Clinician Experiences in Providing Reassurance for Patients with Low Back Pain in Primary Care: a Qualitative Study

Questions:   What reassurance is being delivered by physiotherapists and chiropractors to people with non-specific low back pain? How is it being delivered? What are the barriers and enablers to delivering reassurance to people with non-specific low back pain?

Design:   A qualitative study.

Participants:   Thirty-two musculoskeletal clinicians (16 physiotherapists and 16 chiropractors) who manage low back pain in primary care.

Method:   Semi-structured interviews were conducted about their experiences delivering reassurance. The interview schedule was developed using the Theoretical Domains Framework and analysed using framework thematic analysis.

Results:   Four themes were identified: giving reassurance is a core clinical skill for delivering high-quality care; it takes practice and experience to confidently deliver reassurance; despite feeling capable and motivated, clinicians identified situations that challenge the delivery of reassurance; and reassurance needs to be contextualised to the individual.

Conclusion:   Clinicians possess a strong understanding of reassurance but require clinical experience to confidently deliver it. This study provides insights into how reassurance is individualised in clinical practice, including suggestions for clinicians about how to implement reassurance effectively for people with low back pain.

Keywords:   Low back pain; Primary healthcare; Qualitative research; Reassurance.

From the FULL TEXT Article:

Introduction

Low back pain (LBP) is common and is associated with substantial disability. Worldwide, 619 million people experienced back pain in 2020, [1] and there are significant personal and societal costs related to LBP. [2, 3] In Australia, back pain continues to be the second leading cause of disability [4] and back pain management cost AU$3.36 billion in 2020. [4] The prevalence of LBP has been projected to increase over the next 25 years, with associated increases in disability with healthcare costs. [1] Most LBP is non-specific low back pain (NSLBP), referring to LBP that does not have a known pathoanatomical cause. [5] LBP is a complex condition that is multifactorial in nature, where a person’s pain experience is influenced by biological, psychological and social factors. [6] Recovery from an episode of LBP is also complex; approximately 25% of people with LBP experience recurrence within 12 months [7] and 44% of people can still experience pain at 12 months. [8]

There are more articles like this @

LOW BACK PAIN Section

Clinical Practice Guidelines consistently recommend that people with NSLBP of any duration (acute, sub-acute and chronic) receive reassurance as a component of their care and not in isolation. [9, 10] Reassurance is the act of reducing fear, worry or concern. [11] In a clinical context, reassurance may include a combination of clinician behaviours. The term ‘affective reassurance’ refers to creating rapport and showing empathy. The term ‘cognitive reassurance’ refers to the provision of reassuring information. A systematic review of observational studies found that cognitive reassurance was associated with better outcomes but the impact of affective reassurance was uncertain. [12] Reassuring information recommended in clinical practice guidelines for NSLBP relates, where appropriate, to the absence of serious pathology, the likelihood of a favourable prognosis and the safety of movement. [10, 13] A systematic review found that providing patient reassurance is important because it decreases healthcare utilisation and costs, and leads to improved patient outcomes. [12] Despite identified benefits, there is a disparity between guideline recommendations and use in clinical practice. In primary care settings, such as general practice, physiotherapy and chiropractic, clinicians have reported not offering reassurance in the form of information about prognosis in approximately 25% of first-time consultations for LBP. [14]

Considering that not all people with LBP receive reassuring information, there appear to be complexities when implementing this recommendation into clinical practice. These complexities may be due to guidelines providing limited detail about how best to deliver reassurance, [14] or that there are circumstances that make it more challenging for clinicians to engage in this behaviour. To gain a deeper understanding of the factors that influence clinicians in delivering reassurance, this study sought insights from clinicians to assist in implementing guideline-recommended reassurance for people with NSLBP. A qualitative study allows for the gathering of in-depth and context-rich information on reassurance use. The only available qualitative study exploring reassurance for managing LBP is from a patient perspective in UK general practice. [15] That study highlighted the importance of providing information and advice, but the role of affective reassurance (eg, empathy and relationship building) was less clear.

It is believed that this study is the first qualitative investigation of the use of reassurance in two other primary contact professional groups, physiotherapists and chiropractors, who commonly manage people with NSLBP. [16] This study aimed to explore the experiences of physiotherapists and chiropractors in delivering reassurance to people with NSLBP in clinical practice.

Therefore, the research questions for this qualitative study were:

1. What reassurance is being delivered by physiotherapists and chiropractors to patients with NSLBP?

2. How is it being delivered?

3. What are the barriers to and enablers of delivering reassurance to people with NSLBP?

Read the rest of this Full Text article now!