“It’s hard to trust an individual, it’s easier to trust an image”—patients with low back pain want imaging as a means of coping with uncertainty
Notice bibliographique
Résumé
BACKGROUND: Evidence-based guidelines for low back pain recommend against routine imaging. Despite these guidelines, many patients still seek imaging. We sought to understand why patients with low back pain may want imaging, using a qualitative approach grounded in the Common-Sense Self-Regulation Model (CSSRM), a model that frames how patients' beliefs and actions are shaped by their past experiences and understanding of an illness. METHODS: We interviewed 28 patients from a larger study in Ontario, Canada. Participants were recruited by family physicians (n = 8), chiropractors (n = 10), and physiotherapists (n = 10), and most (82.1%) had previous episodes of low back pain. Participants completed intake questionnaires and semi-structured interviews that explored their experiences with low back pain care and perspectives on imaging. We analyzed the interview transcripts using the CSSRM. RESULTS: The CSSRM domains were represented in patients' narratives: Stimuli and Illness Representations, Coping Procedures, and Appraisal of Outcomes. Within Stimuli and Representations, patients described perceptions of the causes of their pain, and they associated obtaining an image with gaining a sense of control over their diagnosis. Within Coping Procedures, Cognitive Reappraisal emerged as the construct with the most discourse, reflecting how patients interpreted and reassessed their low back pain over time. Many patients expressed the belief that imaging would resolve uncertainty, validate their experience, and confirm that nothing serious had been overlooked. Patients emphasized that imaging would "show what's going on," or help them "feel taken seriously". Within Appraisal of Outcomes, patients described the self-limiting nature of their LBP; the limited discourse about emotional outcomes was often linked to frustrations and fears. The beliefs expressed in interviews were not consistent with participants' questionnaire answers from months previously, suggesting that beliefs may shift over time. CONCLUSIONS: Many patients believed imaging for low back pain was important to gain certainty in diagnosis and reassurance that treatment was appropriate. However, their beliefs about the value of imaging may not be stable over time, as they are influenced by ongoing experiences and reappraisals. To reduce unwarranted imaging, clinicians should consider providing consistent and contextualized messaging that meets the patient's ongoing illness experience.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,010 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 source (Gemma direct ou Codex distillé), 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 ».