Article Figures & Data
Figures
- Figure 1
Thematic framework.
- Figure 2
Health care professionals’ influence on participants.
Tables
Account of their back pain, including how and why the back pain came about The meaning of the pain Premorbid ideas or beliefs about back pain and how these have changed Anything that concerns them about back pain Who they have discussed their back pain with and whom they trust Other places they have looked for information Any health care professionals they have consulted Any investigations they have received Things that have helped or are helping them manage their pain Their own thoughts about the best way to manage low back pain Their thoughts about statements from the New Zealand Acute Low Back Pain Guide Their thoughts about why people may be scared of moving during an episode of low back pain Their thoughts about why people may worry about the consequences of low back pain Anything they think may have helped them manage their low back pain more effectively Nonphysical influences on their pain How much they focus on their back pain Their expectations for the future with regards to their back The meaning of terms for low back pain commonly used by health care professionals Any additional thoughts or information they considered relevant Participant Code, Sex Age y Occupation Pain Duration d Clinical Consultation This Episode Previous Consultation for Low Back Pain RMDQa TSKb ALBP01, female 18 Student 5 No No 1 43 ALBP02, female 29 Administrator 2 No Physiotherapist 19 41 ALBP03, male 50 Student 14 Physiotherapist No 16 44 ALBP04, male 45 Solicitor 30 Osteopath Osteopath 10 36 ALBP05, female 19 Student 5 No Chiropractor 12 42 ALBP06, female 55 Doctor 41 Family doctor, emergency department No 4 34 ALBP07, female 24 Research assistant 30 Family doctor, physiotherapist, massage therapist Family doctor, physiotherapist 14 41 ALBP08, female 36 Early childhood teacher 5 Family doctor No 5 43 ALBP09, male 25 Orange juice production 3 Family doctor No 14 44 ALBP10, male 44 Clinical psychologist, lecturer 20 Family doctor, physiotherapist, occupational health nurse Family doctor, physiotherapist 1 25 ALBP11, male 37 Baker 4 Emergency department Family doctor, Chinese medicine practitioner 12 43 ALBP12, female 52 Administrator 4 No Family doctor, physiotherapist, chiropractor 16 47 Mean (SD) 36.2 (13.1) 13.6 (13.4) 10.3 (6.1) 40.3 (6.0) -
ALBP = acute low back pain participant; RMDQ = Roland Morris Disability Questionnaire; TSK = Tampa Scale of Kinesiophobia.
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↵a Scored on a range from 0 to 24, with higher scores indicating greater disability.
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↵b Scored on a range from 17 to 68, with higher scores indicating greater levels of fear avoidance beliefs.
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Participant Code, Sex Age y Occupation Pain Duration y Clinical Consultation RMDQa TSKb CLBP01, male 45 Doctor 30 Family doctor, physiotherapist, rheumatologist 10 24 CLBP02, female 65 Administration manager 16 Family doctor, physiotherapist, osteopath, acupuncturist, orthopedic surgeon, clinical psychologist, Chinese medicine practitioner 6 25 CLBP03 female 52 Librarian 31 Family doctor, physiotherapist, orthopedic surgeon 15 57 CLBP04, female 39 Writer, editor 20 Family doctor, physiotherapist, osteopath, chiropractor, acupuncturist, orthopedic surgeon, Feldenkrais practitioner, massage therapist 7 36 CLBP05, female 32 Performing arts teacher, performer 8 Physiotherapist, acupuncturist, sports physician 4 37 CLBP06, male 37 Builder, student 15 Family doctor, physiotherapist, osteopath, chiropractor, orthopedic surgeon 13 34 CLBP07, female 48 Quality improvement coordinator 4 Physiotherapist, orthopedic surgeon 20 48 CLBP08, female 25 Student 5 Family doctor, physiotherapist, osteopath, chiropractor, acupuncturist, orthopedic surgeon, craniosacral therapist, reflexologist, spiritual healer 4 27 CLBP09, male 67 Retired 30 Physiotherapist, chiropractor, acupuncturist 22 49 CLBP10, male 60 Information technology manager 20 Family doctor 10 41 CLBP11, female 32 Sickness beneficiary 9 Family doctor, physiotherapist, osteopath, chiropractor, orthopedic surgeon, clinical psychologist, Chinese medicine practitioner, multidisciplinary pain clinic 12 40 Mean (SD) 45.6 (14.1) 17.1 (10.1) 11.2 (6.0) 38.0 (10.5) -
CLBP = chronic low back pain participant; RMDQ = Roland Morris Disability Questionnaire; TSK = Tampa Scale of Kinesiophobia.
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↵a Scored on a range from 0 to 24, with higher scores indicating greater disability.
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↵b Scored on a range from 17 to 68, with higher scores indicating greater levels of fear avoidance beliefs.
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The Article in Brief
The Enduring Impact of What We Say to People With Low Back Pain
Ben Darlow , and colleagues
Background Psychosocial factors are important in the development of low back pain and disability. Depression, passive coping strategies, fear avoidance, and expectations of low recovery are associated with poor low back pain outcomes. This study explores the formation and impact of attitudes and beliefs among people with low back pain.
What This Study Found Although patients with low back pain consult the Internet, family, and friends for information and understanding of their symptoms, health care professionals appear to have the strongest influence on patients' attitudes and beliefs, with messages to "protect the back" having long-term negative effects, and messages of reassurance and encouragement of activity having long-term positive effects. Through interviews with 23 patients with acute or chronic low back pain, researchers found information and advice from health care professionals had the most significant and enduring influence on patients' attitudes, with such information often affecting their beliefs for many years. Notably, messages from clinicians that were interpreted as meaning the back and spine are vulnerable and needed to be protected resulted in increased vigilance, worry, frustration, and guilt for patients.
Implications
- These findings, the authors suggest, paint a discouraging picture of the role clinicians unwittingly play in the management of low back pain. They call on clinicians to provide reassurance to patients in an effort to increase confidence and offer clear advice that will empower patients and positively influence their approach to movement and activity.
Supplemental Appendix
Supplemental Appendix. Boxes 1 Through 6: Quotations
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 6 pages, 187KB
Annals Journal Club
Nov/Dec 2013: Interacting With Patients
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Articles for Discussion
- Loxterkamp D. What do you expect from a doctor? Six habits for healthier patient encounters. Ann Fam Med. 2013;11(6):574-576.
- Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S. The enduring impact of what we say to people with low back pain. Ann Fam Med. 2013;11(6):527-534.
Discussion Tips
This Annals Journal Club provides an opportunity to reflect on a thoughtful essay by an experienced family physician (Loxterkamp), to consider its application to your own practice, and to interpret a research study in this issue.
Discussion Questions
- What problem is addressed by Loxterkamp's essay?
- How does the author engage your interest?
- What are the essay's sources of credibility?
- How does the story set up the 6 habits? How does it make them real or make you question them?
- What is your experience with the habits of identity, listening, touching, looking, planning, and follow-up?
- Are there other habits that you believe should be added to or removed from the list?
- How comparable is the author's experience to your practice setting and personal experience? Does your experience resonate or conflict with his understanding? What is your judgment about the transportability of the insights?
- How might this essay change your practice? How might it change policy, education, or research?
- Who are the constituencies for Loxterkamp's essay? How they might be engaged in interpreting or using the findings?
- How do the 6 habits provide context for your interpretation or application of the findings from the study by Darlow et al of the impact of what we say to people with low back pain?
- What are the next steps in interpreting or applying the findings of Darlow et al?
- What evaluable questions remain?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197.
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- Interacting With Patients