Abstract
BackgroundAn improved understanding of patients’ perceived needs for medical services for low back pain (LBP) will enable healthcare providers to better align service provision with patient expectations, thus improving patient and health care system outcomes. Thus, we aimed to identify the existing literature regarding patients’ perceived needs for medical services for LBP.MethodsA systematic scoping review was performed of publications identified from MEDLINE, EMBASE, CINAHL and PsycINFO (1990–2016). Descriptive data regarding each study, its design and methodology were extracted and risk of bias assessed. Aggregates of patients’ perceived needs for medical services for LBP were categorised.Results50 studies (35 qualitative, 14 quantitative and 1 mixed-methods study) from 1829 were relevant. Four areas of perceived need emerged: (1) Patients with LBP sought healthcare from medical practitioners to obtain a diagnosis, receive management options, sickness certification and legitimation for their LBP. However, there was dissatisfaction with the cursory and superficial approach of care. (2) Patients had concerns about pharmacotherapy, with few studies reporting on patients’ preferences for medications. (3) Of the few studies which examined the patients’ perceived need of invasive therapies, these found that patients avoided injections and surgeries (4) Patients desired spinal imaging for diagnostic purposes and legitimation of symptoms.ConclusionsAcross many different patient populations with data obtained from a variety of study designs, common themes emerged which highlighted areas of patient dissatisfaction with the medical management of LBP, in particular, the superficial approach to care perceived by patients and concerns regarding pharmacotherapy. Patients perceive unmet needs from medical services, including the need to obtain a diagnosis, the desire for pain control and the preference for spinal imaging. These issues need to be considered in developing approaches for the management of LBP in order to improve patient outcomes.
Highlights
Low back pain (LBP) is the leading cause of disability worldwide[1]
Across many different patient populations with data obtained from a variety of study designs, common themes emerged which highlighted areas of patient dissatisfaction with the medical
LBP is costly, amounting to an estimated $88billion in the United States in 2013, with medical services comprising a considerable proportion of the incurred expenditure[3]
Summary
Low back pain (LBP) is the leading cause of disability worldwide[1]. It is highly prevalent and is associated with pain, functional impairment, long-term incapacity, work absenteeism and high utilisation of healthcare[1,2]. Several guidelines have been developed to guide the different presentations of acute and chronic back pain management, to direct clinical practice and to rationalise health care resource utilisation appropriately[4,5,6,7,8,9,10] These guidelines recommend, as relevant to pain duration, a thorough clinical evaluation to exclude serious spinal pathology, judicious use of radiology, patient education to support optimal self-management, exercise therapy, psychological therapies for some people, short-term use of prescription medications and spinal manipulation for pain relief[6,7,8,9,10]. We aimed to identify the existing literature regarding patients’ perceived needs for medical services for LBP
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