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Research ArticleOriginal ResearchA

The Enduring Impact of What Clinicians Say to People With Low Back Pain

Ben Darlow, Anthony Dowell, G. David Baxter, Fiona Mathieson, Meredith Perry and Sarah Dean
The Annals of Family Medicine November 2013, 11 (6) 527-534; DOI: https://doi.org/10.1370/afm.1518
Ben Darlow
1Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
MSportsPhysio
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  • For correspondence: ben.darlow@otago.ac.nz
Anthony Dowell
1Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
MBChB
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G. David Baxter
2Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
DPhil
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Fiona Mathieson
3Department of Psychological Medicine, University of Otago, Wellington, New Zealand
MA
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Meredith Perry
2Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
PhD
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Sarah Dean
4Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
PhD
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  • Listening to the patient's interpretation
    Andrew Claus
    Published on: 20 November 2013
  • Author response: Dr Serena McCluskey
    Ben Darlow
    Published on: 19 November 2013
  • Author response: Dr Peter O'Sullivan
    Ben Darlow
    Published on: 18 November 2013
  • Do we need to talk to 'significant others'?
    Serena McCluskey
    Published on: 18 November 2013
  • Author response: Dr Scott Helmers
    Ben Darlow
    Published on: 17 November 2013
  • What we say may be just as important as what we do
    Peter B O'Sullivan
    Published on: 17 November 2013
  • Illuminating article
    Scott R. Helmers
    Published on: 14 November 2013
  • Published on: (20 November 2013)
    Page navigation anchor for Listening to the patient's interpretation
    Listening to the patient's interpretation
    • Andrew Claus, Lecturer

    Thank you to Ben and colleagues, and to the Annals of Family Medicine for this study.

    Questionnaires have previously informed us that health professionals with high fear-avoidance beliefs will give matching advice to patients with low back pain (Coudevre et al. 2006), and that there is an association between health professionals and patient fear-avoidance beliefs (Poiraudeau et al. 2006). But this seems to be t...

    Show More

    Thank you to Ben and colleagues, and to the Annals of Family Medicine for this study.

    Questionnaires have previously informed us that health professionals with high fear-avoidance beliefs will give matching advice to patients with low back pain (Coudevre et al. 2006), and that there is an association between health professionals and patient fear-avoidance beliefs (Poiraudeau et al. 2006). But this seems to be the first study to interpret causality of patient understanding and behaviour from the patient's perspective, via semi-structured interview. Research methods modelling behavioural change for clinicians, listening to and observing the patient after interventions.

    In addition to being a useful stimulus for clinicians to reflect on the impact (rather than just the intention) of what they communicate, this study may also be a great stimulus for dialogue between clinicians and between educators in health professions. Evidence supporting the need for empathy. It will be important to facilitate this quality of care with our students.

    As mentioned in Peter O'Sullivan's comment about a study with Indigenous Australian participants, I look forward to more studies of this type; evaluating the impact of health-professional communication about low back pain in communities and cohorts across the globe.

    Competing interests: ?? None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (19 November 2013)
    Page navigation anchor for Author response: Dr Serena McCluskey
    Author response: Dr Serena McCluskey
    • Ben Darlow, Physiotherapist and researcher

    Dr McCluskey's letter highlights another important factor. Beliefs held by those who experience back pain and their 'significant others' may well be mutually reinforcing, so what is said to significant others by health professionals should certainly be considered. Significant others could indeed be a valuable resource to support optimal functioning and reinforce helpful beliefs and behaviours.[1]

    McCluskey et a...

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    Dr McCluskey's letter highlights another important factor. Beliefs held by those who experience back pain and their 'significant others' may well be mutually reinforcing, so what is said to significant others by health professionals should certainly be considered. Significant others could indeed be a valuable resource to support optimal functioning and reinforce helpful beliefs and behaviours.[1]

    McCluskey et al.[2] found that significant others' beliefs were influenced by their own experience of chronic illness; this may indicate that the impact of what clinicians say is not limited to the person they say it to.

    1. Brooks J, McCluskey S, King N, Burton K. Illness perceptions in the context of differing work participation outcomes: exploring the influence of significant others in persistent back pain. BMC Musculoskelet Disord. 2013;14:48.

    2. McCluskey S, Brooks J, King N, Burton K. The influence of 'significant others' on persistent back pain and work participation: a qualitative exploration of illness perceptions. BMC Musculoskelet Disord. 2011;12:236.

    Competing interests: Author on paper being discussed

    Show Less
    Competing Interests: None declared.
  • Published on: (18 November 2013)
    Page navigation anchor for Author response: Dr Peter O'Sullivan
    Author response: Dr Peter O'Sullivan
    • Ben Darlow, Physiotherapist and researcher

    Thank you for your thoughts. I too was impressed by the similarities between our findings, and those of Lin et al.(1) It is striking that these studies, conducted entirely independently of each other, amongst very different populations, and with different qualitative methodologies, have arrived at similar conclusions.

    1. Lin IB, O'Sullivan PB, Coffin JA, Mak DB, Toussaint S, Straker LM. Disabling chronic low back...

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    Thank you for your thoughts. I too was impressed by the similarities between our findings, and those of Lin et al.(1) It is striking that these studies, conducted entirely independently of each other, amongst very different populations, and with different qualitative methodologies, have arrived at similar conclusions.

