Abstract
BackgroundReassuring information is recommended in clinical guidelines for the treatment of low back pain (LBP), but has not been clearly defined. The Consultation-based Reassurance Questionnaire (CRQ) was developed as a tool for measuring to what extent reassurance is present in back pain consultations and may provide important information about the clinical encounter. Until now the CRQ has only been tested in general practice patients in the UK although many patients with LBP are seen outside of this setting. The objectives of this study were to translate the CRQ into Danish, test its feasibility in chiropractic practice, and determine if CRQ scores were associated with satisfaction with care and perceived pain control.MethodsOn the day of the first visit for a LBP episode, patients received an electronic survey including the CRQ. Distributions and completeness of responses on the four subscales of the CRQ (data-gathering, relationship-building, generic reassurance, cognitive reassurance) were assessed, and internal consistency for each subscale calculated as Cronbach’s alpha. Outcomes at 2 weeks were; satisfaction with care (5-point Likert scale dichotomised into yes/no) and ability to control pain (0–10). Associations of the CRQ with patient characteristics and outcomes were determined in mixed models to account for dependency of observations within clinics.ResultsFrom 964 patients visiting between November 2016 and October 2017 with new episodes of LBP, 717 completed the CRQ with no more than 1% missing values on any single item. The internal consistency was acceptable for all subscales (0.67–0.86). Scores were generally high, and more so in patients visiting a chiropractor for the first time. All four subscales were positively associated with satisfaction (Odds ratios 1.08–1.23) and generic reassurance was weakly associated with pain control (β = 0.07 [95% CI 0.03–0.11]).ConclusionsThe CRQ was feasible for use in a Danish chiropractic setting and scores on all four reassurance subscales related positively to patients’ satisfaction. Patients who had visited a chiropractor previously reported slightly lower levels of reassuring information, and it should be explored if this is in accordance with the patients’ needs. The potential impact on patient outcomes needs investigation.
Highlights
Reassuring information is recommended in clinical guidelines for the treatment of low back pain (LBP), but has not been clearly defined
The results suggest that patients generally perceive high levels of reassurance when consulting a chiropractor for LBP with median scores that resembled what has been observed in UK general practice [11]
Low scores were more frequently observed for generic reassurance than for the other subscales, with lower scores associated with longer duration of LBP, higher education and
Summary
Reassuring information is recommended in clinical guidelines for the treatment of low back pain (LBP), but has not been clearly defined. Back pain is the most frequent cause for care seeking in parts of the world and globally the leading cause of disability [1, 2]. In most people, it is a recurrent condition and the prognosis of single episodes is good, many people live with some degree of back pain for extended periods of time [3]. Because the support of positive health beliefs and self-efficacy seem central to people with back pain, clinical guidelines generally agree that people seeking care for back pain should have reassuring information as part of the consultation to help people understand the nature of back pain [4]. Clearly reassuring messages are not always effectively conveyed, but until recently there has not been a standardised way to capture to what extent reassurance is part of back pain care
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