Concordance of Patient Expectations Regarding Guideline Recommendations for Management of Psychosocial Factors in Low Back Pain: A Cross-sectional Study.

BACKGROUND: Guidelines for low back pain (LBP) management recommend addressing psychosocial risk factors such as stress and depression, which have been shown to play a prognostic role in nonspecific LBP. LBP management has been found to diverge from published recommendations. The reasons why remain unclear and may be related to patient views and expectations regarding the causes and treatment of LBP. OBJECTIVES: We examined the degree to which patient views regarding psychosocial factors coincided with core recommendations and statements of the German national guideline for nonspecific LBP, as well as factors affecting those views. STUDY DESIGN: Cross-sectional study. SETTING: Data were gathered from June 2018 through September 2018 in 13 general practices in Mecklenburg-Wets Pomerania, Germany. METHODS: Practice staff approached all patients entering the practice, regardless of the reason for consultation, during 3 consecutive days and offered study participation. After providing informed consent, patients received a questionnaire to complete prior to consultation. Nonresponse bias was addressed by using inverse probability weights. Descriptive analysis and multivariate logistic regression models were performed. RESULTS: A total of 977 patient questionnaires were included in the analysis. One-third to one-half of the patients disagreed and one-third agreed that psychological problems and their treatment play a role in LBP management. A significant proportion (13-25%) was undecided. However, relaxation techniques were well accepted. Patients with higher education levels, poorer health status, and more severe LBP but no pain medication in the last 12 months were more likely to expect psychosocial diagnostics and treatment and regarded relaxation techniques as potentially helpful. More severe pain and lower levels of education were associated with disagreement with guideline recommendations and statements regarding management of psychosocial factors. LIMITATIONS: Recall bias is possible, as patients were asked to recall their LBP history. However, we limited the recall time to the last 12 months. Data on income, employment status and co-morbidities were not collected and may have affected the responses. However, educational status, health status, and age were collected. CONCLUSION: A significant portion of patients did not agree that psychosocial aspects should be addressed in LBP. Pain severity, health status, level of education, and previous treatment experience appear to affect patient views. These results highlight the importance of careful patient counseling regarding psychosocial factors and screening for psychosocial problems in LBP, when indicated. Additionally, educational initiatives may help bring patient expectations into agreement with recommendations.

Concordance of patient beliefs and expectations regarding the management of low back pain with guideline recommendations - a cross-sectional study in Germany.

BACKGROUND: Low back pain is a common reason for patients to seek medical care. Physician non-adherence to clinical guidelines has been observed. We investigated the extent to which patient expectations correspond to recommendations of the German national guideline for management of low back pain (G-LBP) and whether patient characteristics, history of LBP and previous treatment experience are associated with expectations. METHODS: A cross-sectional study including patients from 13 general practices was conducted. Data were collected using a questionnaire. Inverse probability weights were used to address non-response bias. Descriptive analysis and multivariate logistic regression models were performed. RESULTS: A total of 977 patients were included in analyses (median age 57 years, 39% male). 75% of patients reported experiencing LBP currently or within the last year. More than 65% indicated they would agree to forgo further examinations if their LBP was judged by their physician to be of no serious concern. This was associated with the highest level of education and no prior imaging, and negatively associated with good-to-poor health status and moderate-to-severe pain intensity. 40% of participants expected imaging. The highest educational level, female gender and no prior imaging were associated with a decreased expectation of imaging. 70% expected prescriptions for massages. Females, participants with good-to-poor health status, current LBP or LBP in the last 12 months had an increased expectation for massages. Expectations for injection therapy (45%) were mainly associated with previous injections. Expectations for physiotherapy (64%) were associated with female gender, lower educational level, good-to-poor health status, current LBP or in the last 12 months. The perspective that daily activities should be continued (66%) was associated with female gender and higher educational level. Participants who agreed to the statement 'There is no effective treatment for LBP' (11%) had a poor health status, current LBP and a severe pain intensity. CONCLUSION: Patient views regarding LBP management are partially concordant with guideline recommendations and are strongly influenced by previous treatment experiences and education level. Exploration of patient expectations and experiences in LBP treatment may help minimize dissatisfaction of patients expecting treatments not endorsed by guidelines and simultaneously increase physician guideline adherence.