    1. Lin IB, O'Sullivan PB, Coffin JA, Mak DB, Toussaint S, Straker LM. Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians. BMJ Open. 2013;3(4).

    Competing interests: Author on paper being discussed

    Show Less
    Competing Interests: None declared.
  • Published on: (18 November 2013)
    Page navigation anchor for Do we need to talk to 'significant others'?
    Do we need to talk to 'significant others'?
    • Serena McCluskey, Senior Research Fellow

    The published article adds weight to the growing body of evidence which highlights the importance of communication in low back pain treatment, providing a valuable insight into how such communication could act as an obstacle to recovery. The article also highlights the possible influence of family and friends, or 'significant others', in this communication process. Recent research investigating the influence of signific...

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    The published article adds weight to the growing body of evidence which highlights the importance of communication in low back pain treatment, providing a valuable insight into how such communication could act as an obstacle to recovery. The article also highlights the possible influence of family and friends, or 'significant others', in this communication process. Recent research investigating the influence of significant others on recovery and return to work for individuals with persistent low back pain has shown they have similar, and in some cases even stronger beliefs than patients, possibly reinforcing unhelpful treatment expectations and continued care-seeking behaviour 1, 2, 3. It has been documented that significant others shoulder the burden of care for individuals with persistent low back pain and are key to their recovery 4. Therefore, it may be equally important to think about what is also said to the significant others of low back pain patients.

    References

    1. McCluskey, S., Brooks, J., King, N. & Burton, K. (2011). The influence of 'significant others' on persistent back pain and work participation: a qualitative study of illness perceptions. BMC Musculoskeletal Disorders, 12, 236.

    2. Brooks, J., McCluskey, S., King, N. & Burton, K. (2013). Illness perceptions in the context of differing work participation outcomes: exploring the influence of significant others in persistent back pain. BMC Musculoskeletal Disorders, 14, 48.

    3. McCluskey, S., Brooks, J., King, N. & Burton, K. (2014). Are the treatment expectations of 'significant others' psychosocial obstacles to work participation for individuals with persistent low back pain? WORK: A Journal of Prevention, Assessment & Rehabilitation - Special Issue on Work & Disability (in press).

    4. Miller J, Timson D. (2004). Exploring the experiences of partners who live with a chronic back pain sufferer. Health and Social Care in the Community, 12, 34-42.

    Competing interests: ?? None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (17 November 2013)
    Page navigation anchor for Author response: Dr Scott Helmers
    Author response: Dr Scott Helmers
    • Ben Darlow, Researcher and Physiotherapist

    Thank you for feedback. This research certainly caused me to re-evaluate my own clinical practice. It is very rewarding to hear that our work is being found helpful by others involved in the delivery of clinical care.

    Competing interests: Author of paper being discussed

    Competing Interests: None declared.
  • Published on: (17 November 2013)
    Page navigation anchor for What we say may be just as important as what we do
    What we say may be just as important as what we do
    • Peter B O'Sullivan, Physiotherapist

    I congratulate the authors on this important paper. These findings presented mirror those of another recent paper in Aboriginal Australians (bmjopen.bmj.com/content/3/4/e002654.full?), that supports 'the things we say' as health care practitioners may have a powerful and enduring impact on people with low back pain. As a clinician i am confronted daily with people suffering with persistent spinal pain, who have been negat...

    Show More

    I congratulate the authors on this important paper. These findings presented mirror those of another recent paper in Aboriginal Australians (bmjopen.bmj.com/content/3/4/e002654.full?), that supports 'the things we say' as health care practitioners may have a powerful and enduring impact on people with low back pain. As a clinician i am confronted daily with people suffering with persistent spinal pain, who have been negatively impacted by the belief that their 'worn out discs' or 'lack of core stability' is the cause of their pain, leaving them fearful, protective and disabled. Ironically as this paper highlights, research does not support that degenerate discs are predictive of future back pain, and in fact to the converse, too much trunk stability is a risk factor for future back pain. This paper is a great challenge to us as health care professionals to examine our own back pain beliefs and how we communicate them - and provide a hopeful, reassuring and evidence based narrative to our patients with low back pain.

    Competing interests: ?? None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (14 November 2013)
    Page navigation anchor for Illuminating article
    Illuminating article
    • Scott R. Helmers, clinician MD

    I have read many articles and discussions of low back pain, but this one is perhaps the most helpful I have seen for a long time. I will really try to change how I interact with a back pain patient to ask his or her understanding, fears, and needs. Similarly, I see how important are my phrases and encouragements.

    Competing interests: ?? None declared

    Competing Interests: None declared.
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The Annals of Family Medicine: 11 (6)
The Annals of Family Medicine: 11 (6)
Vol. 11, Issue 6
November/December 2013
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The Enduring Impact of What Clinicians Say to People With Low Back Pain
Ben Darlow, Anthony Dowell, G. David Baxter, Fiona Mathieson, Meredith Perry, Sarah Dean
The Annals of Family Medicine Nov 2013, 11 (6) 527-534; DOI: 10.1370/afm.1518

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The Enduring Impact of What Clinicians Say to People With Low Back Pain
Ben Darlow, Anthony Dowell, G. David Baxter, Fiona Mathieson, Meredith Perry, Sarah Dean
The Annals of Family Medicine Nov 2013, 11 (6) 527-534; DOI: 10.1370/afm.1518
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Subjects

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