TY - JOUR
T1 - Reassuring Patients with Low Back Pain in Primary Care Consultations
T2 - Does it Happen, and Does it Matter? A ChiCo Cohort Study
AU - Simonsen, Gitte D.
AU - Jensen, Tue S.
AU - Kongsted, Alice
N1 - Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2021/8
Y1 - 2021/8
N2 - Objectives: Reassurance is an important part of treatment for low back pain (LBP). The Consultation-based Reassurance Questionnaire measures patients' perceived reassurance after health care consultations on 4 subdomains (ie, Data-gathering, Relationship-building, Generic reassurance, Cognitive reassurance). The objectives of this study were to investigate associations between the level of reassurance and outcomes and to investigate if the associations were moderated by patients' risk profile. Materials and Methods: Adult patients consulting chiropractors for LBP were emailed the Consultation-based Reassurance Questionnaire directly after the consultation. Outcomes were Global Perceived Effect (GPE) after 2 weeks, and pain (Numeric Rating Scale) and disability (Roland-Morris Disability Questionnaire) 2 weeks and 3 months following treatment. Associations with GPE were tested in logistic mixed models. Associations between each reassurance domain and pain and disability were tested in longitudinal analyses using linear mixed models. Moderations by risk profile were tested by introducing an interaction between risk groups and reassurance level. All models were controlled for several potential confounders. Results: A total of 2056 patients were included in the study, with 46% reporting LBP for less than a week. Associations between reassurance level and improvement in LBP intensity and disability were weak but positive, whereas associations with GPE were potentially clinically relevant. None of the associations were moderated by psychological risk profile. Discussion: Identified associations between reassurance and outcomes were weak, however, for GPE the association might be of a clinically relevant magnitude. The causal relationship is unclear, but with communication always present in a consultation these results suggest that efforts to optimize clinician-patient communication might be worthwhile, also for people with very recent onset of LBP.
AB - Objectives: Reassurance is an important part of treatment for low back pain (LBP). The Consultation-based Reassurance Questionnaire measures patients' perceived reassurance after health care consultations on 4 subdomains (ie, Data-gathering, Relationship-building, Generic reassurance, Cognitive reassurance). The objectives of this study were to investigate associations between the level of reassurance and outcomes and to investigate if the associations were moderated by patients' risk profile. Materials and Methods: Adult patients consulting chiropractors for LBP were emailed the Consultation-based Reassurance Questionnaire directly after the consultation. Outcomes were Global Perceived Effect (GPE) after 2 weeks, and pain (Numeric Rating Scale) and disability (Roland-Morris Disability Questionnaire) 2 weeks and 3 months following treatment. Associations with GPE were tested in logistic mixed models. Associations between each reassurance domain and pain and disability were tested in longitudinal analyses using linear mixed models. Moderations by risk profile were tested by introducing an interaction between risk groups and reassurance level. All models were controlled for several potential confounders. Results: A total of 2056 patients were included in the study, with 46% reporting LBP for less than a week. Associations between reassurance level and improvement in LBP intensity and disability were weak but positive, whereas associations with GPE were potentially clinically relevant. None of the associations were moderated by psychological risk profile. Discussion: Identified associations between reassurance and outcomes were weak, however, for GPE the association might be of a clinically relevant magnitude. The causal relationship is unclear, but with communication always present in a consultation these results suggest that efforts to optimize clinician-patient communication might be worthwhile, also for people with very recent onset of LBP.
KW - back pain
KW - primary care
KW - psychological risk
KW - reassurance
KW - Disability Evaluation
KW - Low Back Pain/therapy
KW - Humans
KW - Adult
KW - Surveys and Questionnaires
KW - Primary Health Care
KW - Referral and Consultation
KW - Cohort Studies
UR - http://www.scopus.com/inward/record.url?scp=85109938103&partnerID=8YFLogxK
U2 - 10.1097/AJP.0000000000000946
DO - 10.1097/AJP.0000000000000946
M3 - Journal article
C2 - 34010222
AN - SCOPUS:85109938103
SN - 0749-8047
VL - 37
SP - 598
EP - 606
JO - Clinical Journal of Pain
JF - Clinical Journal of Pain
IS - 8
ER -