disorders or psychopathologies and addiction problems. The availability of multimodal pain treatment centers in Germany is currently insufficient.

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Patient Expectations of Treatment for Back Pain

Cited by 303 publications

References 51 publications

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

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Multimodale Schmerztherapie

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