Research ArticleOriginal Research

Patient Satisfaction With Medical Care for Chronic Low Back Pain: A Pain Research Registry Study

John C. Licciardone, Salman Patel, Prathima Kandukuri, George Beeton, Ramyashree Nyalakonda and Subhash Aryal
The Annals of Family Medicine March 2023, 21 (2) 125-131; DOI: https://doi.org/10.1370/afm.2949

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Flow of participants.

    PRECISION = Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation.

    Note: Participants were not required to have a physician who treated their low back pain when the registry was established in 2016, and data on the patient-physician relationship were not routinely collected until later that year.

Tables

  • Table 1.

    Participant Characteristics at Registry Enrollment

    CharacteristicOverall Sample
    (N = 1,352)    		Long-Term Medical Care Subgroup
    (n = 355)
    Age y, mean (SD)      53.3 (13.1)      56.3 (11.8)
    Gender, No. (%)
      Female1,009 (74.6)255 (71.8)
      Male    343 (25.4)100 (28.2)
    Race, No. (%)
      American Indian/Alaska Native   19 (1.4)  5 (1.4)
      Asian   20 (1.5)  4 (1.1)
      Black   232 (17.2)  45 (12.7)
      Native Hawaiian/Pacific Islander     4 (0.3)  1 (0.3)
      White1,077 (79.7)300 (84.5)
    Medical comorbidities, No. (%)
      Herniated disc   536 (39.6)163 (45.9)
      Sciatica   676 (50.0)204 (57.5)
      Osteoarthritis   622 (46.0)189 (53.2)
      Osteoporosis   189 (14.0)  59 (16.6)
      Hypertension   591 (43.7)183 (51.5)
      Heart disease   149 (11.0)  50 (14.1)
      Diabetes mellitus   261 (19.3)  75 (21.1)
      Asthma   359 (26.6)  96 (27.0)
      Depression   778 (57.5)208 (58.6)
    Process for delivering medical care for chronic low back pain, mean (SD)
      Physician communication (overall CBQ score)         66.3 (22.4)      71.1 (22.3)
      Physician empathy (overall CARE score)         70.9 (29.1)      74.3 (29.4)
    Current physician prescribing of opioids for low back pain, No. (%)
      Yes   445 (32.9)135 (38.0)
      No   907 (67.1)220 (62.0)
    Outcomes of medical care for chronic low back pain, mean (SD)
      Pain intensity (NRS score)       6.1 (1.8)      6.0 (1.9)
      Back-related disability (RMDQ score)    14.5 (5.7)    14.6 (5.7)
      Health-related quality-of-life deficits (SPADE cluster score)    58.0 (6.9)    58.0 (7.2)
      Patient satisfaction with medical care for chronic low back pain (PSQ-18 score)     62.6 (28.1)    65.1 (28.5)

    • CARE = Consultation and Relational Empathy measure; CBQ = Communication Behavior Questionnaire; NRS = numerical rating scale for low back pain intensity; PSQ-18 = Patient Satisfaction Questionnaire Short-Form (18 items); RMDQ = Roland-Morris Disability Questionnaire; SPADE = sleep disturbance, pain interference with activities, anxiety, depression, low energy or fatigue.

    • Note: Higher scores represent better physician communication, greater physician empathy, and greater patient satisfaction on the CBQ, CARE, and PSQ-18, respectively, whereas higher scores represent worse outcomes on the NRS for pain intensity, RMDQ for back-related disability, and SPADE cluster for health-related quality-of-life deficits.

  • Table 2.

    Factors Associated With Patient Satisfaction With Medical Care for Chronic Low Back Pain (N = 1,352)

