Public and patient perceptions of diagnostic labels for non-specific low back pain: a content analysis

Abstract

Purpose An online randomised experiment found that the labels lumbar sprain, non-specific low back pain (LBP), and episode of back pain reduced perceived need for imaging, surgery and second opinions compared to disc bulge, degeneration, and arthritis among 1447 participants with and without LBP. They also reduced perceived seriousness of LBP and increased recovery expectations. Methods In this study we report the results of a content analysis of free-text data collected in our experiment. We used two questions: 1. When you hear the term [one of the six labels], what words or feelings does this make you think of? and 2. What treatment (s) (if any) do you think a person with [one of the six labels] needs? Two independent reviewers analysed 2546 responses. Results Ten themes emerged for Question1. Poor prognosis emerged for disc bulge, degeneration, and arthritis, while good prognosis emerged for lumbar sprain, non-specific LBP, and episode of back pain. Thoughts of tissue damage were less common for non-specific LBP and episode of back pain. Feelings of uncertainty frequently emerged for non-specific LBP. Twenty-eight treatments emerged for Question2. Surgery emerged for disc bulge, degeneration, and arthritis compared to lumbar sprain, non-specific LBP, and episode of back pain. Surgery did not emerge for non-specific LBP and episode of back pain. Conclusion Our results suggest that clinicians should consider avoiding the labels disc bulge, degeneration and arthritis and opt for labels that are associated with positive beliefs and less preference for surgery, when communicating with patients with LBP.

What does high value care for musculoskeletal conditions mean and how do you apply it in practice? A consensus statement from a research network of physiotherapists in New South Wales, Australia

“… 78–83 For example, the language used when communicating a diagnosis or imaging findings alter treatment intentions and initiate a low value treatment cascade leading to harm. 80 81 In our study, participants agreed that they should look beyond commonly considered harms like medication side effects (statement 12).…”

“…Evidence on harms from treatment has focused on biomedical harms like side effects caused by medications 77. While important, evidence suggests that a traditional biomedical view on harms may not capture other sources of potential harm in care provision 78–83. For example, the language used when communicating a diagnosis or imaging findings alter treatment intentions and initiate a low value treatment cascade leading to harm 80 81.…”

How do people perceive different advice for rotator cuff disease? A content analysis of qualitative data collected in a randomised experiment

“…Although this is the first study to examine how people perceive different advice for rotator cuff disease, the findings are similar to two related studies from our group that explored how people perceive different labels for rotator cuff disease 15 and non-specific low back pain. 32 Labelling rotator cuff disease as a rotator cuff tear more often elicited words or feelings of psychological distress, uncertainty, having a serious issue and perceiving a poor prognosis, and treatment needs of surgery, compared with labelling as bursitis . 15 This likely explains why labelling as bursitis (vs rotator cuff tear ) reduces perceived need for surgery.…”

“… 15 This likely explains why labelling as bursitis (vs rotator cuff tear ) reduces perceived need for surgery. 11 Similarly, labelling non-specific low back pain as a disc bulge , degeneration or arthritis more often elicited feelings of perceiving a poor prognosis and having tissue damage compared with labelling as lumbar sprain , non-specific low back pain and an episode of low back pain , 32 which likely explains why the latter group of labels reduce perceived need for unnecessary care (eg, surgery, imaging). 13 Overall, these findings suggest the influence of advice and labels on treatment preferences for rotator cuff disease, and non-specific low back pain may be driven by similar feelings and perceived treatment needs.…”

General practitioners’ decision-making process to prescribe pain medicines for low back pain: a qualitative study

“…We used content analysis to create a summary of GP’s choices of pain medicines prescribed for each vignette. Content analysis combines both qualitative and quantitative methods, allowing both the content and frequency of categories to be reported 14 15. Two researchers initially reviewed and familiarised themselves with the transcripts, and coded all pain medicines using the following framework: medicines that would be prescribed as first-, second-, third- or fourth-line care, medicines that GPs would conditionally prescribe (eg, depending on a patient characteristic), and those that GPs were against prescribing.…”