Understanding patients’ perceptions of uncomplicated low back pain: a theory-informed qualitative study using the Common-Sense Self-Regulation Model
Notice bibliographique
Résumé
BACKGROUND: Uncomplicated low-back pain (LBP), referring to LBP without symptoms that suggest an underlying medical or surgical cause, is a common and challenging problem for patients and primary healthcare providers. Multiple guidelines discourage the use of diagnostic imaging for uncomplicated LBP due to cost and lack of benefit; despite this, diagnostic imaging remains overused in this condition. Study of primary healthcare providers suggests that patient expectations contribute to imaging for uncomplicated LBP. Dedicated study of patient understanding and experiences of uncomplicated LBP is necessary to design interventions to reduce unnecessary diagnostic imaging. METHODS: In this theory-guided qualitative study, people with uncomplicated LBP were recruited for a semi-structured interview. The Common Sense - Self-Regulation Model (CS-SRM), a framework that explores the relationship between a patient's perceptions, beliefs, and behaviors around their illness and the outcome of their illness, was selected to direct development of the interview guide and analysis. Higher-level themes were created to list patient-related drivers of unnecessary diagnostic imaging for uncomplicated LBP. RESULTS: Thirteen participants (7 female) had experienced uncomplicated LBP for a median of 5 years (IQR 2-20 years; range 1 to 30 years). Framework analysis based on the CS-SRM suggested that most participants understood their uncomplicated LBP as a permanent part of their lives, though some felt that the pain could be controlled or prevented. Participants shared a range of coping mechanisms, including social support, medication, and exercises. For most participants, uncomplicated LBP negatively affected their lives emotional wellbeing characterized by a sense of loss from missing life events due to pain. Nearly all participants had visited their primary care physician (n = 11) and most underwent diagnostic imaging (n = 8); however, participants generally reported that they had not requested diagnostic imaging (n = 8). Several participants reported that they wanted validation and symptom-management advice from their physician rather than diagnostic tests. CONCLUSIONS: In contrast to other studies, we report that most patients with uncomplicated LBP in our setting did not request diagnostic imaging. Patient-facing interventions to address unnecessary diagnostic imaging for uncomplicated LBP may be more effective if they address illness conceptions identified in this study; for example, interventions should convey empathy by acknowledging patient worries, validating suffering, describing potential causes or triggers, addressing self-management strategies, and describing the natural history of uncomplicated LBP.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».