Developing and testing a measure of consultation-based reassurance for people with low back pain in primary care: a cross-sectional study.

Nicola Holt,Tamar Pincus

doi:10.1186/s12891-016-1144-2

Abstract

BackgroundReassurance from physicians is commonly recommended in guidelines for the management of low back pain (LBP), but the process of reassurance and its impact on patients is poorly researched.We aimed to develop a valid and reliable measure of the process of reassurance during LBP consultations.MethodsItems representing the data-gathering stage of the consultation and affective and cognitive reassurance were generated from literature on physician-patient communication and piloted with expert researchers and physicians, a Patient and Public Involvement group, and LBP patients to form a questionnaire. Patients presenting for LBP at 43 General Practice surgeries were sent the questionnaire. The questionnaire was analysed with Rasch modelling, using two samples from the same population of recent LBP consultations: the first (n = 157, follow-up n = 84) for exploratory analysis and the second (n = 162, follow-up n = 74) for confirmatory testing. Responses to the questionnaire were compared with responses to satisfaction and enablement scales to assess the external validity of the items, and participants completed the questionnaire again one-week later to assess test-retest reliability.ResultsThe questionnaire was separated into four subscales: data-gathering, relationship-building, generic reassurance, and cognitive reassurance, each containing three items. All subscales showed good validity within the Rasch models, and good reliability based on person- and item-separations and test-retest reliability. All four subscales were significantly positively correlated with satisfaction and enablement for both samples. The final version of the questionnaire is presented here.ConclusionsOverall, the measure has demonstrated a good level of validity and generally acceptable reliability. This is the first measure to focus specifically on reassurance for LBP in primary care settings, and will enable researchers to further understanding of what is reassuring within the context of low back pain consultations, and how outcomes are affected by different types of reassurance. Additionally, the measure may provide a useful training and audit tool for physicians. The new measure requires testing in prospective cohorts, and would benefit from further validation against ethnographic observation of consultations in real time.

Highlights

Reassurance from physicians is commonly recommended in guidelines for the management of low back pain (LBP), but the process of reassurance and its impact on patients is poorly researched
Delivering effective reassurance to people presenting with musculoskeletal, or non-specific low back pain (LBP) is recommended by most guidelines, to convey the message that LBP has a good prognosis, there is no need for x-rays, there is no underlying serious pathology, and patients should stay active [1]
The authors refer to earlier theoretical work [4] that argues that affective reassurance results in immediate reduction of anxiety, but this in turn leads to reduction in patients’ engagement with cognitive reassurance, breeds dependence on the practitioner, and results in worse outcomes in the long run

Summary

Introduction

Reassurance from physicians is commonly recommended in guidelines for the management of low back pain (LBP), but the process of reassurance and its impact on patients is poorly researched. Delivering effective reassurance to people presenting with musculoskeletal, or non-specific low back pain (LBP) is recommended by most guidelines, to convey the message that LBP has a good prognosis, there is no need for x-rays, there is no underlying serious pathology, and patients should stay active [1]. These messages are considered to enhance patients’ ability to self-manage and reduce long term disability. The participants in this sample noticed, appreciated, and remembered affective behaviours and wanted to feel that their physician understood them and was taking them seriously, but valued information which would help them to manage their problem more highly

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