    FactorUnivariable AnalysisMultivariable Analysis
    Standardized β (95% Cl)tP ValueStandardized β (95% Cl)tP Value
    Age, y  0.095 (0.042 to 0.148)  3.50<.001  0.054 (0.018 to 0.090)  2.97  .003
    Female (vs male)−0.001 (−0.054 to 0.052)−0.03  .97  0.001 (−0.031 to 0.033)  0.05  .96
    Racial minority group (vs White)  0.042 (−0.011 to 0.096)  1.56  .12  0.019 (−0.015 to 0.052)  1.08  .28
    No. of medical comorbidities−0.029 (−0.082 to 0.025)−1.06  .29−0.019 (−0.058 to 0.019)−1.00  .32
    Physician communication (overall CBQ score)  0.671 (0.632 to 0.711)33.26<.001  0.182 (0.133 to 0.232)  7.22<.001
    Physician empathy (overall CARE score)  0.789 (0.756 to 0.822)47.18<.001  0.638 (0.588 to 0.688)25.14<.001
    Current physician prescribing of opioids for low back pain  0.046 (−0.007 to 0.100)  1.70  .09−0.003 (−0.037 to 0.032)−0.15  .88
    Low back pain intensity (NRS score)−0.043 (−0.096 to 0.011)−1.57  .12  0.036 (−0.001 to 0.074)  1.91  .06
    Back-related disability (RMDQ score)−0.129 (−0.182 to −0.076)−4.78<.001−0.022 (−0.067 to 0.024)−0.94  .35
    Health-related quality-of-life deficits (SPADE cluster score)−0.188 (−0.241 to −0.136)−7.05<.001−0.054 (−0.098 to −0.010)−2.41  .02

    • CARE = Consultation and Relational Empathy measure; CBQ = Communication Behavior Questionnaire; NRS = numerical rating scale for low back pain intensity; PSQ-18 = Patient Satisfaction Questionnaire Short-Form (18 items); RMDQ = Roland-Morris Disability Questionnaire; SPADE = sleep disturbance, pain interference with activities, anxiety, depression, low energy or fatigue.

    • Note: Results are based on linear regression models with the table factors as independent variables and the general satisfaction score on the PSQ-18 as the dependent variable. All factors listed in the table were used to compute the adjusted results in the multivariable analysis. Positive and negative standardized β coefficients are associated with increased and decreased patient satisfaction scores, respectively.

  • Table 3.

    Factors Associated With Patient Satisfaction With Medical Care for Chronic Low Back Pain in the Long-Term Medical Care Subgroup (n = 355)

    FactorUnivariable AnalysisMultivariable Analysis
    Standardized β (95% Cl)tP ValueStandardized β (95% Cl)tP Value
    Age, y  0.102 (−0.002 to 0.206)  1.93  .05  0.055 (−0.012 to 0.122)  1.63  .10
    Female (vs male)  0.054 (−0.051 to 0.158)  1.01  .31  0.042 (−0.015 to 0.100)  1.45  .15
    Racial minority group (vs White)  0.081 (−0.023 to 0.185)  1.52  .13  0.095 (0.034 to 0.155)  3.09  .002
    No. of medical comorbidities−0.004 (−0.109 to 0.101)−0.08  .94−0.002 (−0.072 to 0.068)−0.06  .96
    Physician communication (overall CBQ score)  0.751 (0.682 to 0.820)21.37<.001  0.208 (0.105 to 0.311)  3.96<.001
    Physician empathy (overall CARE score)  0.826 (0.767 to 0.885)27.56<.001  0.633 (0.529 to 0.737)11.95<.001
    Current physician prescribing of opioids for low back pain  0.110 (0.006 to 0.214)  2.08  .04  0.009 (−0.051 to 0.069)  0.29  .77
    Low back pain intensity (NRS score)−0.077 (−0.181 to 0.027)−1.45  .15−0.018 (−0.085 to 0.049)−0.53  .60
    Back-related disability (RMDQ score)−0.142 (−0.245 to −0.038)−2.69  .008  0.016 (−0.068 to 0.100)  0.37  .72
    Health-related quality-of-life deficits (SPADE cluster score)−0.238 (−0.340 to −0.136)−4.61<.001−0.085 (−0.168 to −0.001)−2.00  .05

    • CARE = Consultation and Relational Empathy measure; CBQ = Communication Behavior Questionnaire; NRS = numerical rating scale for low back pain intensity; PSQ-18 = Patient Satisfaction Questionnaire Short-Form (18 items); RMDQ = Roland-Morris Disability Questionnaire; SPADE = sleep disturbance, pain interference with activities, anxiety, depression, low energy or fatigue.

    • Note: Results are based on linear regression models with the table factors as independent variables and the general satisfaction score on the PSQ-18 as the dependent variable. All factors listed in the table were used to compute the adjusted results in the multivariable analysis. Positive and negative standardized β coefficients are associated with increased and decreased patient satisfaction scores, respectively.

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